Kranskärlsoperationen är för patienten en stor händelse som leder till många frågor och funderingar. Tidigare forskning har visat att patienter som genomgått en ranskärlsoperation har stort behov av information. Vårt syfte med studien var att beskriva informationen vid en kranskärlsoperation. Studien gjordes som en itteraturstudie. Resultatet av studien utföll i tre kategorier, informationsmetoder, vad informationen innehöll samt olika faktorer som påverkade patientinformationen. Information gavs skriftligt, muntligt, som videofilm, med Internet eller av en patient som tidigare gjort en kranskärlsoperation, ofta i kombination med varandra. Vad patienten ville att informationen skulle innehålla varierade från person till person beroende på i vilken fas patienten befann sig, pre- eller postoperativt. Flera faktorer framkom som var av betydelse. Det var viktigt för patienterna att personalen tog sig tid att lyssna och svara på frågor och funderingar. Patienter med litet socialt nätverk hade större behov av information än andra med stort socialt nätverk. En annan betydelsefull sak var att patienterna lätt skulle kunna komma i kontakt med kompetent personal både innan operationen och efter utskrivningen. Slutsatsen av resultatet var att informationen bör vara individuellt anpassad utifrån varje patients behov. Fortsatt forskning behövs för utveckling av en god patientinformation kring patienternas upplevelse av olika sorters informationssätt, samt att utveckla kontakt med patienter som tidigare gjort en kranskärlsoperation / Coronary artery bypass is for the patient a major event leading to many questions and concerns. Previous research has shown that patients who have undergone coronary artery bypass have great needs of information. Our aim of this study was to describe information before and after a coronary artery bypass. The study was done as a literature review. The results of the study were distributed into three categories, information methods, information content and the various factors that affect patient information. Information was given in writing, orally, by video, by Internet or by a patient previously undergoing a coronary artery surgery, usually in combination with each other. What the patient wanted the information should contain varied from person to person depending on what stage the patient was, pre- or postoperatively. Several factors emerged that were relevant. It was important for the patients that the staff took the time to listen and respond to questions and concerns. Patients with small social networks had a greater need for information than others with larger social network. Another important thing was that patients could easily get in touch with competent personnel both before surgery and after discharge. The conclusion of the result was that the information should be individualized based on each patient's needs. Continued research is needed to develop good patient information on patients' experience of different types of information means, and to develop contact with patients who have previously done a coronary artery bypass.

Background: Despite the recent improvements in surgical techniques and postoperative patient care, atrial fibrillation (AF) remains the most frequent complication after cardiac surgery. Although postoperative AF is often regarded as a benign clinical condition, this arrhythmia has significant adverse effects on patient recovery and postoperative survival. Its exact pathophysiology has not yet been elucidated. The present thesis aims to analyze AF risk factors and their interaction, pre-existing histological explanatory alterations of the atrium, the AF impact on postoperative survival and the compliance of a prophylactic drug regimen. Methods: During a 10-year period, consecutive cardiac surgery cases with complete data on AF occurrence and postoperative survival were extracted. All patients were operated on for coronary or valvular surgery, with cardiopulmonary bypass (CPB). Hospital and long-term survival data were obtained from Swedish population registry. Study I) Isolated coronary artery bypass grafting (CABG, n=7056), aortic valve replacement (n=690) and their combination (n=688) were considered. Independent AF risk factors and AF effects on early and 1 year mortality were investigated. Study II) Patients affected by postoperative AF among isolated CABG patients (n=7621), valvular surgeries (n=995) and their combination (n=879) were studied. Long-term survival was obtained and prognostic factors identified. Study III) Seventy patients were randomized to on-pump (n=35) or off-pump (n=35) CABG. Samples from the right atrial appendage were collected and histology was evaluated by means of light and electronic microscopy with reference to preexistent alterations related to postoperative AF. Study IV) Cardiac surgery patients with complete data on smoking status (n=3245) were reviewed. Effects of smoking on AF development and interaction among variables were explored. Study V) CABG patients without clinical contraindications to receive oral sotalol (80 mg twice daily) and magnesium were prospectively enrolled (n = 49) and compared with a matched contemporary control CABG group (n = 844). The clinical compliance to the AF prophylactic drug regimen was tested. Results: The overall AF incidence was around 26%, subdivided into 23%, 40% and 45% for isolated CABG, valve procedures and their combined surgeries, respectively. Age was the strongest predictor of postoperative AF. Coronary disease superimposed risk factors with reference to myocardial conditions at CPB weaning. Considering the preoperative smoking condition, smokers demonstrated a reduced AF incidence compared to non-smokers (20% versus 27%, p<0.001). An interaction between smoking status and inotropic support was observed: without this interaction smoking conferred a 46% risk reduction of AF (p=0.011). At the histological level, myocyte vacuolization and nuclear derangement represented anatomical independent AF predictors (p=0.002 and p=0.016, respectively). CPB exposure was not associated to postoperative AF nor histological changes. Although, postoperative AF increases the length of hospitalization in all patient groups, it did not affect the hospital survival. However, AF independently impaired the late survival, a phenomenon seen in the CABG group only. With reference to the tested sotalolmagnesium drug regimen, only 55% of CABG patients were compliant to the treatment, with marginal effects on AF occurrence. Conclusions: In addition to age, details at the CPB weaning period, pre-existing histopathological changes, the hyperadrenergic state and catecholamines are key mechanisms in the pathophysiology of postoperative AF. In particular, the CPB period hides valuable information for timely AF prophylactic stratifications. Further, compliance effects due to patient selection should also be considered in a prophylactic therapy model. Postoperative AF increases late mortality after isolated CABG surgery, but not after valvular procedures. Although the mechanisms are unclear, our results draw the attention to possible AF recurrence after hospital discharge, indicating a strict postoperative surveillance.

