BACKGROUND: Up to 3% of patients undergoing heart surgery suffer from an intraabdominal complication (IAC). These complications carry a high mortality besides adding to the morbidity and cost. This review was undertaken to see if a subset of patients with increased risk of IAC could be identified. METHODS: Medical records ...

Antiplatelet therapy is commonly administered for primary and secondary prevention of stroke, recurrent angina, myocardial infarction, and death in patients with cardiovascular disorders. It also is associated with an increased risk of bleeding. We describe the management of antiplatelet therapy in patients undergoing coronary artery bypass graft surgery. In addition, ...

OBJECTIVE: To clarify the position of on-pump beating coronary artery bypass (CAB) and to define preoperative indicators of intentional conversion to the procedure in the era of advancement of off-pump CAB (OPCAB), we assessed on-pump beating CAB performed after the introduction of OPCAB. SUBJECTS AND METHODS: We assessed 130 patients ...

We report the case of a 43-year-old patient with acute ST-segment elevation anterior myocardial infarction who underwent off-pump coronary artery bypass grafting. To reduce the duration of ongoing myocardial ischemia, acute reperfusion of the infarcted coronary artery was achieved using an aortocoronary shunt, thereby perfusing the occluded left anterior descending ...

AIM: The treatment of a severely calcified left anterior descending coronary artery (LAD) remains a challenge in cardiac surgery. The objective of this retrospective study was to assess the early clinical outcome obtained from LAD reconstruction, which was performed using a combination of both, saphenous vein and the left internal ...

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) is associated with a less intense systemic inflammatory response according to biochemical markers. We studied systemic vascular resistance (SVR) as a physiologic response to systemic inflammatory response to determine any differences between OPCAB and on-pump coronary artery bypass grafting (ONCAB) in a prospective ...

OBJECTIVES: To review the evolution of off-pump coronary artery bypass surgery with particular reference to the anaesthetic and perioperative implications. FINDINGS: After review of the literature regarding coronary artery bypass grafting, the adverse effects of cardiopulmonary bypass on the various systems are discussed The development and the present status of ...

AIMS: To assess the benefit of off-pump coronary surgery stratified by the pre-operative risk profile. METHODS AND RESULTS: Prospective and multicentric cohort study. All consecutive patients undergoing a first coronary bypass procedure between November 2001 and November 2003 were potentially eligible. Pre-operative EuroSCORE and in-hospital outcomes were prospectively collected using ...

BACKGROUND: Prolonged cross-clamp time during cardiac surgery increases the risk of postoperative mortality and myocardial injury. This subanalysis from the pexelizumab for reduction of infarction and mortality in coronary artery bypass grafting surgery (PRIMO-CABG) trial, a phase III double-blind, placebo-controlled study of 3,099 patients undergoing on-pump coronary artery bypass graft ...

BACKGROUND: Although totally endoscopic coronary artery bypass using facilitated anastomotic devices is still in development, practical less invasive surgical strategies using sophisticated robotic microsurgical systems have been applied to facilitate the journey to a completely endoscopic procedure. This report summarizes the initial clinical experience with off-pump coronary artery bypass grafting ...

BACKGROUND: This randomized, double-blind, placebo-controlled study was designed to determine whether an intra-operative, intravenous infusion of glucose-insulin-potassium (GIK) could be helpful in the prevention of myocardial ischemia and in the maintenance of intra-operative cardiac performance in patients undergoing off-pump coronary artery bypass (OP-CAB) surgery. METHODS: Eighty two adults undergoing elective ...

More than 12 million people in the United States have coronary heart disease, the second leading cause of hospitalization in the United States. It is known that persons within racial minorities, specifically African Americans, have a higher prevalence of coronary heart disease, yet are much less likely to undergo invasive ...

A 52-year-old man was resuscitated from a cardiac arrest during a marathon run. During initial evaluation, he received a significant amount of crystalloid fluid to maintain end-organ perfusion. Based on electrocardiogram findings, myocardial infarction was suspected and an angiogram was performed. An acute thrombosis of the left anterior descending vessel ...

