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Tricuspid annular plane systolic excursion (TAPSE) is a robust measure of RV function, but the performance of transesophageal echocardiography (TEE) measured TAPSE during surgery is not well established. We aim to evaluate feasibility of various TEE views before, during and after surgery. Furthermore, we compare performance of individual TEE measurements depending on view and method (AMM- and M-mode as well as 2D) as well as TAPSE measured using TEE with transthoracic echocardiography (TTE) TAPSE. The study was conducted from January 2015 through September 2016. In 47 patients with normal left ventricular ejection fraction, TEE was prospectively performed during coronary artery bypass grafting surgery. TAPSE and tricuspid annulus tissue Doppler imaging (TDI) were recorded in five different views at pre-specified time points during surgery. Data were analyzed for availability (obtainable/readable images) and reliability (intra-/inter-observer bias and precision). Finally, TEE TAPSE was compared to TTE TAPSE immediately before and after surgery. TAPSE and TDI with TEE was achievable in > 90% of patients in the transgastric view during surgery. The AM- and M-mode had the best reliability and the best correlation with TAPSE measured with TTE. The deep transgastric view was achievable in less than 50% after sternotomy, and TAPSE measured from 2D had a poorer performance compared to the AM- and M-mode. TDI demonstrated a high reliability throughout surgery. RV function can be evaluated by TAPSE and TDI using TEE during surgery. TEE values from the transgastric view demonstrated high performance throughout surgery and a good agreement with TTE TAPSE measurements.

Tricuspid annular plane systolic excursion (TAPSE) is a robust measure of RV function, but the performance of transesophageal echocardiography (TEE) measured TAPSE during surgery is not well established. We aim to evaluate feasibility of various TEE views before, during and after surgery. Furthermore, we compare performance of individual TEE measurements depending on view and method (AMM- and M-mode as well as 2D) as well as TAPSE measured using TEE with transthoracic echocardiography (TTE) TAPSE. The study was conducted from January 2015 through September 2016. In 47 patients with normal left ventricular ejection fraction, TEE was prospectively performed during coronary artery bypass grafting surgery. TAPSE and tricuspid annulus tissue Doppler imaging (TDI) were recorded in five different views at pre-specified time points during surgery. Data were analyzed for availability (obtainable/readable images) and reliability (intra-/inter-observer bias and precision). Finally, TEE TAPSE was compared to TTE TAPSE immediately before and after surgery. TAPSE and TDI with TEE was achievable in > 90% of patients in the transgastric view during surgery. The AM- and M-mode had the best reliability and the best correlation with TAPSE measured with TTE. The deep transgastric view was achievable in less than 50% after sternotomy, and TAPSE measured from 2D had a poorer performance compared to the AM- and M-mode. TDI demonstrated a high reliability throughout surgery. RV function can be evaluated by TAPSE and TDI using TEE during surgery. TEE values from the transgastric view demonstrated high performance throughout surgery and a good agreement with TTE TAPSE measurements.

Background Use of arterial grafts for coronary artery bypass grafting (CABG) has been argued to improve the angiographic graft patency, and thereby, the patient outcome by fewer cardiac events such as reoccurrence of angina pectoris, repeat revascularization, myocardial infarction (MI) and even death. There is only limited and unclear evidence from randomized trials, but in large-scale retrospective studies it is clear that use of the internal thoracic artery (ITA) as a bypass graft to especially the left anterior descending (LAD) coronary artery leads to improved graft patency and survival and fewer cardiac events compared with use of the greater saphenous vein as a graft (SVG). Bilateral ITA (BITA) grafts seem to increase this benefit further. Because of sternal wound complications related to BITA harvest, the radial artery (RA) has been proposed and widely used in addition to the left ITA (LITA), but also together with BITAs when more grafts are necessesary. The question whether the RA has superior patency than the SVG is therefore central, but in the long term unanswered. Also, the safety and efficacy of a strategy of total arterial revascularization (TAR) using one or both ITA grafts together with the RA is poorly documented. Finally, health-related quality of life (HRQoL) seems to improve after CABG, but whether TAR has an influence is unclear. Methods In this trial including 161 patients randomized to TAR (LITA or BITA and RA) versus 170 patients randomized to conventional revascularization (CR) (LITA and SVGs) and operated with use of heart-lung machine, the primary outcome measures are overall graft patency (graft stenoses below 50%) defined as the patency index (number of patent grafts divided by the number of constructed grafts) and cardiac event-free survival (readmission for suspected or verified MI, unstable angina pectoris, arrhythmia, congestive heart failure, angiography or percutaneous or surgical revascularization) after 1 and 5 y

