Effects of Off-Pump and On-Pump Coronary-Artery Bypass Grafting at 1 Year

From the New England Journal of Medicine

André Lamy, M.D., P.J. Devereaux, M.D., Ph.D., Prabhakaran Dorairaj, M.D., David P. Taggart, Ph.D., Shengshou Hu, M.D., Ernesto Paolasso, M.D., Zbynek Straka, M.D., Leopoldo S. Piegas, M.D., Ahmet Ruchan Akar, M.D., Anil R. Jain, M.D., Nicolas Noiseux, M.D., Chandrasekar Padmanabhan, M.D., Juan-Carlos Bahamondes, M.D., Richard J. Novick, M.D., Prashant Vaijyanath, M.D., Sukesh Kumar Reddy, M.D., Liang Tao, M.D., Pablo A. Olavegogeascoechea, M.D., Balram Airan, M.D., Toomas-Andres Sulling, M.D., Richard P. Whitlock, M.D., Yongning Ou, M.Sc., Janice Pogue, Ph.D., Susan Chrolavicius, B.A., and Salim Yusuf, D.Phil. for the CORONARY Investigators

March 11, 2013

DOI: 10.1056/NEJMoa1301228

Coronary-artery bypass grafting (CABG) reduces mortality among patients with extensive coronary artery disease.1 CABG is usually performed with the use of cardiopulmonary bypass (on-pump CABG). With this approach, perioperative mortality is about 2%, and myocardial infarction, stroke, or renal failure requiring dialysis develop in an additional 5 to 7% of patients. The technique of performing CABG on a beating heart (off-pump CABG) was developed to reduce perioperative complications, some of which may be related to the use of cardiopulmonary bypass and to the cross-clamping of the aorta associated with the on-pump CABG procedure, and to improve long-term outcomes.

Read the entire article here

An example of a heart attack, which can occur ...

An example of a heart attack, which can occur after the use of a performance-enhancing drug. (Photo credit: Wikipedia)

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World Salt Awareness Week

How to understand and use the US Nutritional F...

How to understand and use the US Nutritional Fact Label (Photo credit: Wikipedia)

To reduce your risk of heart disease and stroke—

Everyone can:

Know your recommended limits for daily sodium intake.

Choose to purchase healthy options and talk with your grocer or favorite restaurant about stocking lower sodium food choices.

Read the Nutrition Facts label while shopping to find the lowest sodium options of your favorite foods.

Eat a diet rich in fresh fruits and vegetables and frozen fruits and vegetables without sauce.

Limit processed foods high in sodium.

When eating out, request lower sodium options.

Support initiatives that reduce sodium in foods in cafeterias and vending machines.

More at CDC – DHDSP – Salt: What You Can Do.

Monday – Six Weeks Post-Op

day-mon

Another slow day.  The 3 walking events from last weekend were just too much for now.  In all three instances, they involved parking garages and it was cold.  I remember the visiting nurse saying to put a scarf over his nose to keep the air coming in a bit warmer but, of course, we didn’t have a scarf.

Someone had asked DH to meet at iHop tonight.  I weighed in and said that they should meet at Bob Evans because we knew that there was something there he could eat and we had no idea if there was anything at iHop.

The day slipped by in naps and DH never made the call.  His phone was off and he finally got the message that the person had been waiting for 30 minutes at iHop.  <sigh>

The dog got to go for a ride when we dropped DH off.

Fortunately, DH got a ride home so we didn’t have to go back out.  He said that I was right (of course!) – there wasn’t anything on the menu he could eat.  But he managed to cobble together something with fresh fruit, dry toast and herbal tea.  I thought the only fruit there was in those syrups.

day-wed

We had snow, sort of.  Big, heavy stuff that would have been good for a snowman but we weren’t going out, except for me walking the dog.

I was having a movie kind of day and heard someone out in the driveway, shoveling.  I went out to investigate and found two women from church clearing our driveway.  That was so nice 🙂  In a bit DH came out and said hello, too.

day-thurs

Thursday, I was into day 2 of an itchy cycle.  I haven’t written about that yet, so there’s something to look forward to!  As a result, I don’t do much of anything but itch and be miserable.  At night, I can take Benadryl which helps the itching and makes me sleep.

More on that later!

day-fri

Fridays, I normally play piano duets with an older friend but I hadn’t been since before Christmas.  I decided it was time to go back so I took DH along with me.  We all had a nice visit – we’ve known my friend and her husband for maybe 35 years.  She had a heart attack about 15 or so years ago so DH was able to ask lots of questions.

When we got back, it was nap time, again.  It’s still mostly do something followed by an equal length nap but it’s getting better.

day-sat

I had been awake until 4:30 am so I wasn’t in a great mood when I woke up.  DH wanted to go walking at the Mall – but first, a stop at Staples for more business cards.

I was already tired before we got to the Mall but we walked a bit.  Stopped in the Apple Store to look at iPad Minis, then turned around.  He went into Zales to get the ruby he didn’t get on the first day, the anniversary-heart-attack-day.

