Left ventricular function and adrenergic hyperactivity before and after saphenous vein bypass.

Boudoulas, Harisios; Lewis, Richard P.; Vasko, John S.; Karayannacos, Panayotis E.; Beaver, Brian M.

doi:10.1161/01.cir.53.5.802

Cited by 49 publications

(5 citation statements)

References 48 publications

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“…The PEPIL VET was not different in both groups before and two weeks after surgery, and was mildly but significantly increased. Patients with peri operative infarction were exluded from this analysis, since it is known that peri-operative infarction produces a significant deterioration in left ventricular performance (4,8,10,20,24,25).…”

Section: Resultsmentioning

confidence: 99%

“…Postoperative decrease in left ventricular function as measured from the systolic time intervals two weeks after surgery was mild and identical in both groups. Of note, we excluded patients with perioperative myocardial infarctions from this analysis since myocardial infarction produces a significant deterioration in left ventricular performance (8,25).…”

Section: Discussionmentioning

confidence: 99%

“…The coronary bypass employed standard techniques (8,10). The operative procedure was performed with the aid of cardiopulmonary bypass, hemodilution perfusion, and moderate total body hypothermia (28-32° C).…”

Section: The Control Group Consists Of 50 Patients In Whommentioning

confidence: 99%

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Beneficial effect of continuation of propranolol through coronary bypass surgery

Boudoulas

Lewis

Snyder

et al. 1979

Clinical Cardiology

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Summary: The safety and beneficial effect of continuation of propranolol (Pr) through coronary bypass surgery (CBS) was studied in two groups of patients. In the control group (50 patients) Pr was discontinued 24 h before CBS without reinstitution afterwards. In the propranolol group the drug was maintained up to 4 to 10 h before surgery and was restarted within 24 h afterwards. The incidence of subendocardial myocardial infarction was significantly lower in the Pr group (lout of 30 vs 10 out of 50, p < 0.05) while the incidence of transmural infarction was the same in both groups (3 out of 30, 10 %, vs 5 out of 50, 10%). The incidence of supraventricular tachycardias during the first three postoperative days was significantly lower in the propranolol group compared to control (5% vs 30%, P < 0.01). The 24 h urinary epinephrine and norepinephri ne excretion was significantly greater than normal the day before surgery (136 ± 12 vs 39 ± 4,ug/24 h, P < 0.01), and was still high two weeks after surgery (115.1 ± 14 ,ug124 h). There were no complications related to propranolol. The left ventricular function as measured from the systolic time intervals was the same preSupported in part by the Central Ohio Heart Association, Chapter of the American Heart Association. and postoperatively in both groups. The results of this study show that administration of propranolol up to 4 h before coronary bypass and reinstitution immediately afterwards is safe and beneficial.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Beneficial effect of continuation of propranolol through coronary bypass surgery

Boudoulas

Lewis

Snyder

et al. 1979

Clinical Cardiology

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“…Ischemic injury to the myocardium during bypass surgery has been repeatedly demonstrated from a spectrum of clinical evidence (Sung el al., 1977;Boudoulas et al, 1976). A significant incidence of perioperative myo cardial infarction (Dixon et al, 1973;Oldham et al, 1973;Righetti/et al, 1977a).…”

Section: Discussionmentioning

confidence: 99%

Recovery from Circulatory Depression after Coronary Artery Bypass Surgery

Serruys¹,

Brower²,

Katen³

et al. 1980

Eur Surg Res

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The direct traumatic effects of coronary artery bypass surgery may counterbalance the expected improvement of myocardial function in the early postoperative period. In 55 patients, the regional shortening fraction was measured over 12 months using radiopaque epicardial marker pairs implanted during surgery in the newly perfused regions. The time course of cardiothoracic ratio, heart rate and cuff blood pressure was documented. All patients were catheterized before surgery and 1 year afterwards. There is an initial depression in myocardial function lasting up to 3 months after surgery which is not directionally related to changes in loading conditions or chronotropic state, but most likely to recovery of the myocardium from perioperative injury. At 1 year after surgery the overall ventricular function is unchanged. The evaluation of ventricular function after coronary artery bypass grafting should be performed no sooner than 3 months after surgery to avoid this transient period of depressed myocardial performance.