BACKGROUND: We hypothesized that cardiopulmonary bypass induces a selective alteration of the coronary arterial endothelial cell signal transduction which could be explained by a state of depletion and/or decreased activity of endogenous tetrahydrobiopterin (BH(4)). The aim of this study was to assess the effects of cardiopulmonary bypass and BH(4) on ...

BACKGROUND: Morbidity and mortality after coronary artery bypass graft surgery are directly related to specific preoperative risk factors. We assessed the influence of preoperative risk factors on the effect of pexelizumab, a C5 complement inhibitor, to reduce postoperative morbidity and mortality in this post hoc analysis of the Pexelizumab for ...

BACKGROUND: Patients with severe atheromatous disease of the aorta who underwent coronary artery bypass grafting have an increased risk of stroke and death. We hypothesize that in these high-risk patients off-pump coronary artery bypass grafting is associated with lower rates of stroke and mortality. METHODS: From January 1995 through June ...

BACKGROUND: The effectiveness and advantages of off-pump coronary artery bypass (OPCAB) for patients with concomitant malignant neoplastic disorders were analyzed. METHODS AND RESULTS: The study group comprised 368 patients who underwent OPCAB and of them 18 had concomitant malignant neoplastic disease: 14 with solitary malignant disease, 4 with low-grade lymphocytic ...

Cardiopulmonary bypass is a double-edged sword. Without it, corrective cardiac surgery would not be possible in the majority of children with congenital heart disease. However, much of the perioperative morbidity that occurs after cardiac surgery can be attributed to a large extent to pathophysiologic processes engendered by extracorporeal circulation. One ...

Left ventricular dysfunction is a predictor of perioperative morbidity and mortality in on-pump coronary artery bypass grafting. Obligatory global myocardial ischemia and injury induced during crossclamping as well as adverse systemic effects of cardiopulmonary bypass may induce a disproportionately greater overall physiologic insult in patients with poor ventricular function. All ...

We report the case of a Child class C cirrhotic patient who was diagnosed with coronary artery disease in the course of his pretransplantation evaluation. He underwent off-pump coronary artery bypass grafting (OPCAB), which was complicated with acute renal failure. The morbidity and mortality associated with cardiac operation in patients ...

OBJECTIVE: Superior patency of internal thoracic artery (ITA) grafting to saphenous veins is conclusive. The aim of the present study was to compare the early outcome of patients receiving either bilateral ITA (BITA) or single ITA (SITA) grafts and to identify risk factors for perioperative complications, such as obesity, diabetes ...

BACKGROUND: We validated the clinical relevance of ventricular stiffness by examining surgical morbidity in children with univentricular hearts undergoing Fontan operation. We hypothesized that ventricular stiffness affects Fontan morbidity, particularly duration of pleural effusions. METHODS AND RESULTS: Sixteen children with right ventricular (RV) (n =11) or left ventricular (LV) (n ...

BACKGROUND: Off-pump coronary artery bypass surgery (OPCAB) is currently used as an alternative to conventional "on-pump" surgery, but there are very little data available on long-term follow-up. The aim of this study was to review our long-term experience with the use of systematic OPCAB. METHODS AND RESULTS: 1000 consecutive OPCAB ...

OBJECTIVE: To evaluate the effect of postoperative pain control in cardiac surgical patients on morbidity, mortality and other outcome measures. BACKGROUND: New approaches in pain control have been introduced over the past decade. The impact of these interventions, either alone or in combination, on perioperative outcome was evaluated in cardiac ...

BACKGROUND: A high proportion of patients having cardiac bypass surgery receive erythrocyte transfusions. Decisions about when to transfuse patients having surgery for coronary artery disease may impact on erythrocyte utilization and patient morbidity and mortality. There are no published data about the factors that influence physicians' decisions to transfuse erythrocytes ...

OBJECTIVE: Internal thoracic artery (ITA) grafting to the left anterior descending artery (LAD) may have catastrophic consequences and can be fatal due to "ITA malperfusion syndrome." We have investigated the efficacy of a second graft in this syndrome. METHODS: A total of 35 patients, 29 males (82.9%) and 6 females ...

