MedWorm: Coronary Artery Bypass Graft

Repeat percutaneous coronary revascularization: Indications and outcomes in a “Real World” cohort

Catheterization and Cardiovascular Interventions — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions: In contemporary practice, patients undergoing a first stenting procedure have a low subsequent mortality, and the substantial majority (86.4%) requires no further revascularization over a median 3.8 year follow‐up. For those who do require repeat stenting, this is most commonly at a site remote from the first stent. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

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Coronary artery bypass grafting associated to aortic valve replacement in the elderly: survival and quality of life

Journal of Cardiothoracic Surgery — Mon, 06 Feb 2012 05:00:00 +0100

Myocardial ischemia is often associated to aortic valve stenosis in the elderly. Aim of this study was to evaluate the impact on survival and quality of life of CABG associated to aortic valve replacement in the septuagenarians and octogenarians.Between January 1991 and January 2010, 520 patients ageing >70 years underwent aortic valve replacement with a mechanical prosthesis in two Institutions. They were divided into 2 groups: Group A included 406 patients undergoing isolated aortic valve replacement; Group B 114 patients receiving aortic valve replacement and CABG. A comparative analysis of long-term survival and quality of life (SF-36 test) was performed.Mean age was 74.2+/-3.6 years (74.3+/-3.6 in Group A, 74+/-3.3 in Group B; p=0.33). Hospital mortality was 9.5% (46 patients). Twenty...

Cardiovascular Outcomes Using Intra-Aortic Balloon Pump in High-Risk Acute Myocardial Infarction With or Without Cardiogenic Shock: A Meta-Analysis

Journal of Cardiovascular Pharmacology and Therapeutics — Mon, 06 Feb 2012 05:00:00 +0100

Conclusion: The present meta-analysis suggests that patients with high-risk AMI without cardiogenic shock do not seem to benefit from the use of IABP as measured by in-hospital mortality, rate of reinfarction, and recurrent angina. However, in patients with AMI with cardiogenic shock (systolic blood pressure [SBP] < 90), there was significant reduction in mortality using IABP. The use of IABP is associated with increase in the rate of both moderate and severe bleeding. (Source: Journal of Cardiovascular Pharmacology and Therapeutics)

The use of positron emission tomography in the diagnosis of pacemaker related infection

Heart — Mon, 06 Feb 2012 05:00:00 +0100

A 59-year-old man underwent dual chamber permanent pacemaker (DDD PPM) implantation for complete heart block following emergency mechanical mitral valve replacement and coronary artery bypass grafting. At routine pacemaker check 5 months after the implant, a painless moderate sized swelling persisted over the box. The patient described several episodes of rigours and sweating in the preceding month. The patient was otherwise systemically well and without fever. Blood tests demonstrated a normal white blood cell count (9.9x109) and erythrocyte sedimentation rate (13 mm/h) and a mildly raised C reactive protein (11 mg/l). Chest radiograph was unremarkable. Blood cultures were negative. A transoesophageal echocardiogram did not show evidence of intracardiac vegetation. He under...

Case fatality rates for South Asian and Caucasian patients show no difference 2.5 years after percutaneous coronary intervention

Heart — Mon, 06 Feb 2012 05:00:00 +0100

Conclusion In this large PCI cohort, the in-hospital and longer-term mortality of South Asians appeared no worse than that of Caucasians. South Asians had higher rates of restenosis and CABG during follow-up. Data suggest that the excess coronary mortality for South Asians compared with Caucasians is not explained by differences in case-fatality rates. (Source: Heart)

Professor Credits UA Surgery/Cardio Team in Bypass Recovery

Health — Fri, 03 Feb 2012 07:00:00 +0100

UA professor Richard Michod is three months into his recovery from bypass surgery, and fresh from sailing in the Virgin Islands – a trip he was able to make thanks to a pioneering, minimally invasive, robotic-assisted coronary artery bypass graft procedure offered at The University of Arizona Medical Center. (Source: Health)

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Evaluation of TAPSE as a measure of right ventricular output.

Canadian Journal of Anaesthesia — Fri, 03 Feb 2012 05:00:00 +0100

CONCLUSION: Tricuspid annular plane systolic excursion by M mode and by speckle tracking correlates modestly with SV. There was no correlation between TAPSE and SV by tissue tracking at the inferior wall of the right ventricle. Tricuspid annular plane systolic excursion by M mode and by speckle tracking does not track changes in SV following either volume loading or ephedrine administration. PMID: 22302303 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

Effects of Remote Ischemic Preconditioning With Postconditioning in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery.

Circulation Journal — Fri, 03 Feb 2012 05:00:00 +0100

Conclusions: RIPC+RIPostC by lower limb ischemia decreased postoperative myocardial enzyme elevation by almost half postoperatively in patients undergoing OPCAB. PMID: 22301846 [PubMed - as supplied by publisher] (Source: Circulation Journal)

[Original Articles] Optimism, Response to Treatment of Depression, and Rehospitalization After Coronary Artery Bypass Graft Surgery

Psychosomatic Medicine — Fri, 03 Feb 2012 05:00:00 +0100

Conclusions Among depressed post-CABG patients, optimists responded to depression treatment at higher rates. Independent of depression, optimists were less likely to be rehospitalized by 8 months after CABG. Further research should explore the impact of optimism on these and other important long-term post-CABG outcomes. (Source: Psychosomatic Medicine)

Anticoagulation monitoring during extracorporeal circulation with the HEPCON/HMS device.

Perfusion — Thu, 02 Feb 2012 05:00:00 +0100

CONCLUSION: During cardiac surgery under CPB, heparin and protamine titration with the Hepcon/HMS device could predict a lower protamine dose and lower postoperative bleeding without higher thromboembolic events, and lower perioperative red blood cell transfusion with a shorter chest closure time. PMID: 22301392 [PubMed - as supplied by publisher] (Source: Perfusion)

CABG Outlasts Stenting for Survival (CME/CE)

MedPage Today Cardiovascular — Wed, 01 Feb 2012 16:40:03 +0100

FT. LAUDERDALE (MedPage Today) -- Coronary artery bypass grafing was associated with better longer-term survival compared with percutaneous coronary intervention in certain high-risk subgroups, the large observational ASCERT study showed. (Source: MedPage Today Cardiovascular)

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Lipid Management in High Risk Coronary Patients: How Effective are We at Secondary Intervention?

Heart, Lung and Circulation — Wed, 01 Feb 2012 05:00:00 +0100

Objective: To assess the proportion of patients who achieve and maintain target lipid levels during optimum long term follow up after coronary bypass surgery.Methods: From a prospectively compiled database, we identified 440 patients followed for up to 13 years after CABG as part of a radial artery randomised controlled trial. All available lipid assays conducted during the follow-up period were collected from pathology databases. These were used to calculate the annualised mean lipid exposure for each patient. Based upon National Heart Foundation guidelines, we determined the proportion of patients whose mean lipid exposure attained target levels (total cholesterol (Source: Heart, Lung and Circulation)

Short Term Outcomes after Cardiac Surgery in a Jehovah's Witness Population: An Institutional Experience

Heart, Lung and Circulation — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion: Cardiac surgery can be performed safely in Jehovah's Witness patients with acceptable outcomes. (Source: Heart, Lung and Circulation)

Med Sci Monit 2012; 18(2):CQ1-3 "Postcardiac injury syndrome. Part II"

Medical Science Monitor — Wed, 01 Feb 2012 05:00:00 +0100

A 58-year-old man had undergone 2-vessel off-pump coronary artery bypass surgery (OPCAB), 1 month before he was admitted into the hospital with cardiac tamponade due to pericarditis. Postcardiac injury syndrome (PCIS) was diagnosed. In spite of receiving anti-inflammatory treatment, the patient developed relapsing PCIS. (Source: Medical Science Monitor)

Med Sci Monit 2012; 18(2):CR105-111 "The influence of heparin resistance on postoperative complications in patients undergoing coronary surgery"

Medical Science Monitor — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Mild forms of heparin resistance are relatively frequent and are not associated with increased morbidity and mortality. The isolation of severe heparin resistance as an independent predictor of death in our large cohort of coronary patients suggests that this phenomenon should be given more attention in future studies. (Source: Medical Science Monitor)

Trials Influence Update to PCI/CABG Appropriate-Use CriteriaTrials Influence Update to PCI/CABG Appropriate-Use Criteria

Medscape Today Headlines — Tue, 31 Jan 2012 20:45:42 +0100

The document somewhat expands the appropriateness of PCI in some patients with left main coronary disease, among other indications. Heartwire (Source: Medscape Today Headlines)

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The Influence of Low and Moderate Carotid Stenosis on Neurophysiologic Status of Patients Undergoing on-pump Coronary Artery Bypass Grafting.

Atherosclerosis — Tue, 31 Jan 2012 05:18:06 +0100

Conclusion: Our results suggest that the presence of low and moderate ICA stenosis is one of the factors affecting the neurophysiologic status of CHD patients. It has been assumed that the patients with ≤50% ICA stenoses constitute a high-risk group for cerebral complications after on-pump CABG. PMID: 22279441 [PubMed - in process] (Source: Atherosclerosis)

Atypically Located Pericardial Cyst in a Patient Who Underwent Off-pump Myocardial Revascularization.

Annals of Thoracic and Cardiovascular Surgery — Tue, 31 Jan 2012 05:00:00 +0100

We present a case of an atypically located pericardial cyst in a patient who underwent myocardial revascularization. A 61-year-old man with acute myocardial infarction was scheduled for coronary artery bypass grafting (CABG). Preoperative chest computed tomography revealed a homogenous cystic lesion in the superior mediastinum. The mass was located between the ascending aorta, the superior vena cava, and the left innominate vein. It was growing to the anterior of the aorta and to the right anterior paratracheal area. The density of the mass was close to that of water; thus, the contrast medium failed to enhance its visualization. A concomitant resection of the mass and the CABG was scheduled. After a medial sternotomy and bypass graft harvest, a median pericardectomy was performed. The sur...

Early benefit of preserved cognitive function is not sustained at one-year after cardiac surgery: a longitudinal follow-up of the randomized controlled trial.

