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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We reviewed the results of early (less than 24 hours) coronary artery bypass after unsuccessful percutaneous coronary artery angioplasty in 146 patients treated between October 1979 and July 1986. Overall operative mortality was 2.7%, and risk was significantly increased among patients with hemodynamic instability and new occlusion or further narrowing of the dilated vessel (3.8 versus 0%, p less than 0.05). Actuarial analysis was used to compute the rates of cardiac events during the follow-up interval, and event rates were also estimated in a comparison group of 776 patients who had successful first-time PTCA during the same time period. At a follow-up interval of 5 years, the cumulative risks of recurrence of angina and need for an additional procedure (bypass or angioplasty) were significantly (p less than 0.05) lower for patients who had undergone bypass than for those who had successful angioplasty (angina 21% versus 56%, PTCA 2% versus 21%, CAB 6% versus 16%). Cumulative risks of myocardial infarction and death were 4% versus 9% and 6% versus 9% in the two groups. The differences between late outcomes in the bypass and angioplasty groups persisted when patients were stratified into cohorts with single-vessel and multivessel disease, and the highest late event rate occurred in patients in the angioplasty group who had incomplete revascularization. The difference in late events after bypass or angioplasty was greatest during the first year. These late data should be considered when the mode of revascularization (bypass or angioplasty) is selected for symptomatic patients, especially those with multivessel disease.
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PMID:Early and late results of coronary artery bypass after failed angioplasty. Actuarial analysis of late cardiac events and comparison with initially successful angioplasty. 296 36

Selection and treatment of patients with ischemic heart disease is presently undergoing an evolutionary trend. Percutaneous transluminal coronary angioplasty (PTCA) has been recommended as the initial procedure for many patients with coronary artery disease (CAD), thus possibly redefining candidates for coronary bypass surgery (CABS). Between October 1980 and June 1982, 777 patients having PTCA and 2068 patients having CABS were analyzed for differences in clinical presentation, complications, and early outcome. Patients having CABS were significantly older, had a higher incidence of hypertension (46% vs. 32%), more multivessel disease (80% vs. 12%), and poorer left ventricular function (nl. wall motion = 88% vs. 52%). The incidence of myocardial infarction in patients after PTCA was 1.0% (8/777). Emergency CAB was required in 5.3% of patients following PTCA. There were no deaths following the angioplasty procedure and 25 deaths in 2068 patients having CABS (hospital mortality rate = 1.2%). Since 1973, there has been a progressive decline in hospital mortality rate (now, less than 1%), postoperative infarction (now, 3%), requirement for inotropic drugs (now, 5%) and frequency of IABP (less than 1%). Increasing ability to achieve complete revascularization now means improved survival and freedom from angina with CAB surgery. PTCA and CAB are both procedures that may be used effectively for selected patients, depending on clinical presentation, extent of CAD, and left ventricular function (LVF). Careful patient selection affords the opportunity for use of PTCA in patients with single-vessel disease (SVD) and good LVF and CABS in patients with multivessel disease, regardless of LVF. Symptomatic patients with SVD and total vessel occlusion are not candidates for PTCA. Our data demonstrate that both PTCA and CABS may be accomplished with very low perioperative complications and hospital mortality.
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PMID:Trends in the treatment of coronary disease today. Selective use of PTCA and bypass surgery. 622 8

The Coalescent IPAD (Coalescent Surgical, Sunnyvale, CA, USA) is a novel device that enables creation of a compliant proximal vein anastomosis to the aorta during off-pump coronary artery bypass (OPCAB) surgery while reducing the risk of cerebrovascular emboli and early stenosis. We performed IPAD-created anastomoses in 76 patients having standard OPCAB surgery. Following the procedures, no patients developed myocardial infarctions or reported angina, suggesting patency of the vein grafts to be of high quality. We found the device to be a useful adjunct for minimally invasive CAB graft surgery.
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PMID:A novel device for clampless proximal anastomosis in OPCAB surgery: the IPAD. 1579 7

We report the first case of off-pump complete myocardial revascularization through antero-lateral thoracotomy (Thora-CAB) in Middle-East. 69 year old gentleman having angina pectoris for last three years with severe double vessel disease involving the left anterior descending artery (95% proximal lesion) and the circumflex system (80% mid circumflex lesion with significant osteal disease in obtuse marginal) and insignificant disease in right coronary artery with moderate left ventricular impairment underwent Thora-CAB. Post-operatively, he had minimal pain, quick symptomatic improvement and no complications. He was discharged home on 5th post-operative day. This indicates that the thoracotomy approach is safe and practical for CABG. It is well tolerated hemodynamically with no/ minimal post-operative morbidity.
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PMID:Off-pump coronary artery bypass grafting through left antero-lateral thoracotomy (thora-cab) - case report and review of literature. 2233 42