Background Use of arterial grafts for coronary artery bypass grafting (CABG) has been argued to improve the angiographic graft patency, and thereby, the patient outcome by fewer cardiac events such as reoccurrence of angina pectoris, repeat revascularization, myocardial infarction (MI) and even death. There is only limited and unclear evidence from randomized trials, but in large-scale retrospective studies it is clear that use of the internal thoracic artery (ITA) as a bypass graft to especially the left anterior descending (LAD) coronary artery leads to improved graft patency and survival and fewer cardiac events compared with use of the greater saphenous vein as a graft (SVG). Bilateral ITA (BITA) grafts seem to increase this benefit further. Because of sternal wound complications related to BITA harvest, the radial artery (RA) has been proposed and widely used in addition to the left ITA (LITA), but also together with BITAs when more grafts are necessesary. The question whether the RA has superior patency than the SVG is therefore central, but in the long term unanswered. Also, the safety and efficacy of a strategy of total arterial revascularization (TAR) using one or both ITA grafts together with the RA is poorly documented. Finally, health-related quality of life (HRQoL) seems to improve after CABG, but whether TAR has an influence is unclear. Methods In this trial including 161 patients randomized to TAR (LITA or BITA and RA) versus 170 patients randomized to conventional revascularization (CR) (LITA and SVGs) and operated with use of heart-lung machine, the primary outcome measures are overall graft patency (graft stenoses below 50%) defined as the patency index (number of patent grafts divided by the number of constructed grafts) and cardiac event-free survival (readmission for suspected or verified MI, unstable angina pectoris, arrhythmia, congestive heart failure, angiography or percutaneous or surgical revascularization) after 1 and 5 y

Background Use of arterial grafts for coronary artery bypass grafting (CABG) has been argued to improve the angiographic graft patency, and thereby, the patient outcome by fewer cardiac events such as reoccurrence of angina pectoris, repeat revascularization, myocardial infarction (MI) and even death. There is only limited and unclear evidence from randomized trials, but in large-scale retrospective studies it is clear that use of the internal thoracic artery (ITA) as a bypass graft to especially the left anterior descending (LAD) coronary artery leads to improved graft patency and survival and fewer cardiac events compared with use of the greater saphenous vein as a graft (SVG). Bilateral ITA (BITA) grafts seem to increase this benefit further. Because of sternal wound complications related to BITA harvest, the radial artery (RA) has been proposed and widely used in addition to the left ITA (LITA), but also together with BITAs when more grafts are necessesary. The question whether the RA has superior patency than the SVG is therefore central, but in the long term unanswered. Also, the safety and efficacy of a strategy of total arterial revascularization (TAR) using one or both ITA grafts together with the RA is poorly documented. Finally, health-related quality of life (HRQoL) seems to improve after CABG, but whether TAR has an influence is unclear. Methods In this trial including 161 patients randomized to TAR (LITA or BITA and RA) versus 170 patients randomized to conventional revascularization (CR) (LITA and SVGs) and operated with use of heart-lung machine, the primary outcome measures are overall graft patency (graft stenoses below 50%) defined as the patency index (number of patent grafts divided by the number of constructed grafts) and cardiac event-free survival (readmission for suspected or verified MI, unstable angina pectoris, arrhythmia, congestive heart failure, angiography or percutaneous or surgical revascularization) after 1 and 5 y

