Cardiovascular revascularization medicine : including molecular interventions
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Cardiovasc Revasc Med · Jan 2009
Comparative StudyOff-pump coronary artery bypass grafting improves in-hospital mortality in patients with dialysis-dependent renal failure.
Patients with chronic dialysis-dependent end-stage renal disease are increasingly referred for coronary artery bypass grafting (CABG) and their early outcome is less favorable. Off-pump CABG (OPCAB) has achieved encouraging results in high-risk patients. Therefore, we designed this retrospective study to test the hypothesis that OPCAB reduced surgical risks in dialysis patients. ⋯ Our data suggest that OPCAB is a safe alternative to on-pump CABG in dialysis patients. Avoiding CPB resulted in less perioperative blood utilization, MI, and hospital mortality.
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Cardiovasc Revasc Med · Jan 2009
ReviewRisk and management of upper gastrointestinal bleeding associated with prolonged dual-antiplatelet therapy after percutaneous coronary intervention.
Prolonged dual-antiplatelet therapy with aspirin and clopidogrel is mandatory after drug-eluting stent implantation because of the potential increased risk of late stent thrombosis. The concern regarding prolonged antiplatelet therapy is the increased risk of bleeding. ⋯ Managing gastrointestinal bleeding in a patient who has undergone recent percutaneous coronary intervention requires balancing the risk of stent thrombosis against further catastrophic bleeding. Close combined management between gastroenterologist and cardiologist is advocated to optimize patient outcomes.
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Cardiovasc Revasc Med · Jan 2008
Coronary artery revascularization prior to abdominal nonvascular surgery.
Does preoperative revascularization of the myocardium reduce cardiac risk in noncardiac surgery? The aim of this study was to evaluate the clinical effectiveness of preoperative cardioprotection by coronary artery revascularization in abdominal nonvascular surgery under general anesthesia. ⋯ Preoperative cardioprotection by coronary artery revascularization significantly reduces morbidity and mortality in patients who have undergone abdominal nonvascular surgery. Patients with severe coronary artery stenosis and indication for coronary artery revascularization independently of noncardiac surgery should first undergo cardiosurgical intervention prior to elective abdominal nonvascular surgery.
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Cardiovasc Revasc Med · Jan 2008
Comparative StudyDrug-eluting stents are associated with similar cardiovascular outcomes when compared to bare metal stents in the setting of acute myocardial infarction.
Recent randomized trials have demonstrated conflicting results regarding the use of drug-eluting stents (DESs) as compared to bare metal stents (BMSs) in primary percutaneous coronary intervention (PCI). We compared outcomes among patients presenting with acute ST-elevation myocardial infarction (STEMI) who received DES with those who received BMS. ⋯ Our data do not support the general use of DES in the setting of STEMI given similar cardiovascular outcomes among patients receiving BMS or DES, the need for long-term dual antiplatelet therapy with DES, and the possible repercussions of very late stent thrombosis.
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Cardiovasc Revasc Med · Jul 2007
Case ReportsMultiple carotid stenting for extended thoracic aorta dissection after initial aortic surgical repair.
Acute aortic dissection is one of the most common catastrophes affecting the aorta. Aortic branch occlusion occurs in up to one third of patients with aortic dissection and is associated with increased risk for early death and serious complications. A 67-year-old man without history of cardiovascular disease was referred to our center for acute aortic type A dissection and was treated with a 28-mm Vasculteck prosthesis. ⋯ The patient recovered quickly after the intervention and was discharged after 2 days without any neurologic or vascular complication. The patient did extremely well at two 3-month follow-ups, and coverage of the descending thoracic aorta dissection was scheduled to be performed in the next 2 months. This case suggests that endovascular techniques may offer a reliable and effective answer to extended dissections, helping decrease the risk for neurologic or visceral complications and reducing the operative risk for further complete surgical or endovascular aortic repair.