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PCI in centres without on-site cardiac surgery
Published in Ever D. Grech, Practical Interventional Cardiology, 2017
Kristel Longman, Jehangir Din, Suneel Talwar, Peter O'Kane
The evolution of PCI equipment has been dramatic. In 1982, over-the-wire coaxial balloon systems were introduced, followed by the development of brachial guiding catheters and steerable guide wires. By 1986, Jacques Puel and Ulrich Sigwart implanted the first coronary Wallstents in Toulouse, France.2 These reduced the need for repeated balloon angioplasty and from 1984, stents become commonplace. However, in the 1980s, abrupt and sub-acute closure of a coronary artery at the angioplasty site due to dissection and associated thrombus, were not uncommon and 5%–10% of patients required immediate emergency coronary artery bypass graft surgery (CABG) within 24 hours.
Practice Paper 8: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
Also known as PCI, coronary angioplasty with or without coronary artery stenting is widely viewed as the gold standard in reperfusion therapy following STEMI. Several studies have shown that PCI reduces mortality and significant adverse events following STEMI when compared with thrombolysis. PCI may also be used as a ‘rescue’ treatment when thrombolysis has failed to reperfuse the myocardium. Complications of PCI include arrhythmia, leg ischaemia, femoral aneurysm formation, allergy to the contrast and sudden death. Significant complications may result in the need for emergency coronary artery bypass grafting. Presently, PCI is available only in a select number of institutions.
Perioperative and Postoperative Deaths
Published in Julian L Burton, Guy Rutty, The Hospital Autopsy, 2010
Most patients who die during or after cardiac surgery die from cardiac disease (Lee and Gallagher, 1998). The incidence of postoperative complications in patients undergoing coronary artery bypass grafting is 94 per cent (NCEPOD, 2008). Common autopsy findings of significance include coronary artery bypass graft thrombosis, acute myocardial infarction, small bowel infarction, congestion and fatty change in the liver and pulmonary thromboembolus. With the exception of small bowel infarction and liver changes, which are indicative of multi-organ failure and poor perfusion, other abdominal complications are rare (Hickling et al., 2007). Atrial fibrillation is common postoperatively, more so in patients who undergo valvular repair than in those who have coronary artery bypass grafting. The development of atrial fibrillation postoperatively is associated with an increased risk of stroke and death (Gomes da Silva et al., 2004).
Nanotechnological approach to delivering nutraceuticals as promising drug candidates for the treatment of atherosclerosis
Published in Drug Delivery, 2021
Sindhu C. Pillai, Ankita Borah, Eden Mariam Jacob, D. Sakthi Kumar
Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is performed by opening narrowed coronary arteries to place a stent thus improving the blood flow to the heart and mitigating chest pain. Coronary artery bypass grafting (CABG) involves the grafting of a new artery to bypass the narrowed coronary arteries while boosting blood flow and preventing heart attacks. In the list of surgical methods, carotid endarterectomy is a common surgical process that involves the correction of the internal carotid artery by removing plaque build-up eventually restoring the blood flow to the brain. Surgical procedures of the blood vessel-blockade have achieved clinical success for many years, yet are also associated with numerous complications such as restenosis, in-stent restenosis, and late-stage clotting to name a few (Giannini et al., 2018).
Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery
Published in Disability and Rehabilitation, 2019
Isadora Salvador Rocco, Marcela Viceconte, Hayanne Osiro Pauletti, Bruna Caroline Matos-Garcia, Natasha Oliveira Marcondi, Caroline Bublitz, Douglas William Bolzan, Rita Simone Lopes Moreira, Michel Silva Reis, Nelson Américo Hossne, Walter José Gomes, Ross Arena, Solange Guizilini
To the best of our knowledge, this was the first study to evaluate VO2 on-kinetics before off-pump coronary artery bypass grafting. Our findings suggest that a pre-operative 6MWT-VO2 kinetics assessment can provide insight into a pre-operative patient’s physiologic stability, clinical trajectory post-surgery, and risk for adverse events. In fact, patients with a slower wMRT demonstrated longer intensive care unit and post-operative hospital length of stay, indicating that screening for acute complications could directly foretell short-term outcomes. These results also reinforce that the most functional disable patients are exposed to higher risk after off-pump coronary artery bypass grafting.
Education in the operating room
Published in Baylor University Medical Center Proceedings, 2022
Bryana N. Baginski, Charles S. Roberts
Coronary artery bypass grafting (CABG) is an operation on the first two branches of the aorta that requires a dedicated, expert team. Several specific roles in the operating room are allied to achieve success, including the circulating nurse, scrub nurse, anesthesia technicians, anesthesiologists, perfusionists, physician assistants (PA), and the operating surgeon and assistants. Expertise in these roles requires education, usually on an individual basis during an operation, over the course of weeks, months, or years, depending on the role, until the trainee is fit to be independent.