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F005 Minimally invasive coronary artery surgery in women
Oral Abstracts
FOO5 Minimally invasive cormmy artery surgery in women Pyng Jing Lin, Chau-Hsiung Chang, yi-Cheng Wu, Yu-Shag Chnng
Jaw-Ji
Chu,
Hui-Ping
Liy
Fe??zg-Chm
Tmi,
Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei
Echocardiography (TEE) can provide an excellent imaging modality for screening for aortic atherosclerotic lesions. This pilot study was determined to define the interrelationship between aging and atherosclerosis. Methods: Serial TEE studies were performed based on Mayo clinic criteria and divided into three aging groups: (A) adult group (< 40, N = 12), (B) middle aging group (< 40-64, N = 20), and (0 elderly group (2 65, N = 18). Their clinical characteristics and related aortic atherosclerotic lesions will be fully explored. Results: Clinical Characteristics and TEE Findings (*P s 0.05; **Pi 0.013; ***P 22 0.005)
Minimally invasive s”rgeIy in coronary artery bypass grafting has been applied mainly in the management of one vessel lesion of coronary artery disease. Nine female patients, aged 49.1-81.6 years old (mean 64.3), were operated on for triple vessel disease through minimally invasive surgical techniques. The surgeries were performed through limited left pamsternal incision under femoro-femoral extracorporeal circulation. The myocardium was protected by antegrade infusion of cold blood cardioplegic solution while the aorta was cross-clamped. Under direct vision, the left saphenous vein grafts were connected sequentially to the diagonal branch, obtuse marginal branch and posterior descending branch, and the left internal thoracic arterial graft was anastomosed to the left anterior descending artery in each patient. The number of distal anastomoses was 3 to 4 with a mean of 3.7. The aortic crossclamp time was 52 to 130 minutes (82 f 25 minutes). The duration of extracorporeal circulation was 78-151 minutes (115 f 29 minutes). The postoperative course was uneventful in all patients. The postoperative length of stay was 4-12 days (7.2 f 2.0 days). Follow-up (4.2-8.7 months, mean 6.4) was complete in all patients and there were no late deaths or angina. Coronary angiography of 2 patients showed patent grafts. All patients were satisfied with the goad cosmetic healing of the incision. Our experience demonstrates that minimally invasive surgery in coronary artery bypass grafting is technically feasible and may be an alternative approach in surgical revascularization of triple vessel coronary artery disease, especially in WO”le”.
Table 4 Items
A: Adult Gr (<40,N=12)
B: Middle c: Elderly Gr AgingGr (>65,N=18) (< 50-64, N = 20)
value
P
AvsB
AvsC
BvsC
*
***
*
2
10
16
0 2
5 5
9 7
0 (II) LA smoke/ LAA thrombus WHD)
4
4
*
*
NS
*
**
NS
NS
*
NS
*
**
NS
(I) Atheromatous plaque/debris Irregular Smooth
(III) Systemic Disease (DM/HT)
2
10
12
(IV) AF/Af
2
6
10
(V) TIA/CVA
4
0
8
F006 Conclusions: Atherosclerotic lesions increased with aging. Irregular atheromatous plaque or debris, smoke/thrombi, as well as AF, are three major predictors in further vascular events. The location and the extent of aortic atheromatous lesions can be confidently identified by TEE exam. Any embolic vascular events also increased with aging. Thus, aging played an important role for atherosclerotic processing.
Evidencebased clinical pathways for acute myocardial infhrction Chin-Len
Lin,
Chn-Po
Lai
&Hung
Wang
Wen-Ping
Tseng
Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
Objective: To improve the efficiency and quality of care and to reduce the length of hospital stay in the care of acute myoardial infarction in a general hospital. Methods: Cases with the diagnosis of acute myocardial infarction in previous 12 months at Buddhist Tzu-Chi general hospital were identified and clinical procedures such as labs, X-rays, ultrasounds, cathes, PTCA, and medications analyzed. Literature search was done regarding the guidelines and evidence-based best care plan for acute myocardial infarction. Discussion was then made among cardiologists, emergency physicians, nurses and other personnel to reach a consensus and a day-to-day clinical pathway with physician’s orders and nurses instruction and documentation was formulated. Results: Evidence-based clinical pathways can be used to standardize and facilitate the care of patients presented to the hospital with acute myoardial infarction. The implementation met little resistance and the cooperation of staff members were excellent. Variances from the standard procedure were to be traced and analyzed. Conclusions: Evidence-based clinical pathways for Acute Myocardial Infarction can be formulated and implemented in a general hospital. This has the potential of improving both the efficiency and the quality of medical care.