OBJECTIVES: To investigate whether patency of a thin walled 8 mm fluoropassivated Dacron graft was similar to that of a standard 8mm PTFE graft for femorofemoral crossover bypass surgery. DESIGN: A randomised multicentre clinical trial comparing two vascular grafts with participation of 10 departments of vascular surgery in Denmark, Sweden ...

We report an association between pericardial tamponade and early post-surgical occlusion of a coronary bypass graft. The presented patient developed pericarditis following myocardial infarction and bypass surgery. He was readmitted with myocardial reinfarction and cardiogenic shock 1 week after surgery. Coronary angiography revealed occlusion of a saphenous-vein graft to the ...

BACKGROUND: Off-pump coronary bypass surgery avoids the potential complications of cardiopulmonary bypass. However, its acceptance depends on medical and economic outcome. The aim of this prospective non-randomised study was to compare functional and economic outcome of off-pump and on-pump surgery at 1-year follow-up. METHODS: 102 patients (pts) treated with either ...

OBJECTIVE: Evaluation of randomized, controlled clinical trials studying fast-track treatment in low-risk coronary artery bypass grafting patients. DESIGN: Meta-regression. PATIENTS: Low-risk coronary artery bypass grafting patients. INTERVENTIONS: Fast-track treatments including (high or low) anesthetic dose, normothermia vs. hypothermia, and extubation protocol (within or after 8 hrs). MEASUREMENTS: Number of hours ...

Improving survival from congenital cardiac repairs using cardiopulmonary bypass has appropriately shifted focus to neurologic outcomes. Hypoxic-ischemic mechanisms are the major cause of neurologic injury in neonatal cardiac surgery, and modifications of techniques of cardiopulmonary bypass can affect organ oxygen delivery and the propensity to injury both during and after ...

BACKGROUND: After more than a decade of experience with off-pump coronary bypass surgery, still no consensus exists concerning its benefit on clinical outcome compared to the on-pump technique. In this 12-month follow-up, we compare off-pump and on-pump surgery on the appearance of graft patency, myocardial function, and clinical outcome. METHODS: ...

In the Octopus Study, 281 coronary artery bypass surgery patients were randomized to surgery with or without cardiopulmonary bypass. The primary objective was to compare cognitive outcome between off-pump and on-pump coronary artery bypass surgery. Before and after surgery, psychologists administered a battery of 10 neuropsychological tests to the patients. ...

OBJECTIVE: Endovascular vein harvest (EDVH) requires CO(2) insufflation to expand the subcutaneous space, allowing visualization and dissection of the saphenous vein. The purpose of this study was to assess the extent of CO(2) absorption during EDVH. DESIGN: Prospective observational study. SETTING: Single tertiary care hospital. PATIENTS: Sixty patients (30 EDVH ...

Left upper lobectomy in a patient with a history of Left Internal Mammary Artery (LIMA) graft for Coronary Artery Bypass Graft surgery (CABG) is a challenge for the surgical team. The adhesion formation in the left chest, especially around the left internal mammary artery graft, may cause diffculty for surgery. ...

An emergency off-pump coronary artery bypass (OPCAB) was performed successfully in an aged patient with acute coronary syndrome (ACS). The patient, an 80-year-old woman residing in a nursing home, suddenly lost consciousness during lunch. The electrocardiogram (ECG) showed ventricular fibrillation (Vf) but defibrillation successfully recovered the sinus rhythm. The patient ...

Cardiac surgery is increasingly performed on elderly patients with extensive coronary artery abnormalities who have impaired left ventricular function, decreased physiologic reserve, and multiple comorbid conditions. Considerable numbers of these patients develop perioperative neurologic complications ranging from subtle cognitive dysfunction to more evident postoperative confusion, delirium, and, less commonly, clinically ...

BACKGROUND: Beating heart totally endoscopic coronary artery bypass grafting (TECAB) utilizing a computer-enhanced telemanipulation system is a technically challenging procedure. The objective of our study was to compare two different anastomotic techniques. METHODS: Ten canine beating heart TECAB procedures were performed using Intuitive's daVinci surgical system. Left internal mammary artery ...