Canadian Journal of Anaesthesia — Tue, 31 Jan 2012 05:00:00 +0100

CONCLUSIONS: The short-term preservation of cognitive function in elderly patients using the cell saver management strategy did not translate into a long-term benefit one year after CABG surgery. The presence of progressing cerebrovascular disease may be responsible for the long-term cognitive decline. (ClinicalTrials.gov number, NCT00193999). PMID: 22290354 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

Long-term survival of patients with ischemic cardiomyopathy treated by coronary artery bypass grafting versus medical therapy.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:20:40 +0100

CONCLUSIONS: Among a propensity-matched, risk-adjusted, observational cohort of patients with coronary artery disease, left ventricular ejection fraction less than 0.35, and no left main disease of greater than 50%, CABG is associated with a survival advantage over MED through 10 years of follow-up. PMID: 22269720 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

Impact of preoperative Angiotensin-converting enzyme inhibitor use on clinical outcomes after cardiac surgery.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:20:13 +0100

CONCLUSIONS: We found no association between preoperative ACEi therapy and adverse in-hospital outcomes or long-term survival after CABG. Preoperative ACEi therapy appears to be safe in patients undergoing CABG. PMID: 22269723 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

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Fibrin sealant provides superior hemostasis for sternotomy compared with bone wax.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:19:12 +0100

CONCLUSIONS: Direct injection of fibrin sealant into the sternal marrow cavity significantly reduces the amount of postoperative blood loss and offers an attractive new treatment alternative for senior patients undergoing on-pump CABG. PMID: 22269729 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

Angioplasty with autologous pericardium for bilateral coronary ostial stenosis in takayasu disease.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:19:03 +0100

This report describes successful patch angioplasty using glutaraldehyde-treated autologous pericardium of bilateral coronary ostial stenosis owing to Takayasu disease. PMID: 22269730 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

A novel cardiac positioning device for left main coronary artery stenosis.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:15:56 +0100

We describe here a safe and effective method to reduce the incidence of hemodynamic changes during beating heart surgery in patients with LMCA stenosis. PMID: 22269749 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

SYNTAX, FAME trials influence update to PCI/CABG appropriate-use criteria

theHeart.org — Mon, 30 Jan 2012 22:35:39 +0100

The document somewhat expands the appropriateness of PCI in some patients with left main coronary disease, among other indications. (Source: theHeart.org)

Better Survival for CABG vs PCI in Some High-Risk PatientsBetter Survival for CABG vs PCI in Some High-Risk Patients

Medscape Today Headlines — Mon, 30 Jan 2012 22:30:04 +0100

The ASCERT study, a unique collaboration between the CMS, ACC, and STS, compares survival rates with bypass surgery and PCI in over 190,000 patients. Heartwire (Source: Medscape Today Headlines)

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Appropriate Use Criteria for Revascularization Updated

Forbes.com Healthcare News — Mon, 30 Jan 2012 21:11:51 +0100

The ACC, AHA, and other organizations have released updated appropriate use criterial for coronary revascularization. The 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update incorporates data from the SYNTAX trial on the indications for PCI and CABG in patients with symptomatic, multivessel disease, as well as data from the CathPCI registry. (Source: Forbes.com Healthcare News)

Very Large Observational Study Finds Significant Mortality Advantage for CABG Over PCI in High Risk Patients

Forbes.com Healthcare News — Mon, 30 Jan 2012 19:18:03 +0100

Although PCI has a small, early mortality benefit compared to CABG in high risk patients, after the first year a striking survival advantage for CABG develops, according to results of the ASCERT study, presented on Monday at the annual meeting of the Society of Thoracic Surgeons (STS) meeting. (Source: Forbes.com Healthcare News)

ASCERT: Better survival for CABG vs PCI in some high-risk patients

theHeart.org — Mon, 30 Jan 2012 19:00:00 +0100

The ASCERT study, a unique collaboration between the CMS, ACC, and STS, compares survival rates with bypass surgery and PCI in over 190 000 patients. (Source: theHeart.org)

POAF linked to increased risk for death following CABG

MedWire News - Lipidology — Mon, 30 Jan 2012 00:00:00 +0100

Patients who undergo coronary artery bypass graft surgery have an increased risk for death if they experience postoperative atrial fibrillation, suggest study findings that also showstatin therapy improved survival in this group of patients. (Source: MedWire News - Lipidology)

Asymptomatic Carotid Artery Stenosis and Cognitive Outcomes After Coronary Artery Bypass Grafting

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:15 +0100

Asymptomatic > than 50% carotid stenosis is a risk factor for cognitive decline following coronary artery bypass grafting (CABG). Patients anticipate CABG will improve their quality of life (Koch CG et al. Semin Cardiothorac Vasc Anesth 2008;12:203-17). Preservation and improvement of psycho- emotional well enhances quality of life. Neuropsychological disorders are being more frequently addressed in the care of the postoperative patient. Cerebrovascular disease and coronary artery disease potentionally put patients at risk for cognitive decline. In this paper the authors correlate asymptomatic carotid stenosis with cognitive decline following coronary artery bypass grafting (CABG). They sought to detect the incidence of cognitive decline following CABG, identify risk factors associated wi...

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A First For Ontario: Cardiac Stem Cell Transplant Performed At The Peter Munk Cardiac Centre

Health News from Medical News Today — Fri, 27 Jan 2012 10:00:00 +0100

Heart failure is a leading cause of death in Canada. As part of the ongoing IMPACT-CABG clinical trial to treat advanced heart failure, physicians at the Peter Munk Cardiac Centre performed the first cardiac stem cell transplant in Ontario last week using stem cells derived from the patient's own bone marrow, isolated completely within the operating room, and implanted into the heart at the time of coronary bypass surgery. Researchers hope that stem cell therapy may be developed into a novel treatment for the 50,000 Canadians diagnosed each year with advanced heart failure... (Source: Health News from Medical News Today)

Nitric oxide and the CABG patient.

Current Opinion in Pharmacology — Fri, 27 Jan 2012 05:00:00 +0100

Authors: Suvorava T, Dao VT, Bas M, Kojda G Abstract The post surgery success of coronary artery bypass grafting (CABG) is counteracted by thrombosis and de-endothelialization, intimal hyperplasia and, over the long term, atherosclerosis. There are many reasons to assume that in CABG patients vascular bioavailability of NO generated by the endothelium plays an important role for graft function. This holds true for factors such as graft type, harvesting and storage, the type of surgery, non-pharmacologic prevention of risk factors, for example, regular physical activity (if feasible), and drug therapy. Although the precise role of graft endothelial NO bioavailability for graft patency and clinical endpoints is still uncertain, current data rather speak in favor of NO indicating that...

Ontario's first cardiac stem cell transplant performed last week at the Peter Munk Cardiac Centre

EurekAlert! - Medicine and Health — Thu, 26 Jan 2012 05:00:00 +0100

(University Health Network) Peter Munk Cardiac Centre physicians performed the first cardiac stem cell transplant in Ontario, part of the IMPACT-CABG clinical trial, to treat advanced heart failure, using stem cells derived from the patient's bone marrow, isolated within the operating room, and implanted into the heart at the time of coronary bypass surgery. Researchers hope that stem cell therapy may be developed into a novel treatment for the 50,000 Canadians diagnosed each year with advanced heart failure. (Source: EurekAlert! - Medicine and Health)

Management of Extensive Intracardiac Thombosis in a Patient with Polycythemia Vera Undergoing Coronary Artery Bypass Grafting

Journal of Cardiac Surgery — Thu, 26 Jan 2012 05:00:00 +0100

In this report, we describe a PV patient who suddenly developed extensive thrombosis within all four cardiac chambers and severe ventricular dysfunction during a coronary artery bypass procedure. We also detail the intraoperative salvage maneuvers implemented in this case, which included deep hypothermic circulatory arrest with retrocerebral perfusion and four chamber thrombectomy. (J Card Surg 2012;**:1–3) (Source: Journal of Cardiac Surgery)

Postoperative neurological complications and risk factors for pre-existing silent brain infarction in elderly patients undergoing coronary artery bypass grafting.

Atherosclerosis — Thu, 26 Jan 2012 05:00:00 +0100

CONCLUSION: Patients with SBI were ranked at moderate risk of neurological complications after CABG between control and BI. Increased age, renal dysfunction, and preoperative cognitive impairment appeared to be strongly associated with SBI. PMID: 22278375 [PubMed - as supplied by publisher] (Source: Atherosclerosis)

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CAD and Aortic Stenosis in the TAVR Era: Old Questions, New Paradigms. The Evolving Role of PCI in the Treatment of Patients with Aortic Stenosis.

Circulation — Thu, 26 Jan 2012 05:00:00 +0100

Authors: Kodali SK, Moses JW Abstract Significant coronary artery disease (CAD) is present in up to 50% of patients with symptomatic aortic stenosis (AS). The standard treatment has been coronary artery bypass grafting at the time of surgical aortic valve replacement (AVR). While numerous databases have shown that the addition of bypass grafting to an AVR nearly doubles the mortality, surgical series have shown that leaving significant coronary stenosis untreated increases AVR mortality(1-4). Thus the standard of care for this population has been concomitant coronary artery bypass grafting along with surgical aortic valve replacement. (SELECT FULL TEXT TO CONTINUE). PMID: 22282328 [PubMed - as supplied by publisher] (Source: Circulation)

Survival of patients with well-developed collaterals undergoing CABG or medical treatment: An observational case-controlled study.

Anadolu Kardiyol Der... — Thu, 26 Jan 2012 05:00:00 +0100

CONCLUSION: There was no significant difference regarding the survival rates in patients with well-developed coronary collaterals proceeding with CABG or medical treatment. PMID: 22281787 [PubMed - as supplied by publisher] (Source: Anadolu Kardiyol Der...)

Postoperative neurological complications and risk factors for pre-existing silent brain infarction in elderly patients undergoing coronary artery bypass grafting

Journal of Anesthesia — Wed, 25 Jan 2012 18:13:52 +0100

Conclusion Patients with SBI were ranked at moderate risk of neurological complications after CABG between control and BI. Increased age, renal dysfunction, and preoperative cognitive impairment appeared to be strongly associated with SBI. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00540-012-1327-4Authors Asuka Ito, Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011 JapanTomoko Goto, Department of Anesthesiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Kumamoto, 862-0965 JapanKengo Maekawa, Department of Anesthesiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Kumamoto, 862-0965 JapanTomoko Baba, Department of Anesthesiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Kumamot...

First-in-man study of paclitaxel-eluting stent BiOSS (Bifurcation Optimisation Stent System) dedicated for coronary bifurcation stenoses: three months results.