On the way out of the mall, he said we could go to Bob Evans for breakfast and I said no way!  Too tired.

day-sun

Back to Staples to pick up the cards from Staples, then on to walk around Wal-Mart.  DH looked longingly at no-salt peanuts.  I showed him the back with the calorie counts and pointed out the size of 1 serving and asked if he could stick to that.  He put them back.

Back home and more nap time.

He says he’s feeling better and better, has lost more weight, no more pain killers.  Hooray!

How to Track Your Sodium

Did you know that a fast food sandwich or burger can easily contains more than 100 percent of the sodium you need in a day? If you’re like many Americans, you may be getting way more sodium than your heart can handle.

Most people consume about 3,400 milligrams of sodium a day — more than twice the 1,500 milligrams recommended by the American Heart Association.

It’s easy to understand why. Sodium can be sneaky. It slinks into soups and sandwiches and cozies up to cold cuts and cured meats. It plants itself in your favorite pizza and poultry and burrows into breads and rolls. Learn more about the Salty Six and better alternatives (and see the tips at the end of this story.)

Read more at  How to Track Your Sodium.

It’s Pretty But…

snowstorm

 

 

No shoveling here!  We’ll tough it out somehow.

From Shoveling snow can be hard on the heart

Snow shoveling is a known trigger for heart attacks. Emergency rooms in the snowbelt gear up for extra cases when enough of the white stuff has fallen to force folks out of their homes armed with shovels or snow blowers.

What’s the connection? Many people who shovel snow rarely exercise. Picking up a shovel and moving hundreds of pounds of snow, particularly after doing nothing physical for several months, can put a big strain on the heart. Pushing a heavy snow blower can do the same thing. Cold weather is another contributor because it can boost blood pressure, interrupt blood flow to part of the heart, and make blood more likely to form clots.

The Mixed Blessing of Heart Surgery

Three coronary artery bypass grafts, a LIMA to...

Three coronary artery bypass grafts, a LIMA to LAD and two saphenous vein grafts – one to the right coronary artery (RCA) system and one to the obtuse marginal (OM) system. (Photo credit: Wikipedia)

Angioplasty and heart bypass surgery are giants among medical procedures in America. They are performed more than a million times each year and together drive a $100-billion industry. But an article in the recent issue of Harvard Magazine explores a frightening truth: There’s no evidence that they improve life expectancy by even a single day. – See more at:

The mixed blessing of heart surgery.

A heart attack occurs about every 20 seconds with a heart attack death about every minute…

Dr. Michelle Capdeville's avatarDr. Michelle Capdeville, Cardiothoracic Anesthesiology

  • 1.5 million heart attacks occur in the United States each year with 500,000 deaths.
  • More than 233,000 women die annually from cardiovascular disease.
  • A heart attack occurs about every 20 seconds with a heart attack death about every minute.
  • Sudden death is more common among women with heart attack.
  • The National Registry of Myocardial Infarctions (New England Journal Med., 22Jul99) reports that women have a worse outcome than men after having a heart attack. Data showed that women under the age of 50 had twice the mortality of men after having a heart attack. Variances likely reflect increased severity of the disease in younger women.
  • Almost 14 million Americans have a history of heart attack or angina.
  • About 50% of deaths occur within one hour of the heart attack ––outside a hospital.
  • There is a 6% to 9% early mortality from heart attack for those who survive long enough to…

View original post 203 more words

How Blood Flows Through the Heart

Diagram of the human heart 1. Superior Vena Ca...

Diagram of the human heart 1. Superior Vena Cava 2. Pulmonary Artery 3. Pulmonary Vein 4. Mitral Valve 5. Aortic Valve 6. Left Ventricle 7. Right Ventricle 8. Left Atrium 9. Right Atrium 10. Aorta 11. Pulmonary Valve 12. Tricuspid Valve 13. Inferior Vena Cava (Photo credit: Wikipedia)

From http://www.interactive-biology.com

In this video, I go through the process of how blood flows through the heart. It shows blood entering via the vena cave to the Right atrium, then getting pumped into the right ventricle, to the pulmonary vein to the lungs, to the left atria, left ventricle and then via the aorta to the rest of the body.

Enjoy!

Monday – Five Weeks Post-op

day-mon

Today went pretty well.  DH did some computer work with an employee.  After about 2 hours, DH rested his eyes for a bit while the other guy finished up.

I took the opportunity to go out to do some grocery shopping.  Exciting stuff!

A few phone calls, then DH napped some more – a bit of computer and you know the rest!

Girl Scout Thin Mint cookies

Girl Scout Thin Mint cookies (Photo credit: Wikipedia)

Sometime before this adventure started, DH had ordered 2 boxes of Girl Scout cookies.

Those arrived this evening and DH said he’d have “just one”.

I didn’t check how many he had but I saw that 4 (the typical serving size for Thin Mints) is 125 mg of sodium.  Possible trouble looming.

Maybe I’ll have to sacrifice myself and eat them all first 🙂

day-tues

Today was a pretty good day.  DH actually did some more work got a testimony ready to file, then some napping.  He went out with a friend to meet some others and actually had half a cup of coffee for the first time since surgery.