OBJECTIVES: Right ventricular dysfunction is a possible cause of cardiac failure after coronary surgery. The use of cardiopulmonary bypass is regarded as a major cause for its occurrence, and it has been postulated that performing coronary surgery without cardiopulmonary bypass might reduce ventricular dysfunction. Therefore, this prospective, randomized, controlled study ...

Two studies assessed initiatives to improve the quality and the cost-effectiveness of cardiac surgery. The first evaluated a system for access and stabilization (SAS), with coronary stabilization, and a clinical effectiveness quality initiative (CEQI) in off-pump coronary artery bypass grafting. The SAS + CEQI cohort showed significantly lower mortality, a ...

OBJECTIVE: The use of cardiopulmonary bypass (CPB) for lung transplantation (LTx) has been reported previously. This study reports the authors' experience of planned and unplanned use of cardiopulmonary bypass for LTx. DESIGN: Case series. SETTING: A university teaching hospital. PARTICIPANTS: Patients undergoing LTx. INTERVENTIONS: A retrospective analysis of the charts ...

Extrathoracic cannulation to establish cardiopulmonary bypass has been widely applied in recent years and includes: (a) repeat surgery, (b) minimally invasive surgery, and (c) cases with diseased vessels such as porcelain, aneurysmal, and dissecting aorta. In addition, the success and relative ease of peripheral cannulation, among other technological advances, has ...

BACKGROUND: We aimed to review the early and late results of off-pump coronary artery bypass graft surgery (OPCABG) with coronary endarterectomy in patients undergoing surgical revascularization at our institution. METHODS: Between 1995 and 2004, of 680 OPCABG patients in a single surgeon's practice (W.R.D.), 70 patients (10.29%) who underwent concomitant ...

BACKGROUND: Robotic technology has been proven safe and efficacious in the performance of mitral valve repair and atrial septal defect repair. This report describes a Food and Drug Administration-sanctioned multicenter study of the safety and efficacy of the da Vinci system (Intuitive Surgical, Inc, Mountain View, CA) for totally endoscopic ...

BACKGROUND: Decreases in neurocognitive function have been reported in patients who have undergone off-pump coronary artery bypass surgery; however, few investigators have examined the correlates of the decreases. OBJECTIVES: To explore and determine the correlates of neurocognitive function at the time of discharge from the hospital in patients undergoing off-pump ...

Perioperative myocardial injury (PMI) after coronary revascularization (bypass surgery using cardiopulmonary bypass or percutaneous intervention) is strongly associated with future adverse events, such as death, myocardial infarction, and coronary intervention. The incidence, determinants, and prognostic significance of PMI after bypass surgery without cardiopulmonary bypass (off-pump surgery) are unknown. The study ...

OBJECTIVE: For patients who undergo off-pump coronary artery bypass (OPCAB) surgery, pulmonary artery catheterization (PAC) has been proposed as a useful intraoperative monitoring tool. This study was designed to determine if the choice of PAC versus central venous pressure monitoring (CVP) had any effect on outcome after OPCAB. This study ...

OBJECTIVES: Cardiac surgery involving cardiopulmonary bypass is associated with neurologic deterioration. Several interventions, including anesthetic techniques, have been designed to limit ischemic brain damage and have been evaluated in animals. Markers of neurologic injury may facilitate the assessment of these interventions in humans. DESIGN: A blinded randomized prospective study comparing ...

AIM: Coronary artery bypass graft (CABG) surgery, nowadays, is increasingly performed in patients who are older and have more comorbidities than subjects operated on a decade ago. In this study, we investigated metabolic and hemodynamic features of elderly patients with single vessel coronary artery disease (CAD), undergoing beating heart coronary ...

OBJECTIVE: To determine the feasibility and safety of skeletal myoblast transplantation in patients with chronic myocardial infarction undergoing coronary artery bypass grafting. METHODS: Twelve patients with a previous myocardial infarction and ischemic coronary artery disease underwent treatment with coronary artery bypass grafting surgery and intramyocardial injection of autologous skeletal myoblasts ...