Kardiologia Polska — Wed, 25 Jan 2012 06:54:02 +0100

Conclusions: The BiOSS bifurcation dedicated stent is a feasible device, with promising safety and short-term clinical effectiveness/ profile. Kardiol Pol 2012; 70, 1: 45-52. PMID: 22267425 [PubMed - in process] (Source: Kardiologia Polska)

Inadequate Reporting of Concomitant Drug Treatment in Cardiovascular Interventional Head‐to‐Head Trials

Clinical Cardiology — Wed, 25 Jan 2012 05:00:00 +0100

Conclusions:Poor reporting of medical treatment at discharge might reflect an underestimation of secondary prevention in patients undergoing cardiac surgery or interventional procedures in head‐to‐head interventional trials. Thus, discussion of optimal revascularization procedure has to remain open, even in terms of concomitant medical treatment of patients.Additional Supporting Information may be found in the online version of this article.The authors have no funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)

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Statins Reduce Short‐ and Long‐Term Mortality Associated With Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: Impact of Postoperative Atrial Fibrillation and Statin Therapy on Survival

Clinical Cardiology — Wed, 25 Jan 2012 05:00:00 +0100

Conclusions:POAF is an independent predictor of both short‐ and long‐term mortality following CABG. Moreover, statin therapy was independently associated with better survival in patients with POAF.Dr. Pibarot holds the Canada Research Chair in Valvular Heart Diseases, Canadian Institutes of Health Research. Dr. Mathieu is a research scholar from the Fonds de Recherches en Santé du Québec, Montreal, Canada. Dr. Després has served as a speaker for Abbott Laboratories, AstraZeneca, Solvay Pharma, GlaxoSmithKline, and Pfizer Canada Inc.; has received research funding from Eli Lilly Canada; and has served on the advisory boards of Novartis, Theratechnologies, Torrent Pharmaceuticals Ltd., and Sanofi‐Aventis. The authors have no other funding, financial relationships, or conflicts of in...

Impact of off-pump to on-pump conversion rate on post-operative results in patients undergoing off-pump coronary artery bypass

Interactive CardioVascular and Thoracic Surgery — Wed, 25 Jan 2012 05:00:00 +0100

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: In patients undergoing off-pump coronary artery bypass (OPCAB) surgery, does the off-pump to on-pump conversion rate have an impact on post-operative results? Altogether more than 420 papers were found using the reported search, of which 14 randomized controlled trials (RCTs) represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated and ordered according to the sample size. In the 14 RCTs reviewed, the off-pump to on-pump conversion rate incidence ranged from 0 to 13.3%. The most frequent causes of conversion were haemodyn...

Drug-eluting stent implantation for coronary artery disease: current stents and a comparison with bypass surgery.

Current Opinion in Pharmacology — Wed, 25 Jan 2012 05:00:00 +0100

Authors: Head SJ, Bogers AJ, Kappetein AP Abstract Percutaneous coronary intervention (PCI) with bare-metal stents (BMS) has been performed increasingly ever since its introduction in the late 1970s. BMS have been replaced by drug-eluting stents (DES), and many interventional cardiologists consider this as a breakthrough therapy that might compete with coronary artery bypass grafting (CABG) as the standard treatment for coronary artery disease. Several DES are currently used and elute different agents. This review described what these agents are and provides an overview regarding the outcomes and associated adverse events. More importantly, this review compares outcomes of PCI with DES to CABG for patients with left anterior descending coronary artery involvement, left main involve...

Pleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graft.

Journal of Cardiothoracic Surgery — Wed, 25 Jan 2012 05:00:00 +0100

Conclusion: Subxyphoid insertion of pleural drain provides similar effects to preserved pleural integrity in pulmonary function, clinical outcomes, and thoracic pain after OPCAB. Therefore, our results support the hypothesis that once pleural cavities are incidentally or purposely opened during LITA dissection, subxyphoid placement of the pleural drain is recommended. (Source: Journal of Cardiothoracic Surgery)

A prospective randomized study of intraoperative thoracic epidural analgesia in off-pump coronary artery bypass surgery

Journal of Anesthesia — Tue, 24 Jan 2012 18:14:08 +0100

Conclusions We conclude that GA plus TEA has no impact on the outcomes of OPCABs, while its use leads to a higher requirement for vasoactive drug use. GA followed by PCTEA facilitates the anesthesia administration, while it does not affect the extubation time and the postoperative analgesic effect. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00540-012-1325-6Authors Yongxin Liang, Department of Anesthesiology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, 266000 People’s Republic of ChinaHaichen Chu, Department of Anesthesiology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, 266000 People’s Republic of ChinaHua Zhen, Department of Anesthesiology, The Affiliated Hospital of Qingdao ...

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Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Breast Cancer Research and Treatment — Tue, 24 Jan 2012 07:35:05 +0100

Conclusion We outline five methods of preserving the IMA for future CABG: (1) lowering the level of DIEP flaps to the fourth- and fifth-intercostals spaces, (2) using the DIEP pedicle as an intermediary for CABG, (3) using IMA perforators to spare the IMA proper, (4) using and end-to-side anastomosis between the DIEP pedicle and IMA and (5) anastomosis of DIEP flaps using retrograde flow from the distal IMA. With careful patient selection, we hypothesize using the IMA for autologous breast reconstruction need not be an absolute contraindication for future CABG. Content Type Journal ArticleCategory Preclinical StudyPages 1-18DOI 10.1007/s10549-011-1948-6Authors Warren M. Rozen, Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, Un...

Management of Combined Severe Carotid and Coronary Artery Disease

Current Cardiology Reports — Tue, 24 Jan 2012 07:21:02 +0100

Abstract Patients with severe carotid and coronary disease—especially if they require coronary artery bypass grafting (CABG)—are at high risk of cardiac events and stroke. Carotid revascularization should be considered for patients with symptomatic carotid disease and bilateral severe asymptomatic carotid stenosis. In patients with unilateral asymptomatic carotid stenosis, decision to proceed to revascularization should be based more on a perspective of long-term stroke prevention than of perioperative stroke reduction. Compared with endarterectomy, carotid artery stenting is associated with a lower incidence of periprocedural myocardial infarction, an event linked to long-term mortality. This observation may be particularly relevant for patients with advanced coronary...

Long-Term Survival of Patients With Ischemic Cardiomyopathy Treated by Coronary Artery Bypass Grafting Versus Medical Therapy [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions Among a propensity-matched, risk-adjusted, observational cohort of patients with coronary artery disease, left ventricular ejection fraction less than 0.35, and no left main disease of greater than 50%, CABG is associated with a survival advantage over MED through 10 years of follow-up. (Source: The Annals of Thoracic Surgery)

Metabolic Syndrome Affects Midterm Outcome After Coronary Artery Bypass Grafting [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions The main finding of our study was the association between MetS and mortality both early and late after coronary artery bypass grafting. Thus, MetS should be recognized as an independent preoperative variable that can lead to the identification of high-risk patients and as a risk factor to correct with lifestyle modifications and pharmacologic therapy. (Source: The Annals of Thoracic Surgery)

Refractory Spasm of Coronary Arteries and Grafted Conduits After Isolated Coronary Artery Bypass Surgery [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions Diffuse RVS after CABG is a rare but lethal condition. Our experience, although limited, indicates that in such cases an aggressive treatment, that is, prompt extracorporeal membrane oxygenation institution and controlled cardiocirculatory assistance, represents the preferred solution to face such a dramatic event and may save patient lives. (Source: The Annals of Thoracic Surgery)

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High-Pressure Distention of the Saphenous Vein During Preparation Results in Increased Markers of Inflammation: A Potential Mechanism for Graft Failure [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions These studies demonstrate that markers of inflammation are upregulated in response to SV distention. The data suggest that the pressure used in graft preparation procedures should be regulated to avoid inflammation and its potential to induce graft failure. (Source: The Annals of Thoracic Surgery)

Impact of Preoperative Angiotensin-Converting Enzyme Inhibitor Use on Clinical Outcomes After Cardiac Surgery [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions We found no association between preoperative ACEi therapy and adverse in-hospital outcomes or long-term survival after CABG. Preoperative ACEi therapy appears to be safe in patients undergoing CABG. (Source: The Annals of Thoracic Surgery)

Clinical Outcomes in Patients With Prolonged Intensive Care Unit Length of Stay After Cardiac Surgical Procedures [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions Patients with prICULOS after cardiac operations have worse overall outcomes. These data may be used to inform these patients and their families of realistic expectations regarding their clinical course. (Source: The Annals of Thoracic Surgery)

Fibrin Sealant Provides Superior Hemostasis for Sternotomy Compared With Bone Wax [NEW TECHNOLOGY]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions Direct injection of fibrin sealant into the sternal marrow cavity significantly reduces the amount of postoperative blood loss and offers an attractive new treatment alternative for senior patients undergoing on-pump CABG. (Source: The Annals of Thoracic Surgery)

Angioplasty With Autologous Pericardium for Bilateral Coronary Ostial Stenosis in Takayasu Disease [CASE REPORTS]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

This report describes successful patch angioplasty using glutaraldehyde-treated autologous pericardium of bilateral coronary ostial stenosis owing to Takayasu disease. (Source: The Annals of Thoracic Surgery)

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A Novel Cardiac Positioning Device for Left Main Coronary Artery Stenosis [HOW TO DO IT]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

We describe here a safe and effective method to reduce the incidence of hemodynamic changes during beating heart surgery in patients with LMCA stenosis. (Source: The Annals of Thoracic Surgery)

Overuse of Health Care Services in the United States: An Understudied Problem [Special Article]

Archives of Internal Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Conclusions The robust evidence about overuse in the United States is limited to a few services. Reducing inappropriate care in the US health care system likely requires a more substantial investment in overuse research. (Source: Archives of Internal Medicine)

“Choke” vessels between vascular territories of the abdominal wall: Literature review and rare case of Leriche's syndrome

Clinical Anatomy — Mon, 23 Jan 2012 05:00:00 +0100

AbstractWe undertook a review of the anatomical changes of “choke” vessels between the internal thoracic artery (ITA) and deep inferior epigastric artery (DIEA), as highlighted by a case of aortoiliac occlusive disease (Leriche's syndrome), and discuss the physiological concepts observed with regard to surgical delay procedures within the abdominal wall performed prior to abdominal cutaneous free flaps and coronary artery bypass grafting. Computed tomographic angiography (CTA) was undertaken on a patient with a rare case of Leriche's syndrome and a literature review of over 200 references on the anatomy, physiology and clinical uses of choke vessels in the abdominal wall was undertaken. The CTA demonstrated that in patients with Leriche's syndrome, there is a marked dilatation of all I...