FO07 Detection of sthemsclerotic plaques by transesophageal echocardiography: cllnlcal significance and appltcatton Mike Lin,
ShoaLin
Lin,
Ming-Yang
Chang,
Cheng-Seng
Tat Hong-Ting
its
Chiong
FYNAH and CAGH-Ping Tong; CGMH and VGH-KS
Objective: Atherosclerotic plaques and debris are common findings in elderly patients and their clinical significance needs further confirmation. Transesophageal
FOOS TGF-@ response and resteaosis after PTCA Akito
fiwaguchi
Akiro
Yamamoto
National Cardiovascular Center, Osaka, Japan
Restenosis after coronary angioplasty (PTCA) is based on fibrocelluar intimal hyperplasia. Vascular injury initiates platelets aggregation and thrombosis with increasing fibrinolytic activity. Lp (a) as an atherogenic lipoprotein may interfere plasmin generation, while t-PA facilitate plasmin generation. Plasmin is a potent swine protease, which activate TGF-6 from latent form. TGF-P is a multifunction cytokine suggesting inhibition of smooth muscle cell proliferation. So, we clinically observed the time course of active TGF-8 concentration as well as associated atherothrombotic parameters. Method: Sixty-four patients with successful PTCA had been followed by blood sampling from 5 days to six months after angioplasty. The associating parameters were measured as follows; Lp(a), t-PA, PAI-1, tPAIC (tPA/PAI-1 complex), PIC (plasmin/az-plasmin inhibitor complex, TAT (thrombin/anti-thrombin complex), TFPI (tissue factor pathway inhibitor), TGF-P (active and latent) and so on. The parameters were plotted in the time course. Next, the parameters of the patients confirmed restenosis by angiography were compared with those of the other. Result: Most of parameters showed abrupt increasing just after PTCA and subsiding within 1 month. However, next increasing has followed, forming dome shaped curve from 1 month to 6 months. Among them, active TGF-0 concentration, tPAIC was statistically higher in the patients with clinical restenosis than that in the patients without restenosis. While free form TFPI antigen was lower in the restenosis group. Conclusion: After PTCA, atherothrombotic parameters had drastically changed, forming spike and dome shaped responses. Active TGF-P is one of the culprit growth factor, resulting in excess intimal hyperplasia after vascular injury.
FOO5 Minimally invasive cormmy artery surgery in women Pyng Jing Lin, Chau-Hsiung Chang, yi-Cheng Wu, Yu-Shag Chnng
Jaw-Ji
Chu,
Hui-Ping
Liy
Fe??zg-Chm
Tmi,
Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei
Echocardiography (TEE) can provide an excellent imaging modality for screening for aortic atherosclerotic lesions. This pilot study was determined to define the interrelationship between aging and atherosclerosis. Methods: Serial TEE studies were performed based on Mayo clinic criteria and divided into three aging groups: (A) adult group (< 40, N = 12), (B) middle aging group (< 40-64, N = 20), and (0 elderly group (2 65, N = 18). Their clinical characteristics and related aortic atherosclerotic lesions will be fully explored. Results: Clinical Characteristics and TEE Findings (*P s 0.05; **Pi 0.013; ***P 22 0.005)
Minimally invasive s”rgeIy in coronary artery bypass grafting has been applied mainly in the management of one vessel lesion of coronary artery disease. Nine female patients, aged 49.1-81.6 years old (mean 64.3), were operated on for triple vessel disease through minimally invasive surgical techniques. The surgeries were performed through limited left pamsternal incision under femoro-femoral extracorporeal circulation. The myocardium was protected by antegrade infusion of cold blood cardioplegic solution while the aorta was cross-clamped. Under direct vision, the left saphenous vein grafts were connected sequentially to the diagonal branch, obtuse marginal branch and posterior descending branch, and the left internal thoracic arterial graft was anastomosed to the left anterior descending artery in each patient. The number of distal anastomoses was 3 to 4 with a mean of 3.7. The aortic crossclamp time was 52 to 130 minutes (82 f 25 minutes). The duration of extracorporeal circulation was 78-151 minutes (115 f 29 minutes). The postoperative course was uneventful in all patients. The postoperative length of stay was 4-12 days (7.2 f 2.0 days). Follow-up (4.2-8.7 months, mean 6.4) was complete in all patients and there were no late deaths or angina. Coronary angiography of 2 patients showed patent grafts. All patients were satisfied with the goad cosmetic healing of the incision. Our experience demonstrates that minimally invasive surgery in coronary artery bypass grafting is technically feasible and may be an alternative approach in surgical revascularization of triple vessel coronary artery disease, especially in WO”le”.