While he was out, I went to bell rehearsal to sub for someone else.  A very odd feeling to be subbing in my own group but they’re getting ready for a festival and someone has to ring my position – and it can’t be me.  I won’t be able to be away overnight for a while.

It was nice to be back, even briefly 🙂

day-wed

Up early in the morning for the stress test on the treadmill at the cardiologist.  I dropped DH off at the front door.  By the time I’d parked and gotten upstairs, he was already hooked up to the monitors but they wouldn’t let me go in.

Apparently, he passed with flying colors, all the way up to a 7% grade so he can start cardiac rehab as soon as we can get it set up!

On the way home, we saw my mom out walking so pulled over to say hello.  She was on her way to the library.  She had an appointment with her oncologist next Wednesday and she had been dithering about changing that in case DH’s rehab was on Wednesday mornings.  I told her not to change it – she might change TO the rehab date.  As it turned out, the oncologist had cancelled her.  Problem solved.

We decided to be brave and went to Bob Evans for breakfast.  DH did fairly ok with veggie omelet, egg beaters, fruit plate and dry whole wheat toast.  Another step in getting out into the real world again…

day-thurs

Last night didn’t go well.  I tossed and turned all night.  DH started trying to sleep in our room and went to the recliner about 1:00am, then back to the room about 4:00am.  About 8:00am he was in the recliner again so I guess he didn’t sleep well, either.

The day was like most days – a lot of napping and working.

DH called rehab and he can’t start for 2 weeks.  A bit disappointing 😦

I cleaned out our pantry and got rid of all the canned foods with sodium in them.  I took some to my mom, then took the rest to church to send to Western Fairfax Christian Ministries.

I went to church choir.  They’re getting ready for Holy Week and Easter so there’s lots of new music to learn.  I’m starting to feel less mole-like.

day-fri

Another lazy day.  We were going to go to the mall to walk but work and naps got in the way.

DH is sitting in his recliner listening to some app that will teach him Spanish.

Our son came home and DH actually went with me to Union Station to pick him up from the train.  I parked as close as I could so it was a short walk to the escalator, then another walk, another escalator and a longer walk.

DH was hungry so we went to get some Jamba Juice.  Even though the store was open, they said that they were cleaning up and closed.  DH went into Starbucks against my better judgement and got some kind of strawberry muffin thing.

On the way home, he wanted to go to McDonalds so I went through the drive-through and got 3 shamrock shakes, a grilled chicken sandwich for DH and a quarter pounder, no cheese for me.

Going out into the world is going to wreck all my careful food planning over the last 4 weeks!

day-sat
I woke up at 4:00am with a raging headache, possibly from that shamrock shake.  I’m not used to all that sugar any more 😦  It’s too bad – that’s about the only thing I really like(d) at Mickey D’s.  Oh, well.

At 11 we had our first Mended Hearts meeting.  That went pretty well.  I actually talked some – DH, of course, talked more.  I found it ironic that the snacks included no coffee but the raffle gift was a coffee cup.  HMMM…

It was good listening to other patients and caregivers talking about some of the issues we’ve gone through.

day-sun

 

Today was a take-it-easy day, a bit of TV, napping and playing piano duets with our son.  At night, we took him back to the train station.  Later, DH said that his chest was hurting a bit, probably from so much walking in the train today and Friday and the walking through the parking garage and hospital on Saturday.

Hopefully, a little Tylenol will help.

Next report next Monday…

Coronary Artery Bypass Graft (CABG off-pump)

heart with coronary arteries

heart with coronary arteries (Photo credit: Wikipedia)

Before we talk about treatment, let’s start with a discussion about the human body and about your medical condition.

Your doctor has recommended that you have coronary artery bypass surgery. But what does that actually mean?

  • Your heart is located in the center of your chest.
  • It is surrounded by your rib cage and protected by your breastbone.
  • Your heart’s job is to keep blood continually circulating throughout your body.
  • The vessels that supply the body with oxygen-rich blood are called arteries.
  • The vessels that return blood to the heart are called veins.
  • Like any other muscle in the body, the heart depends on a steady supply of oxygen rich blood. The arteries that carry this blood supply to the heart muscle are called coronary arteries.
  • Sometimes, these blood vessels can narrow or become blocked by deposits of fat, cholesterol and other substances collectively known as plaque.
  • Over time, plaque deposits can narrow the vessels so much that normal blood flow is restricted. In some cases, the coronary artery becomes so narrow that the heart muscle itself is in danger.
  • Coronary bypass surgery attempts to correct this serious problem. In order to restore normal blood flow, the surgeon removes a portion of a blood vessel from the patient’s leg or chest, most probably the left internal mammary artery and the saphenous vein.
  • Your doctor uses one or both of these vessels to bypass the old, diseased coronary artery and to build a new pathway for blood to reach the heart muscle.
  • These transplanted vessels are called grafts and depending on your condition, your doctor may need to perform more than one coronary artery bypass graft.