Aprotinin is a serine protease inhibitor with antithrombotic, antifibrinolytic, and antiinflammatory effects. It is effective in reducing bleeding and the need for blood transfusions after cardiac surgery with cardiopulmonary bypass. Additional benefits, such as cerebral protection, are hypothesized but not yet thoroughly substantiated. The safety of aprotinin has been questioned ...

The MASS III Trial is a large project from a single institution, The Heart Institute of the University of Sao Paulo, Brazil (InCor), enrolling patients with coronary artery disease and preserved ventricular function. The aim of the MASS III Trial is to compare medical effectiveness, cerebral injury, quality of life, ...

When open-heart operations are necessary in patients who have undergone pneumonectomy, the unavoidable shift of mediastinal structures should be carefully considered. Surgical access, revascularization procedures, and the institution of cardiopulmonary bypass can all require approaches that differ from the usual. In particular, no general recommendations exist regarding the management of ...

Decreased right ventricular function after coronary artery bypass grafting is a common and well-known (if not well-understood) phenomenon.We prospectively evaluated right ventricular function via echocardiographic tricuspid annular motion, tricuspid annular velocity, and right ventricular strain analysis before and after coronary artery bypass grafting. We also evaluated the effect of right ...

Our goal was to investigate the safety of single- and double-vessel coronary endarterectomy as an adjunct to coronary artery bypass grafting in patients with diffuse coronary disease. In reviewing the records of 9,443 patients who underwent isolated coronary artery revascularization over a 4-year period, we found 310 patients (3.28%) who ...

Less-invasive options are available for surgical treatment of multivessel coronary artery disease. We hypothesized that stenting combined with grafting of the left anterior descending artery with the left internal thoracic artery through a minithoracotomy (hybrid procedure) would provide the best outcome. Patients with equivalent numbers of coronary lesions (2.8 +/- ...

End stage renal disease is a risk factor for mortality after coronary artery bypass grafting. We conducted a retrospective review of 37 consecutive dialysis-dependent patients who underwent off-pump coronary artery bypass grafting between April 2001 and July 2004. Complete revascularization was successfully performed in all patients. The mean number of ...

A 34-year-old man with a prior history of Hodgkin's disease and coronary artery bypass surgery for radiation-induced left main disease presented with persistent chest pain. Cardiac catheterization showed near simultaneous filling of the venous system during arterial injection and could not precisely delineate the insertion point of the vein graft ...

Perioperative myocardial infarction remains a frequent complication after coronary artery bypass grafting, and is associated with a poor prognosis. This retrospective study compared cardiac troponin I concentrations after on-pump bypass grafting in 2 groups of patients: 100 operated on using a single-clamp technique to perform anastomoses, and 80 operated on ...

In coronary artery bypass grafting there is a risk of graft occlusion which may result in myocardial infarction. A three-axis acceleration sensor may give additional information about heart function during surgery and the first postoperative days. This paper describes the assembly and packaging of a three-axis micro acceleration sensor for ...

AIM: In order to investigate the neuroprotective efficacy of off-pump coronary artery bypass surgery (OPCAB) over conventional on-pump coronary artery bypass surgery (CCAB), we have performed a prospective randomized study evaluating retinal circulation changes after OPCAB and CCAB. METHODS: Twenty patients were randomized to OPCAB or CCAB. Retinal fluorescein angiography ...

The rationale and design of the Surgical Treatment for Ischemic Heart Failure trial is described. Before the Surgical Treatment for Ischemic Heart Failure trial, less than 1000 patients with ischemic cardiomyopathy had been studied in randomized comparisons of medical therapy versus coronary artery bypass grafting. Trial data reflect how these ...

BACKGROUND: The aim of this study was to investigate the differences between pre- and post-operative hearing thresholds, measured by high frequency audiometry, in patients undergoing open heart surgery. MATERIALS AND METHODS: Pre- and post-operative audiometric assessments were performed in 20 patients undergoing open heart surgery. Pure tone audiometry testing was ...