Heart Rate Variability Response to Standing in Men and Women Receiving D,L-Sotalol Following Coronary Artery Bypass Graft Surgery

Biological Research For Nursing — Mon, 23 Jan 2012 05:00:00 +0100

In this study, the HRV response to standing 4 days following CABG surgery in men and women prescribed d,l-sotalol was measured to examine the influence of d,l-sotalol on previously reported HRV responses, taking age and gender into consideration. Participants included 28 men and 10 women who completed testing in supine and standing postures; all had received low-dose d,l-sotalol daily since the first postoperative day. Data included continuous electrocardiograph recording of R-R interval for 10 min in each posture. Participants showed significant effects of standing on the autonomic modulation of HR, as seen by a decrease in parasympathetic indices and R-R interval and an increase in BP. In men, standing decreased parasympathetic modulation and increased the sympathetic nervous system indi...

Cangrelor helps maintain platelet inhibition before CABG

MedWire News - Cardiology — Mon, 23 Jan 2012 00:00:00 +0100

Cangrelor leads to an increased rate of platelet inhibition maintenance among patients who discontinue thienopyridine therapy before cardiac surgery, say researchers. (Source: MedWire News - Cardiology)

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NEJM: More targeted CABG strategies needed to minimize stroke, cognitive decline

Cardiovascular Business News — Fri, 20 Jan 2012 12:39:52 +0100

Targeted strategies based on screening risk factors for stroke and cognitive decline in patients referred for coronary artery bypass graft (CABG) surgery may help reduce adverse neurologic outcomes, authors of a review article in the Jan. 19 issue of the New England Journal of Medicine proposed. But to date, such procedures are not a standard of care. (Source: Cardiovascular Business News)

Indocyanine Green Angiography for Intra-operative Assessment in Vascular Surgery.

PubMed: Eur J Vasc Endovasc ... — Fri, 20 Jan 2012 05:00:00 +0100

CONCLUSION: HEMS angiography can accurately assess peripheral arterial perfusion in surgical cases with ASO and AAA. PMID: 22264591 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Trends in isolated coronary artery bypass grafting: An analysis of the Society of Thoracic Surgeons adult cardiac surgery database

The Journal of Thoracic and Cardiovascular Surgery — Thu, 19 Jan 2012 09:10:16 +0100

Conclusions: Over the past decade, the risk profile of patients undergoing CABG has changed, with fewer smokers, more diabetic patients, and better medical therapy characterizing patients referred for surgical coronary revascularization. The left internal thoracic artery is nearly universally used and outcomes have improved substantially, with a significant decline in postoperative mortality and morbidity. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Discussion

The Journal of Thoracic and Cardiovascular Surgery — Thu, 19 Jan 2012 09:10:16 +0100

Dr T. Bruce Ferguson (Greenville, NC). This nice analysis of major patient risk factor observational processes and outcomes compared between 2000 and 2009 (>1.4 million patients) is an excellent update. They did a nice job of handling different versions of the STS database data in their trends over time analysis. The study clearly documented continued improvement in CABG outcomes, particularly in the CABG PCI era of the last decade. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Surgical approaches to left ventricular reconstruction: a matter of perspective

Heart Failure Reviews — Thu, 19 Jan 2012 06:54:51 +0100

Abstract Surgical reconstruction of physiological shape and size of a postischemically remodeled left ventricle has been advocated to improve ventricular function and improve patient long-term outcome. What initially started as linear aneurysm resection surgery developed over the years into the endoventricular repair techniques (surgical ventricular reconstruction, SVR) that have also been applied in patients with postischemically dilated ventricles and mainly anterior akinesia. SVR improved function as measured by the ejection fraction. Whether it affects survival was finally tested in the largest surgical trial ever conducted, the STICH trial (Surgical Treatment for IsChemic Heart failure). The trial, however, presented rather sobering information with its Hypothesis 2 o...

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Non-HDL cholesterol predicts long-term cardiac risk in CHD patients

MedWire News - Lipidology — Thu, 19 Jan 2012 00:00:00 +0100

Baseline levels of non-high-density lipoprotein cholesterol may be useful for predicting long-term cardiac death in patients with coronary heart disease after coronary artery bypass graft surgery, say Japanese researchers. (Source: MedWire News - Lipidology)

Cognitive and Neurologic Outcomes after Coronary-Artery Bypass Surgery

New England Journal of Medicine — Wed, 18 Jan 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 3, Page 250-257, January 2012. (Source: New England Journal of Medicine)

Novel Antiplatelet Bridges Patients to CABG (CME/CE, with video)

MedPage Today Cardiovascular — Wed, 18 Jan 2012 15:00:00 +0100

(MedPage Today) -- The investigational antiplatelet drug cangrelor maintains low levels of platelet reactivity in patients who must discontinue thienopyridine therapy before undergoing CABG, a randomized trial showed. (Source: MedPage Today Cardiovascular)

Comparison of human cardiac gene expression profiles in paired samples of right atrium and left ventricle collected in vivo

Physiological Genomics — Wed, 18 Jan 2012 05:00:00 +0100

In conclusion, our results suggest that biopsies from the auricula of the right atrium may be suitable for various genetic studies, but not studies directly related to muscle work. (Source: Physiological Genomics)

Anomalous right coronary artery from the left sinus: a minimally invasive approach [CONGENITAL]

European Journal of Cardio-Thoracic Surgery — Wed, 18 Jan 2012 05:00:00 +0100

CONCLUSIONS ARCA can be managed with good early and midterm results using a minimally invasive right thoracotomy approach. (Source: European Journal of Cardio-Thoracic Surgery)

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Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis [ADULT CARDIAC]

European Journal of Cardio-Thoracic Surgery — Wed, 18 Jan 2012 05:00:00 +0100

Coronary artery bypass surgery can offer excellent results when performed with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). The debate as to which technique is superior remains unanswered. Intra-operative conversion from off- to on-pump coronary surgery is a relatively unexplored phenomenon, which cannot be assessed within randomised controlled trial design. We aimed to assess the effect of off-pump conversion on patient mortality. Medline, Embase, Cochrane and Google Scholar databases were systematically reviewed for studies published between 1980 and 2010 that compared the incidence of mortality between converted and non-converted off-pump patients. Publication bias and heterogeneity were assessed and data were extracted independently by multiple observe...

Risk factors of depressive and anxiety symptoms 8 years after coronary artery bypass grafting [ADULT CARDIAC]

European Journal of Cardio-Thoracic Surgery — Wed, 18 Jan 2012 05:00:00 +0100

CONCLUSIONS Depressive and anxiety symptoms occurred in many cardiosurgical patients before and after CABG. Good results of the surgical procedure did not cause reduction of depressive symptoms. Anxiety symptoms were much more common perioperatively than depressive ones and decreased significantly after surgery. Preoperative assessment of depressive and anxiety symptoms can indicate the risk group and suggest care proceedings during the rehabilitation period to improve the effectiveness of surgical coronary revascularization. (Source: European Journal of Cardio-Thoracic Surgery)

The 2010 ESC/EACTS guidelines on myocardial revascularization does not present suggestions about disease-free saphenous vein grafts at the time of redo coronary artery bypass grafting [LETTERS TO THE EDITOR]

European Journal of Cardio-Thoracic Surgery — Wed, 18 Jan 2012 05:00:00 +0100

(Source: European Journal of Cardio-Thoracic Surgery)

Drug Found To Help Lower Clotting Risk Prior To Cardiac Surgery

Forbes.com Healthcare News — Tue, 17 Jan 2012 21:00:52 +0100

As a potent and reversible platelet inhibitor, cangrelor has been proposed for use in a bridging strategy for patients scheduled for surgery who are currently taking clopidogrel or another thienopyridine. To test this strategy, the BRIDGE investigators randomized 210 ACS or stent patients awaiting CABG and taking a thienopyridine to receive either cangrelor or placebo for at least 48 hours prior to surgery. The results have now been published in JAMA. (Source: Forbes.com Healthcare News)

A patient with possible TRALI who developed pulmonary hypertensive crisis and acute pulmonary edema during cardiac surgery

Journal of Anesthesia — Tue, 17 Jan 2012 07:10:54 +0100

Abstract There are very few case reports of transfusion-related acute lung injury (TRALI) under close hemodynamic monitoring. We encountered a case of possible TRALI during on-pump coronary artery bypass grafting (CABG). A 66-year-old man who had undergone on-pump CABG was administered fresh frozen plasma (FFP). One hour after FFP transfusion, pulmonary hypertensive crisis and subsequent hypoxic decompensation occurred. A second cardiopulmonary bypass (CPB) was needed for circulatory and respiratory deterioration. Extracorporeal life support (ECLS), intraaortic balloon pumping (IABP), and nitric oxide therapy were required after the surgery. Despite the severity of the initial state, his recovery was comparatively smooth. ECLS and IABP were removed on postoperative day (PO...

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Bridging Antiplatelet Therapy With Cangrelor in Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial [Original Contribution]

JAMA — Tue, 17 Jan 2012 05:00:00 +0100

Conclusions Among patients who discontinue thienopyridine therapy prior to cardiac surgery, the use of cangrelor compared with placebo resulted in a higher rate of maintenance of platelet inhibition. Trial Registration clinicaltrials.gov Identifier: NCT00767507 (Source: JAMA)

Cost analysis of re-exploration for bleeding after coronary artery bypass graft surgery

British Journal of Anaesthesia — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions The resource utilization costs were substantially higher in patients requiring re-exploration for bleeding. From a strict cost-effectiveness perspective, clinical interventions to prevent haemorrhage might be underutilized. (Source: British Journal of Anaesthesia)

Safety and Feasibility of Transradial Approach for Coronary Bypass Graft Angiography and Intervention

Angiology — Mon, 16 Jan 2012 05:00:00 +0100

The transradial approach (TRA) is commonly applied for coronary catheterization. However, there are few reports on the safety and feasibility of transradial catheterization in patients with prior coronary artery bypass graft (CABG) surgery. We retrospectively evaluated 124 consecutive patients who underwent graft angiography and intervention via the transradial (TRA group, n = 68) or transfemoral approach (TFA group, n = 56). The baseline clinical characteristics between the 2 groups were similar except for prior myocardial infarction. No significant difference (P > .05)was observed in procedure time, the success rate of puncture, angiography, and intervention procedure between the 2 groups. There was no significant difference in major adverse cardiac and cerebrovascular events during h...

Prevalence, Predictors, and Outcomes of Conservative Medical Management in Non-ST-Segment Elevation Acute Coronary Syndromes in Gulf RACE-2

Angiology — Mon, 16 Jan 2012 05:00:00 +0100

We assessed the prevalence, predictors, and in-hospital and long-term outcomes of conservative medical management for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) compared with percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG). This prospective study conducted from October 2008 to June 2009 in 65 hospitals from 6 Arabian Gulf countries included 30-day and 1-year mortality follow-up for 3661 patients. Compared with conservative management group (2859 patients; 78.1%), the PCI group (638; 17.4%) had significantly better unadjusted and adjusted in-hospital (odds ratio [OR]: 0.40, 95% confidence interval [CI]: 0.17-0.97), 30-day (OR: 0.44, 95% CI: 0.24-0.76) and 1-year (OR: 0.58, 95% CI: 0.40-0.87) mortality rates. Comparison w...