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“…There have been relatively few studies examining changes in preoperative and postoperative perfusion as provided by individual coronary artery bypass grafts.27 28 Furthermore, even though numerous studies have shown that bypass grafts will provide significant relief of angina in 75-80% of patients who undergo surgery,', 29 the effectiveness of this procedure in improving left ventricular function remains controversial. [29][30][31][32][33][34][35][36][37][38][39][40][41][42] In this study we investigated the significance of preoperative perfusion defects and left ventricular contraction abnormalities in patients with unstable angina by measuring the effects of coronary artery bypass surgery upon reversing such perf-usion and contraction abnormalities and relating the results of surgery to the clinical response. …”

mentioning

confidence: 99%

Improvement of myocardial perfusion and left ventricular function after coronary artery bypass grafting in patients with unstable angina.

Kolibash¹,

Goodenow²,

Bush³

et al. 1979

Circulation

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SUMMARY Changes in myocardial perfusion and left ventricular function were evaluated pre-and postoperatively (3-6 months) in 14 patients with unstable angina who underwent coronary artery bypass surgery. Perfusion was studied with intracoronary and intragraft injections of radiolabeled macroaggregated albumin particles. Of 20 abnormal perfusion areas identified preoperatively, 13 demonstrated improved perfusion postoperatively. Segmental analysis of the left ventriculogram demonstrated improved wall motion in 29 abnormally contracting segments; 18 normalized. Areas which showed improvement of left ventricular perfusion were invariably associated with improvement of left ventricular wall motion. Five patients showed improvement in perfusion and contraction in areas of apparent old myocardial infarction.Thirteen of the 14 patients had significantly less angina whether or not there was evidence of improved perfusion. However, only those patients who demonstrated improved perfusion had a significant improvement in their treadmill exercise tolerance postoperatively. Thus, patients with unstable angina have perfusion defects which may be reversed as a result of saphenous vein graft surgery. Reversal of these perfusion abnormalities results in improved left ventricular performance and better exercise tolerance postoperatively.CORONARY ARTERY BYPASS SURGERY has an important and widespread role in the treatment of coronary artery disease.1'3 Of particular significance to many investigators is the preoperative detection of ischemic, but viable, myocardium and the ultimate effects of revascularization upon improvement of left ventricular perfusion and function.4-5 Perhaps this problem is best exemplified in those patients with unstable angina who have poorly contracting areas of the ventricle which are being supplied by vessels with highly stenotic lesions. The recent reports of resting perfusion abnormalities in this group of patients6' 7 further raises the question whether these areas represent viable (reversibly damaged) myocardium or nonviable (irreversibly damaged) myocardium.Various techniques using intervention ventriculography have been used to identify potentially viable myocardium.8320 Another method used to differentiate between viable and nonviable myocardial tissue is the use of direct intracoronary instillation of radiolabeled, macroaggregated albumin particles.7 21-26Since these particles lodge in the coronary microcirculation, the presence of radioactivity throughout the myocardium has been equated with tissue viability. ticularly, the relationship of perfusion defects to segmental left ventricular contraction abnormalities and their potential for reversibility after coronary artery bypass surgery has not been demonstrated. If such perfusion defects do not always imply infarction, myocardial revascularization would be expected to correct the ischemia by improving blood flow, resulting in concomitant relief of angina and improvement of left ventricular performance. There have been relatively few studies exam...

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Left ventricular function and adrenergic hyperactivity before and after saphenous vein bypass.

Cited by 49 publications

References 48 publications

Beneficial effect of continuation of propranolol through coronary bypass surgery

Beneficial effect of continuation of propranolol through coronary bypass surgery

Recovery from Circulatory Depression after Coronary Artery Bypass Surgery

Improvement of myocardial perfusion and left ventricular function after coronary artery bypass grafting in patients with unstable angina.

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