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Coronary artery bypass surgery (CABS) is highly stressful for couples, since comorbid anxiety and depression are most commonly reported and hence most researched pre- and postoperative emotional states. Thus, patients' psychological well-being may contribute more to the level of disability than their physical impairment. Despite this extremely stressful process, psychological preparation is ironically often neglected in CABS couples. The primary aim of the study was to examine the feasibility of hypnotherapeutic ego strengthening (HES) to enhance the ability of CABS couples' to cope with psychological distress associated with hospitalisation and surgery. Secondary aims were to determine the contribution of HES in reducing anxiety and depression, as well as enhancing and maintaining ego strength, quality of life and dispositional optimism in CABS patients and spouses. An overview of coronary heart disease (CHD), risk factors involved, psychological aspects concomitant to CABS (specifically anxiety and depression) and a conceptualisation of HES according to the relevant literature, preceded the empirical study. The experimental design consisted of a two-group, pre-post-follow-up assessment design. A sample of fifty married, male patients admitted to Unitas Hospital in Pretoria with a first, uncomplicated CABS was randomly assigned, together with their spouses, to an experimental- (n = 25) and control group (n = 25). Informed consent was obtained for all project participants. Thus, both groups consisted of twenty-five patients and spouses. To test the hypotheses, experimental patients and spouses were required to participate in the HES intervention. Respondents completed the Beck Depression Inventory (BDI-II) (Beck, Steer, & Brown, 1995). Profile of Mood States (POMS) (McNair, Lorr & Doppleman, 1992), Epstein and O'Brien Ego Strength Scale (1982), Quality of Life Inventory (QOLI) (Frisch, 1994) as well as the Life Orientation Test (LOT) (Scheier & Carver, 1985). Test administration of couples occurred preoperatively, on the day of discharge, and at six-week follow-up. Before commencing the intervention, group comparability was confirmed by means of the t-test for independent groups. At programme completion the significance of differences within and between groups was determined by means of t-tests. Statistically significant p-values were subjected to Cohen's d statistic to determine the practical significance of the findings. A confidence interval of 99% determined the values of the differences between the postoperative and follow-up findings. Results confirmed that the HES intervention significantly reduced postoperative anxiety and depression levels in experimental CABS patients and spouses, which was maintained at follow-up. No change was observed among control group patients and spouses. Moreover, the HES intervention significantly improved and maintained postoperative ego strength, quality of life and dispositional optimism in experimental CABS couples. The overall outcome of the control patients and spouses revealed a decreasing trend with regard to dispositional optimism and quality of life. Qualitative responses largely confirmed quantitative indications of reduced comorbidity and enhanced psychological well-being among experimental participants. Despite design limitations, the results confirmed that HES enhanced CABS couples' inner resources and attenuated concomitant negative mood states. Thus, it was concluded that HES played a meaningful role in the preparation and care of CABS couples by reducing comorbidity and improving their psychological well-being. Finally, recommendations for further studies were made. / Thesis (Ph.D. (Psychology))--North-West University, Potchefstroom Campus, 2004.