PURPOSE OF REVIEW: In the era of percutaneous coronary intervention, surgeons are confronted with performing coronary artery bypass graft surgery on patients with previous balloon dilatation or stenting. This review evaluates the impact of previous percutaneous coronary intervention on patient survival and choice of optimal myocardial revascularization technique. RECENT FINDINGS: ...

BACKGROUND: A prospective observational study was carried out in a Cardiosurgical Intensive Care Unit (ICU) in order to evaluate the incidence of Acute Renal Failure (ARF) after coronary artery bypass graft surgery and identify its predictors. The effects of ARF on outcome were also investigated. METHODS: The study enrolled 3,013 ...

During cardiopulmonary bypass (CPB), hypoperfusion and reperfusion may cause oxidative stress and lipid peroxidation that generates ethane. The aim of this pilot study was to assess the feasibility of frequent sampling of exhaled ethane during cardiac surgery. After approval of the Research Ethics Committee, 10 patients undergoing combined aortic valve ...

To evaluate the results of on-pump beating-heart coronary bypass grafting, a retrospective study was carried out on 106 patients who had this procedure between 2003 and 2006. There were 87 (82%) men and 19 (18%) women, with a mean age of 60.53 +/- 11.97 years. Five (5%) patients had unstable ...

BACKGROUND: Left main coronary stenosis, including ostial lesions, is conventionally treated by coronary bypass surgery. This approach, however, restores a less physiological retrograde perfusion to part of the myocardium and may contribute to a competition of flows in non-occluded coronaries. Direct surgical reconstruction of the LMCA has been described and ...

Induction of the coagulation and inflammatory cascades can cause multiorgan dysfunction after cardiopulmonary bypass (CPB). In light of these observations, strategies that can stabilize the coagulation process as well as attenuate the inflammatory response during and after cardiac surgery are important. Aprotinin has effects on hemostasis. In addition, aprotinin may ...

OBJECTIVES: The benefits of statin therapy for patients with coronary artery disease have been well documented, including those occurring after coronary artery bypass graft surgery. The purposes of this study were to assess statin prescription rates in patients who have undergone coronary artery bypass graft surgery and to identify the ...

BACKGROUND AND OBJECTIVES: Volatile anaesthetics have gained more popularity recently due to the potential for cardiac protection. Ultra-fast-track anaesthesia implies the immediate extubation after cardiac surgery. The purpose of this prospective randomized double-blind controlled study is to compare the cardioprotective effects of sevoflurane and isoflurane in off-pump cardiac bypass surgery. ...

BACKGROUND: Cardiac rehabilitation (CR) is effective in prolonging survival and reducing disability in patients with coronary heart disease. However, national use patterns and predictors of CR use have not been evaluated thoroughly. METHODS AND RESULTS: Using Medicare claims, we analyzed outpatient (phase II) CR use after hospitalizations for acute myocardial ...

BACKGROUND: Left main trunk stenosis (> or = 50%) has traditionally been treated with coronary artery bypass grafting. Improvements in coronary stents have led some to advocate percutaneous coronary intervention. To provide a benchmark of outcomes against which percutaneous coronary intervention may be compared, we (1) assessed survival and freedom ...

Mannose-binding lectin (MBL) is an important component of innate immunity and activator of the lectin complement pathway. Within the MBL2 gene are seven 5' "secretor" haplotypes that code for altered serum MBL levels and complement activation. However, recent evidence suggests that 3' MBL2 haplotypes may also modify MBL function and ...

OBJECTIVE: End-stage renal disease is an independent predictor of mortality after coronary artery bypass grafting. Limited information exists, however, regarding the impact of chronic kidney disease on long-term outcome after bypass grafting. The purpose of this study was to assess the impact of kidney function on long-term outcomes in patients ...

BACKGROUND: Cardiopulmonary bypass may exacerbate myocardial damage in compromised left ventricles. Early and mid-term outcomes of off-pump coronary artery bypass grafting (OPCAB) vs on-pump coronary artery bypass grafting (On-pump CABG) were compared in patients with poor left ventricular dysfunction, using an analysis of a propensity score matching. METHODS AND RESULTS: ...