Background Use of arterial grafts for coronary artery bypass grafting (CABG) has been argued to improve the angiographic graft patency, and thereby, the patient outcome by fewer cardiac events such as reoccurrence of angina pectoris, repeat revascularization, myocardial infarction (MI) and even death. There is only limited and unclear evidence from randomized trials, but in large-scale retrospective studies it is clear that use of the internal thoracic artery (ITA) as a bypass graft to especially the left anterior descending (LAD) coronary artery leads to improved graft patency and survival and fewer cardiac events compared with use of the greater saphenous vein as a graft (SVG). Bilateral ITA (BITA) grafts seem to increase this benefit further. Because of sternal wound complications related to BITA harvest, the radial artery (RA) has been proposed and widely used in addition to the left ITA (LITA), but also together with BITAs when more grafts are necessesary. The question whether the RA has superior patency than the SVG is therefore central, but in the long term unanswered. Also, the safety and efficacy of a strategy of total arterial revascularization (TAR) using one or both ITA grafts together with the RA is poorly documented. Finally, health-related quality of life (HRQoL) seems to improve after CABG, but whether TAR has an influence is unclear. Methods In this trial including 161 patients randomized to TAR (LITA or BITA and RA) versus 170 patients randomized to conventional revascularization (CR) (LITA and SVGs) and operated with use of heart-lung machine, the primary outcome measures are overall graft patency (graft stenoses below 50%) defined as the patency index (number of patent grafts divided by the number of constructed grafts) and cardiac event-free survival (readmission for suspected or verified MI, unstable angina pectoris, arrhythmia, congestive heart failure, angiography or percutaneous or surgical revascularization) after 1 and 5 y

Reverse flow in the internal mammary artery (IMA) graft due to stenosis or occlusion of the proximal ipsilateral subclavian artery causes coronary subclavian steal syndrome (CSSS). We describe two patients who were diagnosed with CSSS following CABG. Patient A presented with angina pectoris, was diagnosed with CSSS and treated by transposition of the proximal IMA from the subclavian artery to the aorta. Patient B was diagnosed with CSSS by control angiography. Myocardial scintigraphy showed reversible silent ischemia. He was offered treatment, but refused as he was symptom-free Udgivelsesdato: 2008/3/31

Background Use of arterial grafts for coronary artery bypass grafting (CABG) has been argued to improve the angiographic graft patency, and thereby, the patient outcome by fewer cardiac events such as reoccurrence of angina pectoris, repeat revascularization, myocardial infarction (MI) and even death. There is only limited and unclear evidence from randomized trials, but in large-scale retrospective studies it is clear that use of the internal thoracic artery (ITA) as a bypass graft to especially the left anterior descending (LAD) coronary artery leads to improved graft patency and survival and fewer cardiac events compared with use of the greater saphenous vein as a graft (SVG). Bilateral ITA (BITA) grafts seem to increase this benefit further. Because of sternal wound complications related to BITA harvest, the radial artery (RA) has been proposed and widely used in addition to the left ITA (LITA), but also together with BITAs when more grafts are necessesary. The question whether the RA has superior patency than the SVG is therefore central, but in the long term unanswered. Also, the safety and efficacy of a strategy of total arterial revascularization (TAR) using one or both ITA grafts together with the RA is poorly documented. Finally, health-related quality of life (HRQoL) seems to improve after CABG, but whether TAR has an influence is unclear. Methods In this trial including 161 patients randomized to TAR (LITA or BITA and RA) versus 170 patients randomized to conventional revascularization (CR) (LITA and SVGs) and operated with use of heart-lung machine, the primary outcome measures are overall graft patency (graft stenoses below 50%) defined as the patency index (number of patent grafts divided by the number of constructed grafts) and cardiac event-free survival (readmission for suspected or verified MI, unstable angina pectoris, arrhythmia, congestive heart failure, angiography or percutaneous or surgical revascularization) after 1 and 5 y

Reverse flow in the internal mammary artery (IMA) graft due to stenosis or occlusion of the proximal ipsilateral subclavian artery causes coronary subclavian steal syndrome (CSSS). We describe two patients who were diagnosed with CSSS following CABG. Patient A presented with angina pectoris, was diagnosed with CSSS and treated by transposition of the proximal IMA from the subclavian artery to the aorta. Patient B was diagnosed with CSSS by control angiography. Myocardial scintigraphy showed reversible silent ischemia. He was offered treatment, but refused as he was symptom-free Udgivelsesdato: 2008/3/31