The Sirolimus-Eluting Cypher Select Coronary Stent for the Treatment of Bare-Metal and Drug-Eluting Stent Restenosis: Insights From the e-SELECT (Multicenter Post-Market Surveillance) Registry

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions Use of SES for either BMS or DES ISR treatment is safe and associated with low target lesion revascularization recurrence and no apparent safety concern. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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Changes in Coronary Microvascular Reactivity After Cardioplegic Arrest in Patients With Uncontrolled Versus Controlled Diabetes

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:23 +0100

Introduction: We investigated the effects of cardioplegic arrest and reperfusion (CP-Rep) on coronary arteriolar responses to endothelium-dependent and -independent vasodilators in controlled, uncontrolled, and non-diabetic patients. Methods: Human right atrial tissue was harvested pre- and post-CPB/CP-Rep from non-diabetic (ND) patients (n = 12, HbA1C = 5.3 ± 0.2), controlled diabetic patients (n = 12, HbA1C = 6.1 ± 0.15) and uncontrolled diabetic patients (n = 8, HbA1C = 8.3± 0.3) undergoing coronary artery bypass grafting. Coronary arterioles (90-160 μm in diameter) were dissected from the harvested tissues for in-vitro microvesel study. In-vitro relaxation responses of pre-contracted coronary arterioles were examined in the presence of the endothelium-dependent vasodilators adenosi...

Quality Measures for Assessing Hospital Mortality: Evaluation Using Instrumental Variable Analysis

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:01 +0100

Conclusions: Composite measures forecast large differences in hospital mortality with surgery. Based on instrumental variable analysis, these differences in mortality are not due to unmeasured hospital differences in patient severity of illness, indicating that composite measures can be useful quality indicators for public reporting and pay-for-performance. (Source: Journal of Surgical Research)

The Impact of Glycoprotein IIB/IIIA Antiplatelet Infusion on the Choice of Revascularization Conduits in Patients Undergoing Coronary Artery Bypass Grafting

Journal of Surgical Research — Sat, 14 Jan 2012 22:28:53 +0100

(Source: Journal of Surgical Research)

[Department of Error] Department of Error

LANCET — Sat, 14 Jan 2012 05:00:00 +0100

Mehilli J, Pache J, Abdel-Wahab M, et al, for the Is Drug-Eluting-Stenting Associated with Improved Results in Coronary Artery Bypass Grafts? (ISAR-CABG) Investigators. Drug-eluting versus bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised controlled superiority trial. Lancet 2011;378: 1071–78—In table 1 of this Article (Sept 17), the mean age of the drug-eluting stent group should have been 71·4 (9·0) years. This correction has been made to the online version as of Jan 13. (Source: LANCET)

Regenerative Therapies for Improving Myocardial Perfusion in Patients with Cardiovascular Disease: Failure to Meet Expectations but Optimism for the Future.

Current Vascular Pharmacology — Fri, 13 Jan 2012 05:00:00 +0100

Authors: Sellke FW, Lassaletta AD, Robich MP, Chu LM, Ruel M Abstract Cardiovascular disease continues to be a major cause of death in the Western world and has been extending into areas previously seemingly immune to its effects. Catheter-based interventions and coronary artery bypass surgery have markedly improved cardiovascular health, but a number of patients with coronary artery disease cannot undergo repeated interventions or they receive an incomplete revascularization with standard revascularization methods, which has been associated with a poor clinical outcome. Despite early demonstration of improvement in myocardial perfusion and function with growth factor, gene therapy or cellular therapies, clinical studies have found little if any real benefit. The discordance betwee...

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Intramyocardial hematoma with epicardial rupture following percutaneous coronary intervention

Journal of Clinical Ultrasound — Thu, 12 Jan 2012 05:00:00 +0100

We describe here the case of 63‐year‐old man in whom an intramyocardial hematoma with epicardial rupture occurred after PCI. The patient was treated conservatively with a successful outcome. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012. (Source: Journal of Clinical Ultrasound)

Cardiac displacement during off-pump coronary artery bypass grafting surgery: effect on sublingual microcirculation and cerebral oxygenation

Interactive CardioVascular and Thoracic Surgery — Thu, 12 Jan 2012 05:00:00 +0100

Cardiac displacement during off-pump coronary artery bypass (OPCAB) surgery causes a fall in cardiac output. Here, we investigate how this drop in systemic perfusion is transferred to the oxygenation of sublingual and cerebral tissue. Sublingual microcirculatory perfusion or microcirculatory hemoglobin oxygen saturation (μHbSO2) measurements were performed using sidestream dark-field imaging and reflectance spectrophotometry, respectively (both n=12). The cerebral tissue oxygenation index was measured by near-infrared spectrophotometry (n=12). Cardiac output was calculated by pulse contour analysis of arterial pressure. Cardiac displacement reduced the cardiac output from 4.3±0.8 to 1.2±0.3 l/min (P<0.05), paralleled by a decrease in μHbSO2 from 64.2±9.1 ...

eComment: Cardiac displacement during off-pump coronary artery bypass grafting surgery: how much displacement is too much?

Interactive CardioVascular and Thoracic Surgery — Thu, 12 Jan 2012 05:00:00 +0100

(Source: Interactive CardioVascular and Thoracic Surgery)

Systemic levels of endothelin correlate with systemic inflammation and not with myocardial injury or left ventricular ejection fraction in patients undergoing percutaneous coronary intervention and on-pump coronary artery bypass grafting

Interactive CardioVascular and Thoracic Surgery — Thu, 12 Jan 2012 05:00:00 +0100

Endothelin (ET-1) is a potent vasoconstrictor. We compared patterns of ET-1 in percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and correlated it with markers of inflammation. Patients with multivessel disease were enrolled in a prospective randomized study of PCI vs. on-pump CABG. Procedural myocardial injury was assessed biochemically (CK-MB) and with new late gadolinium enhancement (LGE) on magnetic resonance imaging (MRI) one week postprocedure. ET-1 was measured at baseline, 1 h, 6 h, 12 h, 24 h and one week postprocedure. Log ET-1 values were compared between PCI and CABG and between patients without significant myocardial injury. Measurement of ET-1 values was performed in 36 PCI and 31 CABG patients. Baseline ET-1 values were si...

eComment: Preserved consciousness in general anesthesia for combined carotid and coronary artery bypass grafting surgery

Interactive CardioVascular and Thoracic Surgery — Thu, 12 Jan 2012 05:00:00 +0100

(Source: Interactive CardioVascular and Thoracic Surgery)

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Characteristics, management and outcomes of patients with acute coronary syndrome and prior coronary artery bypass surgery: findings from the second Gulf Registry of Acute Coronary Events{star}

Interactive CardioVascular and Thoracic Surgery — Thu, 12 Jan 2012 05:00:00 +0100

Conclusions: ACS patients from Middle East countries with prior CABG have adverse baseline characteristics, reported higher GRACE risk score, multivessel disease, more severe LV dysfunction, cardiogenic shock, in-hospital major bleeding, but with less incidence of STEMI with less prominent surge of cardiac biomarkers. However, there was no significant difference in mortality during hospitalization, at 30 days and at one year between ACS patients with and without prior CABG. The reasons for this 'risk-mortality' paradox need to be further evaluated. (Source: Interactive CardioVascular and Thoracic Surgery)

Does a 'no-touch' technique result in better vein patency?

Interactive CardioVascular and Thoracic Surgery — Thu, 12 Jan 2012 05:00:00 +0100

A best evidence topic was written according to a structured protocol. The question addressed was whether harvesting the saphenous vein (SV) as a conduit for coronary artery bypass grafting (CABG) using a no-touch technique would result in better patency rates. This technique involves the harvest of the SV with a pedicle of peri-vascular tissue left intact and the avoidance of distension of the vein prior to anastomosis. A total of 405 papers were found using the reported searches of which eight represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found analysed the ultrastructural and mechanical properties of the endothelium and vessel walls of the two harvesting techn...

Vascular antispastic medication should take priority over other antihypertensives after coronary artery bypass grafting using a radial artery conduit

Interactive CardioVascular and Thoracic Surgery — Thu, 12 Jan 2012 05:00:00 +0100

We report a case of a patient with a radial artery graft who did not receive vasodilators after surgery due to hypotension. The patient developed vasospasm of the radial artery conduit which did not respond to direct injection of vasodilators into the conduit but recovered after taking oral vasodilators for four weeks. (Source: Interactive CardioVascular and Thoracic Surgery)

Percutaneous Coronary Intervention With Drug-Eluting Stent Implantation vs. Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease in Metabolic Syndrome Patients With Acute Myocardial Infarction.

Circulation Journal — Wed, 11 Jan 2012 05:00:00 +0100

Conclusions: PCI-DES had an equivalent 12-month mortality risk to CABG for the treatment of multivessel disease in metabolic syndrome patients with AMI. CABG is more favorable for STEMI patients in terms of MACCE. PMID: 22240598 [PubMed - as supplied by publisher] (Source: Circulation Journal)

Relationship Between Vein Graft Failure and Subsequent Clinical Outcomes Following Coronary Artery Bypass Surgery.

Circulation — Wed, 11 Jan 2012 05:00:00 +0100

CONCLUSIONS: VGF is common after CABG surgery and is associated with repeat revascularization, but not with death and/or MI. Further investigations are needed to evaluate therapies and strategies for decreasing VGF to improve outcomes in patients undergoing CABG surgery. PMID: 22238227 [PubMed - as supplied by publisher] (Source: Circulation)

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Comparative long‐term efficacy and safety of drug‐eluting stent versus coronary artery bypass grafting in ostial left main coronary artery disease

Catheterization and Cardiovascular Interventions — Tue, 10 Jan 2012 05:00:00 +0100

Conclusions: DES implantation for ostial LMCA lesions showed similar 5‐year outcomes of death, major adverse events, and TVR compared with CABG. Although meticulous adjustments decreased baseline difference between the two treatments, the absence of statistical significance could be attributable to the size of the study sample and hidden bias. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

Fistula between right coronary artery vein graft and right atrium as an immediate complication of percutaneous coronary intervention

Catheterization and Cardiovascular Interventions — Tue, 10 Jan 2012 05:00:00 +0100

We report the first case of a fistula between SVG and the right atrium (RA) as an immediate complication after a percutaneous coronary intervention (PCI) in an 86‐year‐old female. She presented with inferior ST‐elevation myocardial infarction (STEMI) and was treated with thrombolytic therapy in a peripheral hospital, which was unsuccessful. PCI to SVG to the right coronary (RCA) was complicated by a fistula to RA. Cardiac magnetic resonance (CMR) confirmed the site of the fistula and also presence of a significant arteriovenous (AV) shunt. Reversal of anticoagulation had no effect on fistula closure. Therefore, a covered stent was deployed for closure of the fistula to avoid long‐term complications of the significant AV shunt. In summary, the diagnosis and appropriate management of...