Table 4 Items
A: Adult Gr (<40,N=12)
B: Middle c: Elderly Gr AgingGr (>65,N=18) (< 50-64, N = 20)
value
P
AvsB
AvsC
BvsC
*
***
*
2
10
16
0 2
5 5
9 7
0 (II) LA smoke/ LAA thrombus WHD)
4
4
*
*
NS
*
**
NS
NS
*
NS
*
**
NS
(I) Atheromatous plaque/debris Irregular Smooth
(III) Systemic Disease (DM/HT)
2
10
12
(IV) AF/Af
2
6
10
(V) TIA/CVA
4
0
8
F006 Conclusions: Atherosclerotic lesions increased with aging. Irregular atheromatous plaque or debris, smoke/thrombi, as well as AF, are three major predictors in further vascular events. The location and the extent of aortic atheromatous lesions can be confidently identified by TEE exam. Any embolic vascular events also increased with aging. Thus, aging played an important role for atherosclerotic processing.
Evidencebased clinical pathways for acute myocardial infhrction Chin-Len
Lin,
Chn-Po
Lai
&Hung
Wang
Wen-Ping
Tseng
Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
Objective: To improve the efficiency and quality of care and to reduce the length of hospital stay in the care of acute myoardial infarction in a general hospital. Methods: Cases with the diagnosis of acute myocardial infarction in previous 12 months at Buddhist Tzu-Chi general hospital were identified and clinical procedures such as labs, X-rays, ultrasounds, cathes, PTCA, and medications analyzed. Literature search was done regarding the guidelines and evidence-based best care plan for acute myocardial infarction. Discussion was then made among cardiologists, emergency physicians, nurses and other personnel to reach a consensus and a day-to-day clinical pathway with physician’s orders and nurses instruction and documentation was formulated. Results: Evidence-based clinical pathways can be used to standardize and facilitate the care of patients presented to the hospital with acute myoardial infarction. The implementation met little resistance and the cooperation of staff members were excellent. Variances from the standard procedure were to be traced and analyzed. Conclusions: Evidence-based clinical pathways for Acute Myocardial Infarction can be formulated and implemented in a general hospital. This has the potential of improving both the efficiency and the quality of medical care.
FO07 Detection of sthemsclerotic plaques by transesophageal echocardiography: cllnlcal significance and appltcatton Mike Lin,
ShoaLin
Lin,
Ming-Yang
Chang,
Cheng-Seng
Tat Hong-Ting
its
Chiong
FYNAH and CAGH-Ping Tong; CGMH and VGH-KS
Objective: Atherosclerotic plaques and debris are common findings in elderly patients and their clinical significance needs further confirmation. Transesophageal
FOOS TGF-@ response and resteaosis after PTCA Akito
fiwaguchi
Akiro
Yamamoto
National Cardiovascular Center, Osaka, Japan
Restenosis after coronary angioplasty (PTCA) is based on fibrocelluar intimal hyperplasia. Vascular injury initiates platelets aggregation and thrombosis with increasing fibrinolytic activity. Lp (a) as an atherogenic lipoprotein may interfere plasmin generation, while t-PA facilitate plasmin generation. Plasmin is a potent swine protease, which activate TGF-6 from latent form. TGF-P is a multifunction cytokine suggesting inhibition of smooth muscle cell proliferation. So, we clinically observed the time course of active TGF-8 concentration as well as associated atherothrombotic parameters. Method: Sixty-four patients with successful PTCA had been followed by blood sampling from 5 days to six months after angioplasty. The associating parameters were measured as follows; Lp(a), t-PA, PAI-1, tPAIC (tPA/PAI-1 complex), PIC (plasmin/az-plasmin inhibitor complex, TAT (thrombin/anti-thrombin complex), TFPI (tissue factor pathway inhibitor), TGF-P (active and latent) and so on. The parameters were plotted in the time course. Next, the parameters of the patients confirmed restenosis by angiography were compared with those of the other. Result: Most of parameters showed abrupt increasing just after PTCA and subsiding within 1 month. However, next increasing has followed, forming dome shaped curve from 1 month to 6 months. Among them, active TGF-0 concentration, tPAIC was statistically higher in the patients with clinical restenosis than that in the patients without restenosis. While free form TFPI antigen was lower in the restenosis group. Conclusion: After PTCA, atherothrombotic parameters had drastically changed, forming spike and dome shaped responses. Active TGF-P is one of the culprit growth factor, resulting in excess intimal hyperplasia after vascular injury.