Contents 1. Introduction 7 1.1. The aim of the study 8 1.2. Tasks of the study 9 1.3. The scientific novelty and originality of the study 9 1.4. Practical importance of the study 9 2. Material and methods 11 2.1. The contingent of studied patients 11 2.2. Methods 12 2.2.1.Coronary artery bypass grafting 12 2.2.2. The used equipment 12 2.2.3. The method of myocardial SPECT performance 12 2.2.4. Evaluation of myocardial SPECT 13 2.3. Statistical analysis of data 15 3. Results 16 3.1. The evaluation of influence of left ventricular ejection fraction on postoperative changes of perfusion of revascularized myocardium 16 3.2. The evaluation of influence of left ventricle ejection fraction on postoperative changes of contraction of revascularized myocardium 18 3.3. The evaluation of influence of collaterals on postoperative changes of perfusion of revasculized myocardium 19 3.4. The evaluation of influence of collaterals on postoperative changes of contraction of revasculized myocardium 21 3.5. The prediction of postoperative myocardial perfusion and contraction 23 3.6. The identification of period of the maximal recovery of myocardial perfusion and contraction after surgical revascularization 27 4. Conclusions 29 5. List of publications 30 6. Summary in Lithuanian 31 7. Autobiography 34 1. Introduction Heart and blood vessels diseases, the most common of which is coronary artery disease (CAD), are the leading causes of death and disability of middle-aged and elderly... [to full text]

This study determined whether a pre-operative cardiac “pre-habilitation” (Prehab) program improves the health of elective coronary artery bypass graft (CABG) surgery patients to a greater extent than standard care (StanC). Seventeen elective CABG patients were randomized to StanC (n= 9) or Prehab (n= 8) at Baseline and were followed at 1-2 weeks pre-operatively (Preop) and Three months post-operatively. Functional walking ability was assessed using the 6-Minute Walk Test (6MWT) and 5-meter Gait Speed Test. Baseline data was not different between groups. Patients in StanC did not improve 6MWT scores; whereas Prehab patients improved 6MWT distance by 35% and 39% at Preop and Three months post-operatively, respectively (p<0.05). Gait speed scores were 25% and 27% lower in Prehab patients at Preop and Three months post-operatively, respectively, as compared to StanC (p<0.05). These data suggest that Prehab is an attractive intervention for enhancing functional walking ability before and after elective CABG surgery.

Coronary artery bypass surgery (CABS) is highly stressful for couples, since comorbid anxiety and depression are most commonly reported and hence most researched pre- and postoperative emotional states. Thus, patients' psychological well-being may contribute more to the level of disability than their physical impairment. Despite this extremely stressful process, psychological preparation is ironically often neglected in CABS couples. The primary aim of the study was to examine the feasibility of hypnotherapeutic ego strengthening (HES) to enhance the ability of CABS couples' to cope with psychological distress associated with hospitalisation and surgery. Secondary aims were to determine the contribution of HES in reducing anxiety and depression, as well as enhancing and maintaining ego strength, quality of life and dispositional optimism in CABS patients and spouses. An overview of coronary heart disease (CHD), risk factors involved, psychological aspects concomitant to CABS (specifically anxiety and depression) and a conceptualisation of HES according to the relevant literature, preceded the empirical study. The experimental design consisted of a two-group, pre-post-follow-up assessment design. A sample of fifty married, male patients admitted to Unitas Hospital in Pretoria with a first, uncomplicated CABS was randomly assigned, together with their spouses, to an experimental- (n = 25) and control group (n = 25). Informed consent was obtained for all project participants. Thus, both groups consisted of twenty-five patients and spouses. To test the hypotheses, experimental patients and spouses were required to participate in the HES intervention. Respondents completed the Beck Depression Inventory (BDI-II) (Beck, Steer, & Brown, 1995). Profile of Mood States (POMS) (McNair, Lorr & Doppleman, 1992), Epstein and O'Brien Ego Strength Scale (1982), Quality of Life Inventory (QOLI) (Frisch, 1994) as well as the Life Orientation Test (LOT) (Scheier & Carver, 1985). Test administration of couples occurred preoperatively, on the day of discharge, and at six-week follow-up. Before commencing the intervention, group comparability was confirmed by means of the t-test for independent groups. At programme completion the significance of differences within and between groups was determined by means of t-tests. Statistically significant p-values were subjected to Cohen's d statistic to determine the practical significance of the findings. A confidence interval of 99% determined the values of the differences between the postoperative and follow-up findings. Results confirmed that the HES intervention significantly reduced postoperative anxiety and depression levels in experimental CABS patients and spouses, which was maintained at follow-up. No change was observed among control group patients and spouses. Moreover, the HES intervention significantly improved and maintained postoperative ego strength, quality of life and dispositional optimism in experimental CABS couples. The overall outcome of the control patients and spouses revealed a decreasing trend with regard to dispositional optimism and quality of life. Qualitative responses largely confirmed quantitative indications of reduced comorbidity and enhanced psychological well-being among experimental participants. Despite design limitations, the results confirmed that HES enhanced CABS couples' inner resources and attenuated concomitant negative mood states. Thus, it was concluded that HES played a meaningful role in the preparation and care of CABS couples by reducing comorbidity and improving their psychological well-being. Finally, recommendations for further studies were made. / Thesis (Ph.D. (Psychology))--North-West University, Potchefstroom Campus, 2004.