Increased Preoperative C-Reactive Protein Levels Are Associated with Inhospital Death After Coronary Artery Bypass Surgery

Inflammation — Mon, 09 Jan 2012 19:40:14 +0100

Abstract Increased C-reactive protein (CRP) is a predictor of cardiovascular risk, but its influence on outcomes after coronary artery bypass grafting surgery (CABG) is still incompletely studied. We studied the association between preoperative CRP and inhospital death after CABG. Patients with acute or chronic infectious or inflammatory disorders, autoimmune diseases, cancer, and prior cardiac surgery were excluded. Seventy-six patients were studied [27.6% with elevated CRP (>3 mg/l)]. Elevated CRP was more frequently found in patients who died than in those who survived (83.3% vs 17.1%, p = 0.003); mean CRP levels were, respectively, 6.5 ± 3.4 vs 2.4 ± 3.5 mg/l (p = 0.03). The hazard ratio of death was 11.7 for elevated CRP, and the ROC curve...

Avoiding the clamp during off-pump coronary artery bypass reduces cerebral embolic events: results of a prospective randomized trial

Interactive CardioVascular and Thoracic Surgery — Mon, 09 Jan 2012 05:00:00 +0100

The purpose of this study was to determine whether a clampless facilitating device (CFD) to perform proximal aortocoronary anastomoses would result in a lower incidence of cerebral embolic events compared with a partial clamping strategy during off-pump coronary artery bypass (OPCAB). After epiaortic ultrasound confirmed the mild aortic disease (Grades I and II), 57 patients were randomly assigned to have proximal anastomoses using a partial-occluding clamp (CL, n = 28) or a CFD [Heartstring (HS), n = 29] (Maquet Cardiovascular LLC, San Jose, CA). Solid and gaseous emboli in the middle cerebral arteries were detected using transcranial Doppler ultrasonography. The mean number of proximal anastomoses was similar between groups 1.93 ± 0.72 (CL) and 1.72&n...

Perioperative serum troponin I levels are associated with higher risk for atrial fibrillation in patients undergoing coronary artery bypass graft surgery

Interactive CardioVascular and Thoracic Surgery — Mon, 09 Jan 2012 05:00:00 +0100

Atrial fibrillation (AF) remains a frequent complication after coronary artery bypass graft surgery (CABG). We evaluate the association of AF occurrence and serum cardiac troponin I (cTnI) levels in the early postoperative period after CABG. Between April 2009 and January 2010, 95 consecutive patients with sinus rhythm who underwent CABG were evaluated. The patients were divided into two groups according to their postoperative rhythms: sinus rhythm group (SR) and AF group (AF). Demographic, clinical variables, and troponin I were evaluated at the pre- and postoperative times. There were no clinical or demographic differences between the two groups. The postoperative troponin I in the SR group was lower than that in the AF group (0.66 ± 1.62 vs. 2.07 ± 5.01...

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The role of myocardial ischaemic preconditioning during beating heart surgery: biological aspect and clinical outcome

Interactive CardioVascular and Thoracic Surgery — Mon, 09 Jan 2012 05:00:00 +0100

Short periods of ischaemia consecutive to reperfusion periods before a sustained ischaemic condition, the so-called ischaemic preconditioning (IP), aim to protect myocardial cells against prolonged ischaemia. IP appears as a considerable endogenous cardioprotective mechanism decreasing the infarct size after total occlusion in either experimental models or humans. Angina periods before an acute coronary syndrome limit the myocardial infarction being protective for the myocardium. Our report aims to review the international bibliography of the IP during off-pump coronary artery bypass grafting. (Source: Interactive CardioVascular and Thoracic Surgery)

Surgical treatment of bilateral coronary-to-pulmonary artery fistulas

Interactive CardioVascular and Thoracic Surgery — Mon, 09 Jan 2012 05:00:00 +0100

Bilateral coronary artery fistulas with the coronary artery stenosis are rare. In this case, we successfully performed closure of coronary artery fistulas with coronary artery bypass grafting. Furthermore, we were able to measure the flow in the coronary artery fistulas using transit-time flow measurement. (Source: Interactive CardioVascular and Thoracic Surgery)

Tapia's syndrome -- a rare complication following cardiac surgery

Interactive CardioVascular and Thoracic Surgery — Mon, 09 Jan 2012 05:00:00 +0100

We describe this rare complication which occurred at our institute. A 49-year old man developed Tapia's syndrome after an uneventful coronary artery bypass surgery. He complained of dysphonia, hoarseness of voice and an inability to swallow soon after extubation. The syndrome resolved completely over the following weeks with no neurological deficit. (Source: Interactive CardioVascular and Thoracic Surgery)

Gender’s impact on outcome in coronary surgery with minimized extracorporeal circulation

Clinical Research in Cardiology — Sun, 08 Jan 2012 06:34:06 +0100

Conclusions Gender-related disparity in outcome still remains present after surgery with minimized extracorporeal circulation. However, female gender per se is not an independent risk factor for in-hospital mortality, but close attention should be paid on modifiable risk factors. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00392-011-0410-4Authors Michael Ried, Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, GermanyDirk Lunz, Department of Anesthesiology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, GermanyReinhard Kobuch, Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee ...

Deep vein thrombosis associated with a single dose of romiplostim in a high-risk patient.

American Journal of Health-System Pharmacy : AJHP — Fri, 06 Jan 2012 20:28:58 +0100

Conclusion A 63-year-old man with a history of cardiovascular disease and prior malignancy developed a DVT after receiving a single dose of romiplostim for the treatment of ITP. PMID: 22215358 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

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Waking up from Coronary Bypass Surgery and One Eye does not Move Right

Neurocritical Care — Thu, 05 Jan 2012 06:52:25 +0100

Conclusion Acute pupil-sparing partial oculomotor nerve palsy should be recognized as a neurological complication of cardiac surgery. Pupillary involvement can be helpful in identifying the underlying etiology. Content Type Journal ArticleCategory NeuroimagePages 1-4DOI 10.1007/s12028-011-9666-9Authors Shamir Haji, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USAManoj K. Mittal, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USAEelco F. Wijdicks, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA Journal Neurocritical CareOnline ISSN 1556-0961Print ISSN 1541-6933 (Source: Neurocritical Care)

Influence of Surgeon Volume on Outcomes With Aortic Valve Replacement.

The Annals of Thoracic Surgery — Thu, 05 Jan 2012 05:00:00 +0100

CONCLUSIONS: Surgeon volumes have a significant influence on operative outcomes in high-risk patients undergoing aortic valve replacement or aortic valve replacement with coronary artery bypass grafting. PMID: 22226491 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)

Left Atrial Expansion Index for Predicting Atrial Fibrillation and In-Hospital Mortality After Coronary Artery Bypass Graft Surgery.

The Annals of Thoracic Surgery — Thu, 05 Jan 2012 05:00:00 +0100

CONCLUSIONS: Left atrial expansion index independently predicts post-CABG AF and in-hospital mortality. PMID: 22226234 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2011

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

There have been rapid advances in oral anticoagulation. The oral factor Xa inhibitors rivaroxaban and apixaban and the oral direct thrombin inhibitor dabigatran recently have been rigorously evaluated. These novel anticoagulants will usher in a new paradigm for perioperative anticoagulation. Perioperative blood conservation in cardiac surgery recently has been highlighted in the updated guidelines by the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. These recommendations reflect a comprehensive evaluation of the recent evidence to optimize transfusion practice. Transcatheter mitral valve repair continues to mature. Transcatheter aortic valve implantation for aortic stenosis has entered the clinical mainstream, with randomized trials showing its superiori...

Advances in the Management of Carotid Artery Disease: Focus on Recent Evidence and Guidelines

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

Recent landmark randomized trials and society guidelines have significantly revised the management of carotid artery disease. Duplex ultrasonography is the recommended initial diagnostic test for the assessment of extracranial carotid artery stenosis. Carotid artery imaging is reasonable in select patients scheduled for coronary artery bypass graft (CABG) surgery. Carotid revascularization can be achieved safely and effectively with carotid endarterectomy or carotid artery stenting. Because each procedure has a different risk/benefit profile, the optimal approach is to match the particular patient to the intervention that maximizes outcome benefit. Carotid revascularization is recommended in patients scheduled for CABG surgery when the carotid artery stenosis is symptomatic and/or bilatera...

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Total Ischemia Time Alters the Longitudinal and Circumferential Shortening of the Right Ventricle in Transplanted Hearts

Seminars in Cardiothoracic and Vascular Anesthesia — Tue, 03 Jan 2012 05:00:00 +0100

Conclusion. Total ischemia time of the transplanted heart may play a role in deterioration of longitudinal and circumferential shortening of the RV. (Source: Seminars in Cardiothoracic and Vascular Anesthesia)

Bilateral Tension Pneumothoraces Leading to Cardiac Arrest after Coronary Artery Bypass Surgery.

The Thoracic and Cardiovascular Surgeon — Tue, 03 Jan 2012 05:00:00 +0100

We present the case of bilateral tension pneumothoraces leading up to cardiorespiratory arrest in a 57-year-old male, weighing 130 kg, who underwent without any complications a coronary artery bypass surgery. Thoracic chest tubes (retrosternal and intrapericardial) and a left pleural tube were removed 24 hours prior to the incident. Diffuse sternal pain sensation accompanied by slow progressive respiratory distress and confusion shortly before the incident were all developed over a period of 12 hours. A prompt cardiopulmonary resuscitation and bilateral chest tube insertion had prevented a fatality in the patient. PMID: 22215502 [PubMed - as supplied by publisher] (Source: The Thoracic and Cardiovascular Surgeon)

Off-pump CABG better than PCI for three-vessel coronary artery disease

Modern Medicine — Tue, 03 Jan 2012 05:00:00 +0100

NEW YORK (Reuters Health) - Long-term outcomes are better for patients with three-vessel coronary artery disease when they undergo off-pump coronary artery bypass grafting rather than percutaneous coronary intervention with a drug-eluting stent (DES), according to the results of a Korean study. (Source: Modern Medicine)

Decreased pre-surgical CD34+/CD144+ cell number in patients undergoing coronary artery bypass grafting compared to coronary artery disease-free valvular patients.