BACKGROUND: Blood transfusion with cardiac surgery accounts for 20% of transfusions in the United States. The effect of perioperative transfusion on cardiac surgery outcomes is unknown. We hypothesized that cardiac surgery with perioperative blood transfusion was associated with worse outcomes. METHODS: A prospectively maintained (Society of Thoracic Surgeons) institutional database ...

OBJECTIVE: The invention of robotic systems has begun a new era of endoscopic cardiac surgery. Reports on totally endoscopic coronary artery bypass grafting are limited, however, and data regarding feasibility, safety, and efficacy are needed to determine this technique's position in the therapeutic armamentarium. This study describes the largest multicenter ...

Sixty-five patients scheduled for coronary surgery were randomized into three groups: A - conventional coronary artery bypass grafting, B - off-pump surgery, C - coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of re-infusion of cardiotomy blood into the circuit. On the completion of peripheral ...

Rupture of coronary artery bypass graft during percutaneous coronary intervention is a rare but serious complication. These perforations are often associated with myocardial infarction, pericardial tamponade, immediate or delayed, emergency bypass surgery and even death. We report an interesting case where perforation of a saphenous vein graft occurred after direct ...

OBJECTIVE: To investigate whether supraclavicular ultrasonography of left internal mammary artery (LIMA) to left anterior descending (LAD) area grafts can reliably predict (distal) string sign grafts on arteriography. METHODS: Fifty-five patients (42 M, 61 +/- 7 years) with the LIMA to LAD area grafting were prospectively studied. Control arteriography was ...

Percutaneous salvage of failing arteriovenous grafts with diffuse disease or occlusion in the venous outflow remains an issue with no ideal solution. The present report describes a method of percutaneous creation of vascular bypasses in a patient with a failing graft. The patient had a long-segment stenosis in the venous ...

OBJECTIVE: To assess and compare the two commonly applied models--EuroSCORE and Parsonnet--in our local adult cardiac surgery patients, according to risk factor quantification related to mortality using a risk stratification protocol to assess the quality of cardiac surgical care. DESIGN: Prospective study. SETTING: Cardiac surgery centre in a regional hospital ...

BACKGROUND: Cardiopulmonary bypass (CPB)-related inflammatory response can be attenuated by glucocorticoid treatment, but its impact on postoperative cardiopulmonary function remains controversial. It was investigated whether the systemic and myocardial antiinflammatory effects of glucocorticoids are associated with improved cardiopulmonary function in cardiac surgery patients. METHODS: Eighty patients undergoing elective coronary artery ...

BACKGROUND: We evaluated the effects of coronary artery bypass with off-pump skeletonized bilateral internal thoracic artery grafting in patients with insulin-dependent diabetes. METHODS: One hundred eighty-five consecutive patients with insulin-dependent diabetes who underwent isolated coronary artery bypass grafting with bilateral internal thoracic grafts were retrospectively compared according to surgical technique, ...

OBJECTIVES: We sought to examine the effect of revascularization with coronary artery bypass grafting on specific causes of death in the Bypass Angioplasty Revascularization Investigation cohort. Although the effect of coronary revascularization on long-term mortality has been previously described, there are limited data describing its effect on specific causes of ...

OBJECTIVE: Automatic devices have been recently introduced to make the anastomosis procedure quick and efficient when creating a coronary bypass on the beating heart. However, the implantation of these devices could modify the graft configuration, consistently affecting the hemodynamics usually found in the traditional anastomosis. As local fluid dynamics could ...

Spontaneous slow flow without significant obstructive stenosis, as encountered during diagnostic angiography, has mostly been reported in native coronary arteries. This phenomenon has been associated with angina, myocardial ischemia and infarction. Slow flow and "no-reflow" in saphenous vein grafts (SVG) have mostly been observed during percutaneous interventions as a complication ...