This study determined whether a pre-operative cardiac “pre-habilitation” (Prehab) program improves the health of elective coronary artery bypass graft (CABG) surgery patients to a greater extent than standard care (StanC). Seventeen elective CABG patients were randomized to StanC (n= 9) or Prehab (n= 8) at Baseline and were followed at 1-2 weeks pre-operatively (Preop) and Three months post-operatively. Functional walking ability was assessed using the 6-Minute Walk Test (6MWT) and 5-meter Gait Speed Test. Baseline data was not different between groups. Patients in StanC did not improve 6MWT scores; whereas Prehab patients improved 6MWT distance by 35% and 39% at Preop and Three months post-operatively, respectively (p<0.05). Gait speed scores were 25% and 27% lower in Prehab patients at Preop and Three months post-operatively, respectively, as compared to StanC (p<0.05). These data suggest that Prehab is an attractive intervention for enhancing functional walking ability before and after elective CABG surgery.

Myocardial ischemia is a major cause of postoperative heart failure and adverse outcome in coronary artery bypass graft surgery (CABG). Conventional treatment of postoperative heart failure with inotropic drugs may aggravate underlying ischemic injury. Glutamate has been claimed to increase myocardial tolerance to ischemia and promote metabolic and hemodynamic recovery after ischemia. The aim of this work was to investigate if intravenous glutamate infusion given in association with CABG for acute coronary syndrome can reduce mortality and prevent or mitigate myocardial injury and postoperative heart failure. We also wanted to assess neurological safety issues, as a concern with the use of glutamate is that it may act as an excitotoxin under certain conditions.A metabolic strategy for perioperative care was assessed in an observational study on 104 consecutive patients with severe left ventricular dysfunction undergoing CABG. Based on encouraging clinical results, unsurpassed in the literature, the GLUTAMICS-trial was initiated. 861 patients undergoing CABG for acute coronary syndrome were randomly allocated to blinded intravenous infusion of L-glutamicacid solution or saline. The primary endpoint was a composite of postoperative mortality (≤30 days), perioperative myocardial infarction and left ventric ular heart failure in association with weaning from cardiopulmonary bypass. Secondary endpoints included neurological safety issues, degree of myocardial injury,postoperative hemodynamic state, use of circulatory support and cardiac mortality.The event rate was lower than anticipated and the primary endpoint did not differ significantly between the groups. Regarding secondary endpoints there were significant differences compatible with a beneficial effect of glutamate on post-ischemic myocardial recovery. The putative effect of glutamate infusion was seen in more ischemic patients (CCS class IV) and in patients with evident or anticipated LV-failure on weaning from CPB. No evidence for increased incidence of clinical or subclinical neurological injury was found. In conclusion, intravenous glutamate infusion is safe in the dosages employed and could provide a novel and important way of promoting myocardial recovery after ischemic injury.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.