Atherosclerosis — Tue, 03 Jan 2012 05:00:00 +0100

CONCLUSIONS: Pre-surgical CD34+/CD144+ numbers are decreased in CABG patients, compared to valvular patients with absence of coronary disease. PMID: 22214418 [PubMed - as supplied by publisher] (Source: Atherosclerosis)

Bilateral Tension Pneumothoraces Leading to Cardiac Arrest after Coronary Artery Bypass Surgery

The Thoracic and Cardiovascular Surgeon — Tue, 03 Jan 2012 05:00:00 +0100

We present the case of bilateral tension pneumothoraces leading up to cardiorespiratory arrest in a 57-year-old male, weighing 130 kg, who underwent without any complications a coronary artery bypass surgery. Thoracic chest tubes (retrosternal and intrapericardial) and a left pleural tube were removed 24 hours prior to the incident. Diffuse sternal pain sensation accompanied by slow progressive respiratory distress and confusion shortly before the incident were all developed over a period of 12 hours. A prompt cardiopulmonary resuscitation and bilateral chest tube insertion had prevented a fatality in the patient.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents | Abstract | Full text (Source: The Thoracic a...

Preoperative mobilization of bone marrow-derived cells followed by revascularization surgery: early and long-term outcome.

The International Journal of Artificial Organs — Tue, 03 Jan 2012 05:00:00 +0100

Conclusions: Our study suggests that the combination of BMC mobilization and CABG may be safely performed. However, considering the small series, final conclusions about the benefit of this procedure must await a larger prospective study comparing the role of cytokines alone, myocardial perforation, and the combination of both. PMID: 22287202 [PubMed - as supplied by publisher] (Source: The International Journal of Artificial Organs)

No Greater Risk or Mortality Observed for Endoscopic Vein Harvesting for Coronary Bypass Surgery

MedlinePlus Health News — Mon, 02 Jan 2012 13:34:22 +0100

Source: Agency for Healthcare Research and Quality Related MedlinePlus Page: Coronary Artery Bypass Surgery (Source: MedlinePlus Health News)

Current management of left main coronary artery disease

European Heart Journal — Sun, 01 Jan 2012 05:00:00 +0100

Coronary artery bypass surgery is considered as the gold standard treatment of unprotected left main coronary artery (ULMCA) disease. Over the last 20 years, improvement in stent technology and operators experience explained the increased number of reports on the results of percutaneous coronary interventions (PCIs) for the treatment of left main (LM) coronary artery lesion. The recent data comparing efficacy and safety of PCIs using drug-eluting stent and coronary artery bypass surgery showed comparable results in terms of safety and a lower need for repeat revascularization for coronary artery bypass surgery. Patient selection for both techniques is fundamental and directly impacts the clinical outcome. Further randomized trials must be conducted to precise the indications of both techni...

Coronary artery bypass grafting and dengue fever.

Annals of Cardiac Anaesthesia — Sun, 01 Jan 2012 05:00:00 +0100

Authors: Wiwanitkit V PMID: 22234028 [PubMed - in process] (Source: Annals of Cardiac Anaesthesia)

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The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting.

Annals of Cardiac Anaesthesia — Sun, 01 Jan 2012 05:00:00 +0100

This study was designed to study the efficacy of intravenous dexmedetomidine for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation in patients with coronary artery disease. Sixty adult patients scheduled for elective off-pump coronary artery bypass surgery were randomly allocated to receive dexmedetomidine (0.5 mcg/kg) or normal saline 15 min before intubation. Patients were compared for hemodynamic changes (heart rate, arterial blood pressure and pulmonary artery pressure) at baseline, 5 min after drug infusion, before intubation and 1, 3 and 5 min after intubation. The dexmedetomidine group had a better control of hemodynamics during laryngoscopy and endotracheal intubation. Dexmedetomidine at a dose of 0.5 mcg/kg as 10-min infusion was administered prio...

The effects of preemptive pregabalin on attenuation of stress response to endotracheal intubation and opioid- sparing effect in patients undergoing off-pump coronary artery bypass grafting.

Annals of Cardiac Anaesthesia — Sun, 01 Jan 2012 05:00:00 +0100

This study was a comparison between two groups of 30 adult patients scheduled for elective off pump coronary artery bypass surgery. In the control group, the patients were given placebo capsules, and in the pregabalin group, the patients were given pregabalin 150 mg capsule orally 1 h before surgery. The patients were compared for hemodynamic changes before the start of the surgery, after induction, 1, 3, and 5 min after intubation. Additionally, fentanyl requirement during surgery and the first postoperative day was also compared. The present study shows that a single oral dose of 150 mg pregabalin given 1 h before surgery attenuated the pressor response to tracheal intubation in adults, but the drug did not show any effect on perioperative opioid consumption and was devoid of side-effect...

High-intensity track and field training in a cardiac rehabilitation program.

Baylor University Medical Center Proceedings — Sun, 01 Jan 2012 05:00:00 +0100

Authors: Kennedy K, Adams J, Cheng D, Berbarie RF Abstract A 65-year-old male athlete with coronary artery disease enrolled in our cardiac rehabilitation (CR) program after successful coronary artery bypass graft surgery following an acute myocardial infarction. Unlike the typical sedentary cardiac patient in his age group, he loved to participate in hurdle events at masters division track meets (competitions for athletes aged 30 years and older). He expressed a strong desire to return to his sport, so we designed a sport-specific, symptom-limited exercise program that enabled him to train safely but at a higher intensity than is typically allowed in conventional CR programs. Although his measured peak heart rates during the sport-specific sessions were significantly higher than th...

Coronary arteriovenous fistula with giant aneurysm treated with surgical removal and coronary artery bypass grafting.

Texas Heart Institute Journal — Sat, 31 Dec 2011 08:54:03 +0100

Authors: Jung KT, Lee KJ PMID: 22199451 [PubMed - in process] (Source: Texas Heart Institute Journal)

Insufficient Platelet Inhibition Is Related to Silent Embolic Cerebral Infarctions After Coronary Angiography.

Stroke — Thu, 29 Dec 2011 05:00:00 +0100

CONCLUSIONS: Insufficient platelet inhibition after administration of antiplatelet agents is related with SECI appearing after coronary angiography. PMID: 22207508 [PubMed - as supplied by publisher] (Source: Stroke)

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Familial genetic risk factors in premature cardiovascular disease: a family study.

Molecular Biology Reports — Wed, 28 Dec 2011 05:00:00 +0100

In conclusion, it is possible to determine a specific family history in young adults with CVD. From this perspective, the emergence of more serious CVD may be prevented by providing disease-related information to the other family members and implementing preventive measures. PMID: 22203489 [PubMed - as supplied by publisher] (Source: Molecular Biology Reports)

Assessment of platelet function by whole blood impedance aggregometry in coronary artery bypass grafting patients on acetylsalicylic acid treatment may prompt a switch to dual antiplatelet therapy

Heart and Vessels — Tue, 27 Dec 2011 17:03:35 +0100

Abstract Residual platelet reactivity (RPR) following coronary artery bypass grafting (CABG) might be related to thrombotic complications and major ischemic cardiac events. The aim of this study was to evaluate the changes in platelet reactivity monitored pre- and postoperatively using multiple-electrode aggregometry (MEA) and to propose an alternative therapeutic approach in a subgroup of patients with postoperative RPR. Ninety-nine patients undergoing elective CABG were enrolled in the study, of whom 41 (41.4%) were diabetic. Preoperatively, all patients received 100 mg acetylsalicylic acid (ASA), with 47 of 99 (47.4%) patients receiving an additional 75 mg clopidogrel (CLO). The blood samples were drawn the day before surgery, and on the first and 4th postoperative day....

Dabigatran Use in a Postoperative Coronary Artery Bypass Surgery Patient with Nonvalvular Atrial Fibrillation and Heparin-PF4 Antibodies (January).

The Annals of Pharmacotherapy — Tue, 27 Dec 2011 05:00:00 +0100

CONCLUSIONS:Further research on the use of dabigatran in patients with recent coronary bypass surgery and heparin/PF4 antibodies is needed before any recommendations can be made. PMID: 22202498 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)

Comparison of coronary artery bypass grafting with percutaneous coronary intervention for unprotected left main coronary artery disease.

Yonsei Medical Journal — Tue, 27 Dec 2011 03:58:38 +0100

Conclusion: Despite the fact that patients treated with PCI were at higher operative risk, PCI with DES was shown to be comparable to CABG in terms of mortality, stroke and ACS. However, the frequency of repeat revascularizations remains a constant concern with PCI. PMID: 22187233 [PubMed - in process] (Source: Yonsei Medical Journal)

Is there a beneficial effect difference between age, gender, and different cardiac pathology groups of exercise training at ventilatory threshold in cardiac patients?

Cardiology Journal — Sat, 24 Dec 2011 18:12:03 +0100

Conclusions: A training program conducted at personalised V(Th) significantly improves the aerobic physical capacities of all cardiac patients, and inducessimilar benefits whatever the age, gender or cardiac pathology. (Cardiol J 2011; 18, 6: 632-638). PMID: 22113750 [PubMed - in process] (Source: Cardiology Journal)

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Surgery for coronary artery disease

Surgery (Medicine Publishing) — Fri, 23 Dec 2011 00:08:11 +0100

Abstract: Coronary artery disease (CAD) is one of the commonest diseases in the western world, with over 100,000 deaths a year in the UK. It occurs as a result of mismatch between supply and demand of oxygen, usually due to atherosclerotic narrowing of one of more of the major coronary arteries. CAD can remain asymptomatic initially as the stenosis caused by the plaques may not be flow-limiting. As it progresses with time, patients present with angina, acute coronary syndromes or even sudden death. Treatment can be medical or surgical, including percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG). CABG provides a safe and effective treatment for a large number of people with coronary artery disease for whom PCI and medications are unsatisfactory. With ove...

Successful Surgical Repair of a Giant Calcified Left Ventricular Aneurysm: A Report of a Case.