BACKGROUND AND OBJECTIVE: Transmitral inflow patterns have been used for detection of myocardial ischaemia. However, its diagnostic value has not been tested in anaesthetized and mechanically ventilated patients undergoing coronary artery bypass graft surgery. METHODS: Transmitral inflow patterns were studied by transoesophageal Doppler echocardiography in 43 patients undergoing coronary artery ...

OBJECTIVE: To determine the relationship between change in blood pressure during coronary artery bypass graft operations and early cognitive dysfunction. DESIGN: Cohort study. SETTING: Quaternary care facility. Patients Fifteen patients undergoing coronary artery bypass graft operations who were at high risk for postoperative stroke. Preoperative and intraoperative mean arterial pressures ...

BACKGROUND: After coronary bypass surgery, occlusion or narrowing of bypass grafts may occur over time. The present study prospectively evaluated the angiographic patency of bypass grafts after 1 year in relation to the preoperative angiographic and functionally severity of the coronary lesion assessed by fractional flow reserve measurement to test ...

Cognitive decline and delirium are common complications after heart bypass surgery. Based on the reported role of the APOE-epsilon 4 allele in neurodegenerative diseases, we studied its association with these complications. A neuropsychological test battery consisting of the Mini Mental State Examination, the Wechsler's Memory Scale Revised, the Brief Psychiatric ...

OBJECTIVES: Aprotinin is a drug used to reduce bleeding in patients undergoing cardiothoracic surgery with cardiopulmonary bypass. A recent cohort evaluation found elevated risks of renal, cardiovascular, and cerebrovascular events when aprotinin was used. We sought to determine the impact of aprotinin on safety variables among patients receiving cardiothoracic surgery ...

OBJECTIVE: Coronary artery bypass graft surgery remains associated with significant postoperative cardiovascular morbidity and mortality in high-risk patients. MC-1 (pyridoxal-5'-phosphate monohydrate) inhibits purinergic receptors and intracellular influx of Ca2+, thereby reducing cellular injury during experimental ischemia and reperfusion. The MEND-CABG trial tested the hypothesis that MC-1 reduces cardiovascular morbidity and ...

AIM: Minimally invasive direct coronary artery bypass (MIDCAB) through a small anterolateral thoracotomy on the beating heart can be considered as the better approach for treating isolated lesions on the left anterior descending (LAD) artery. This original MIDCAB procedure, however, involves a larger and often painful thoracotomy due to rib ...

INTRODUCTION: The Authors reports their experience with the use of femoro-femoral cross-over bypass graft in the management of acute lower limb ischaemia. PATIENTS AND METHODS: Fourteen femoro-femoral bypass graft were performed for acute lower limb ischaemia due to unilateral thrombosis of iliac and femoral artery in 8 cases, late unilateral ...

The impact of diffuseness of coronary artery disease on the outcome of coronary bypass grafting remains unclear due to the absence of an objective grading system for diffuseness. This study proposes a system and validates it by transit time flow measurements. All patients operated upon by the author from July ...

OBJECTIVES: To perform intravascular imaging of atherosclerotic human coronary conduits in an animal model under conditions of flow and cardiac motion that approximate those encountered in vivo. BACKGROUND: Given the lack of animal models of vulnerable plaque, a model which would allow imaging of human disease and simulate coronary motion ...

Perturbation of coronary blood flow (CF) is an important contributor to myocardium-related complications. The study was primarily designed to assess the impact of cardiopulmonary bypass (CPB) surgery on CF by aid of transthoracic Doppler echocardiography. Changes in CF after off-pump coarctation surgery were also studied. All ultrasounds were performed before ...

OBJECTIVE: To assess the health economic impact of perioperative myocardial infarction in a cohort of patients undergoing coronary artery bypass graft surgery. DESIGN: Retrospective cohort analysis using data from hospital bills and uniform billing forms. SETTING: A total of 147 geographically diverse hospitals in the United States. PATIENTS: The study ...