Annals of Thoracic and Cardiovascular Surgery — Thu, 22 Dec 2011 05:00:00 +0100

Authors: Sugimura Y, Toyama M, Katoh M, Kotani M, Kato Y, Hisamoto K Abstract A 68-year-old man presented at the outpatient clinic with epigastric discomfort. He had suffered a myocardial infarction 10 years previously. Chest radiography and computed tomography showed a giant calcified aneurysm in the left ventricle. Electrocardiography indicated atrial fibrillation. Echocardiography showed moderate mitral regurgitation and enlarged left atrium. End-diastolic volume and ejection fraction were 164 ml and 31%, respectively. Coronary angiography revealed total occlusion of the left anterior descending artery and diffuse stenosis of the right coronary artery. Aneurysmectomy, mitral annuloplasty, maze procedure, and coronary artery bypass were performed. The patient was discharged 16 da...

Successful Management of Refractory Lethal Coronary Spasm after Off-pump Coronary Bypass Grafting.

Annals of Thoracic and Cardiovascular Surgery — Thu, 22 Dec 2011 05:00:00 +0100

Authors: Hosoba S, Suzuki T, Takashima N, Kinoshita T, Kuryanagi S, Nota H, Asai T Abstract Coronary artery spasm after coronary artery bypass grafting is a rare cause of acute myocardial infarction. A 68-year-old man who successfully tolerated off-pump coronary artery bypass grafting had a life-threatening spasm at 16 hours postoperatively. Emergent coronary angiography was performed and demonstrated whole vessel spasm of the bilateral coronary arteries and completely patent grafts. Several transcatheter intracoronary injections of vasodilators failed to relieve the spasm completely. After observation in ICU for 4 days with intra-aortic balloon pumping and a high dose of catecholamine, cardiac function was re-established and the patient recovered. PMID: 22190422 [PubMed - as s...

Effect of remote ischemic preconditioning on clinical outcomes in patients undergoing coronary artery bypass graft surgery (ERICCA): rationale and study design of a multi-centre randomized double-blinded controlled clinical trial

Clinical Research in Cardiology — Wed, 21 Dec 2011 20:13:37 +0100

Abstract Background Novel cardioprotective strategies are required to improve clinical outcomes in high risk patients undergoing coronary artery bypass graft (CABG) ± valve surgery. Remote ischemic preconditioning (RIC), in which brief episodes of non-lethal ischemia and reperfusion are applied to the arm or leg, has been demonstrated to reduce perioperative myocardial injury following CABG ± valve surgery. Whether RIC can improve clinical outcomes in this setting is unknown and is investigated in the effect of remote ischemic preconditioning on clinical outcomes (ERICCA) trial in patients undergoing CABG surgery. (ClinicalTrials.gov Identifier: NCT01247545). Methods The ERICCA trial is a multicentre randomized double-blinded contr...

Endoscopic Venous Harvesting by Inexperienced Operators Compromises Venous Graft Remodeling [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

Conclusions Under normal conditions, intraluminal shear stress leads to positive remodeling of vein grafts during the first postoperative week. Injury to conduits, a frequent sequela of the learning curve for EVH, was a predictor of early graft failure and of blunted positive remodeling and greater negative remodeling of endoscopically harvested vein grafts. Given the current annual volume of cases in which EVH is used, rigorous monitoring of the learning curve for this procedure represents an important and unrecognized issue in public health. (Source: The Annals of Thoracic Surgery)

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Cardiac Surgery in Jehovah's Witness Patients: Ten-Year Experience [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

Conclusions Bloodless cardiac surgery in Jehovah's Witness patients can be performed with excellent outcomes in both elective and urgent situations. Mortality rates for isolated coronary artery bypass graft surgery and isolated aortic valve replacement are within the expected 95% confidence intervals of STS predicted mortality. (Source: The Annals of Thoracic Surgery)

A Method to Evaluate Cardiac Surgery Mortality: Phase of Care Mortality Analysis [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

Conclusions This analysis identifies the occurrence of potentially avoidable mortalities in the 4 hospital phases of care, with the largest absolute number of avoidable mortalities occurring in the preoperative phase. A focus on these phases of care provides significant opportunity for quality improvement initiatives. Utilizing phase of care mortality analysis stimulates surgeons and hospitals to develop and refine mortality reviews and provides a structured statewide platform for discussion, education, quality improvement, and enhanced outcomes. (Source: The Annals of Thoracic Surgery)

Aortic Valve Replacement in the Elderly: The Real Life [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

Conclusions Today, valve replacement has acceptable low hospital mortality, even in the elderly. Thus, older patients should not be denied surgery due to their advanced age alone. Conventional surgery remains the gold standard treatment for aortic stenosis; the decision should be made on an individual basis. If several risk factors suggest very high-risk surgery, then percutaneous valve implantation should be considered instead. (Source: The Annals of Thoracic Surgery)

Coronary Artery Disease in Adult Congenital Heart Disease: Outcome After Coronary Artery Bypass Grafting [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

Conclusions Concomitant CABG may be required at the time of correction of ACHD. Survival is higher when a LIMA graft is used, and late functional outcome is good, with a low incidence of late angina and need for reintervention. (Source: The Annals of Thoracic Surgery)

Blunt Aortic Injury in a Patient With Prior Coronary Artery Bypass Surgery [CASE REPORTS]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

This report describes successful treatment of a patient with a thoracic endograft and carotid subclavian bypass to preserve the left internal mammary artery inflow. (Source: The Annals of Thoracic Surgery)

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Pentraxin-3 predicts functional recovery and 1-year major adverse cardiovascular events after rehabilitation of cardiac surgery patients.

Journal of Cardiopulmonary Rehabilitation and Prevention — Wed, 21 Dec 2011 05:00:00 +0100

CONCLUSION:: PTX3, a marker of vascular inflammation and cardiovascular damage, is a predictor of short-term functional recovery and 1-year MACE in patients undergoing rehabilitation after cardiac surgery, regardless of clinical and instrumental parameters. PMID: 22193930 [PubMed - as supplied by publisher] (Source: Journal of Cardiopulmonary Rehabilitation and Prevention)

Comparison of the effects of ketamine-dexmedetomidine and sevoflurane-sufentanil anesthesia on cardiac biomarkers after cardiac surgery: an observational study.

Physiological Research — Tue, 20 Dec 2011 05:00:00 +0100

Authors: Riha H, Kotulak T, Brezina A, Hess L, Kramar P, Szarszoi O, Netuka I, Pirk J Abstract Inhalational anesthetics have demonstrated cardioprotective effects against myocardial ischemia-reperfusion injury. Clinical studies in cardiac surgery have supported these findings, although not with the consistency demonstrated in experimental studies. Recent investigations have questioned the advantages of inhalational over intravenous anesthetics with respect to cardiac protection. Ketamine has been shown to be comparable with sufentanil, and has even demonstrated anti-inflammatory properties. Dexmedetomidine has been established as a sedative/anesthetic drug with analgesic properties, and has also demonstrated myocardial protective effects. In this retrospective observational study, ...

Regarding “Short-term results of a randomized trial examining timing of carotid endarterectomy in patients with severe asymptomatic unilateral carotid stenosis undergoing coronary artery bypass grafting”

Journal of Vascular Surgery — Mon, 19 Dec 2011 23:06:58 +0100

As a supporter of randomized trials in determining evidence-based practice, I congratulate the authors on undertaking this study, albeit within a cohort of patients who would previously have been thought to be one of the lowest-risk subgroups for having stroke after coronary artery bypass graft (CABG). Yet, despite having excluded emergency procedures, non-CABG cardiac surgery and those with significant aortic arch disease (52% of the original cohort), patients with a unilateral asymptomatic 70% to 99% stenosis undergoing isolated CABG followed by delayed carotid endarterectomy (CEA) incurred a 9% rate of death/stroke at 90 days, compared with only 1% in those randomized to prior/synchronous CEA. (Source: Journal of Vascular Surgery)

Reply

Journal of Vascular Surgery — Mon, 19 Dec 2011 23:06:58 +0100

We thank Dr Naylor for his comments. The reason in this study for the high number of post-coronary artery bypass grafting (CABG) strokes ipsilateral to an asymptomatic carotid stenosis, compared with some contemporary studies quoted by Dr Naylor, is probably twofold: first, in almost all of these studies, the follow-up was limited to 30 days after CABG, and second, a large number of patients had a moderate carotid stenosis between 50% to 70%, very different from what was observed in our randomized trial. (Source: Journal of Vascular Surgery)

Isolated right ventricular myocardial infarction mimicking anterior myocardial infarction in a patient with coronary artery bypass grafts.

Texas Heart Institute Journal — Mon, 19 Dec 2011 09:30:03 +0100

Authors: Cetin M, Ucar O, Canbay A, Cicekcioglu H, Diker E PMID: 22163147 [PubMed - in process] (Source: Texas Heart Institute Journal)

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Cardiac surgery: a century of progress.

Texas Heart Institute Journal — Mon, 19 Dec 2011 09:30:03 +0100

Authors: Weisse AB Abstract Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of coronary artery bypass grafting greatly aided the ...

Appropriateness Criteria to Assess Variations in Surgical Procedure Use in the United States [Review Article]

Archives of Surgery — Mon, 19 Dec 2011 05:00:00 +0100

Conclusions Most existing AC are outdated, and AC have never been developed for most common surgical procedures. A broad and coordinated effort to develop and maintain AC would be required to implement this tool to address variation in the use of surgical procedures. (Source: Archives of Surgery)

Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report

Clinical and Developmental Immunology — Sun, 18 Dec 2011 23:53:19 +0100

A 65-year-old female patient with severe mitral valve stenosis plus coronary artery disease was scheduled for mitral valve replacement and 2-vessel coronary artery bypass graft (CABG) surgeries simultaneously. After a successful procedure, resistance was met on a CVC withdrawal. During postoperative fluoroscopy, fixation of the catheter at the heart was confirmed which necessitated reopening the chest, cutting the suture, and removing the catheter. When a catheter became hard to withdraw after open heart surgery, we should never withdraw it forcefully and blindly. Although rare, one should consider inadvertent entrapment of CVC by a suture as the possible cause. (Source: Clinical and Developmental Immunology)

Why cardiothoracic surgeons must tweet and blog

The Journal of Thoracic and Cardiovascular Surgery — Sat, 17 Dec 2011 21:02:14 +0100

Health care systems around the world are under stress and are being reformed. New models of care are required for a rapidly aging population. Care that is currently hospital based must be transferred to the community. Cardiothoracic surgery provides treatments that may be very effective but remain very invasive and expensive. The specialty lags behind general surgery, which has changed dramatically during the past 10 to 15 years. Many cardiac treatments, previously undertaken through open surgery, are now available with a catheter, carried out by cardiologists. Although percutaneous coronary intervention numbers remain stable, numbers of coronary artery bypass grafting operations, for many years staple fare for cardiac surgeons, are falling precipitously in both the United States and the U...