BACKGROUND/AIM: Factors associated with mortality and morbidity following coronary artery bypass graft surgery have been well defined and the Parsonnet score is widely used in mortality prediction. The evaluation of quality of life has not been still implemented in everyday work and preoperative echocardiographic factors affecting the quality of life ...

Cardiopulmonary bypass has revolutionized the ability to provide cardiorespiratory support and has advanced the field of cardiac surgery. This invention has given surgeons the ability to perform many procedures that were not possible previously. The concept and development of cardiopulmonary bypass has been pioneered by numerous legendary surgeons. Cardiopulmonary bypass, ...

Two features of off-pump coronary artery bypass (OPCAB) can lead to hemodynamic instability: transient occlusion of coronary arteries during distal anastomosis construction and displacement of the heart to provide access to distal coronary arteries. The position of the heart during OPCAB trans-esophageal echocardiography (TEE) can often provide an indication as ...

Acute myocardial infarction resulting from saphenous vein graft occlusion occurs not infrequently in patients who have undergone coronary artery bypass graft surgery. In this case report, we present a novel case of spontaneous recanalization of a thrombotic graft occlusion in a patient who presented with a subacute myocardial infarction. The ...

Primary cardiac pheochromocytoma is an extremely rare neoplasm. We report a 15-year-old girl who was presented with paroxysmal hypertension. An iodine-131 metaiodobenzylguanidine scintigraphy scanning showed a pheochromocytoma in her right atrial and ventricular wall. The tumor was subsequently confirmed by magnetic resonance imaging and coronary angiogram. This patient underwent a ...

A dog that was referred to the University of Florida Veterinary Medical Center was discovered to have a bamboo skewer within the right atrium and right ventricle, traversing the tricuspid valve. The skewer was ingested approximately four months prior to referral and was partially removed via gastrotomy. The presenting complaint ...

It is still a highly difficult choice with no definitive answer whether to perform cardiac surgery on cardioplegically arrested heart or to operate on a beating heart, especially for patients with dilated cardiomyopathy (DCM). A 73-year-old man, who had ascending aortic aneurysm and DCM with ejection fraction (EF) of 16.5% ...

OBJECTIVES: Optimal treatment strategies for patients with ischemic cardiomyopathy and moderately reduced left ventricular function remain controversial. We assessed the early and midterm outcomes after surgical revascularization alone versus revascularization and additional left ventricular remodeling in these patients. METHODS: Between 2000 and 2003, 285 consecutive patients with coronary artery disease ...

A 59-year-old man with cardiac dysfunction was admitted to our hospital because of thrombus formation in the left ventricle 10 days following acute myocardial infarction. Echocardiography revealed evidence of two mobile thrombi, each measuring about 2 cm in diameter. Urgent coronary artery bypass grafting and video-assisted transaortic thrombectomy were performed ...

Emergency coronary artery bypass is associated with increased operative mortality. The objective of this study was to evaluate the efficiency and safety of off-pump emergency coronary artery bypass, and to compare the outcome with that of the conventional on-pump procedure. Data of 79 patients who underwent emergency isolated coronary artery ...

AIM: Calcium dobesilate (CD) is a synthetic benzene sulfonate derivative and an angioprotective agent used orally. It can be used in patients who have diabetic retinopathy or chronic venous insufficiency. The aim of this study was to investigate the effect of CD on the reduction of oxidative stress during coronary ...

OBJECTIVE: The effect of training on outcomes in cardiac surgery is poorly studied. We aimed to study the results of coronary artery bypass grafting procedures performed by surgeons in training across our state with respect to short- and midterm postoperative outcomes. METHODS: All coronary artery bypass grafting surgeries performed by ...

OBJECTIVE: This prospective randomized study sought to verify the systemic inflammatory response, inflammatory myocardial damage, and early clinical outcome in coronary surgery with the miniaturized extracorporeal circulation system or on the beating heart. METHODS: Sixty consecutive patients were randomized to miniaturized extracorporeal circulation (n = 30) or off-pump coronary revascularization ...

OBJECTIVE: Myocardial viability and left ventricular dyssynchrony are important predictors of long-term outcomes in patients with ischemic left ventricular dysfunction. The objective of this study was to test the hypothesis that assessment of myocardial viability and left ventricular dyssynchrony will predict perioperative mortality in high-risk patients with ischemic left ventricular ...

OBJECTIVE: The aim of our study was to evaluate the impact of recent clopidrogel use before off-pump coronary artery bypass grafting on the postoperative risk of bleeding. METHODS: During the period January 2003 to December 2006, 1104 consecutive patients underwent off-pump coronary artery bypass grafting. Patients were divided into two ...

BACKGROUND: The calcium sensitizer levosimendan has anti-ischaemic effects mediated via the opening of sarcolemmal and mitochondrial ATP-sensitive potassium channels. These properties suggest potential application in clinical situations where cardioprotection would be beneficial, such as cardiac surgery. We thus decided to investigate whether pharmacological pre-treatment with levosimendan reduces intensive care unit ...

BACKGROUND: We evaluated the association between the preoperative use of intraaortic balloon pumping and in-hospital and long-term outcomes in high-risk patients undergoing coronary artery bypass grafting. METHODS: From 714 total patients undergoing coronary artery bypass grafting during a 4-year period, we compared the clinical, biochemical, and echocardiographic findings up to ...

We report a case of rapid and progressive severe metabolic acidosis in the postoperative period after coronary artery bypass grafting. After exclusion of potential causes for this phenomenon, it was attributed to perioperative intravenous propofol infusion causing propofol infusion syndrome. We discontinued this intravenous agent resulting in a prompt and ...

Thermography is a relatively new contact-free method used in experimental and clinical studies and in cardiovascular surgery to investigate the myocardium and coronary artery function. Objects of complex study included mongrel dogs and patients with coronary artery disease who underwent cardiac surgery. For active dynamic thermography, we used a thermovision ...

OBJECTIVE: This study was undertaken to assess the impact of increasing patient complexity and health care cost on coronary artery bypass grafting quality and cost-effectiveness in the United States over an 18-year period. METHODS: A retrospective study was carried out utilizing the Nationwide Inpatient Sample to track the characteristics and ...

The aetiology of left ventricular hypertrophy (LVH) in an athlete is often difficult to identify. We describe a 29-year-old fitness instructor who was referred for investigation of syncope. He gave a history of intensive weight lifting and anabolic steroid use at supra-therapeutic doses for the preceding 6 years. Electrocardiography showed ...

Abnormalities of the electrocardiogram are extremely useful for the diagnosis of heart disease, but they may also occur in non-cardiac conditions. The electrocardiographic abnormalities that have been described in neurological diseases are among the most striking deviations from normal. We describe a patient with an intracranial space occupying lesion (pilocytic ...

The contribution of biomechanical factors to the incidence and distribution of coronary artery and bypass graft disease is underrecognized. This review examined the literature to determine which factors were relevant and the evidence for their importance. It identified two primary biomechanical factors that predispose to disease: (1) low-wall shear stress ...

Volatile anaesthetic agents have direct protective properties against ischemic myocardial damage. The implementation of these properties during clinical anaesthesia can provide an additional tool in the treatment or prevention, or both, of ischemic cardiac dysfunction in the perioperative period. A recent meta-analysis showed that desflurane and sevoflurane reduce postoperative mortality ...

Myocardial bridge (MB), which covers a part of the left anterior descending coronary artery (LAD), is a normal anatomical variant structure (45% in frequency by autopsy) in LAD. MB contraction plays the role of a "double-edged sword" on the coronary events, suppressing coronary atherosclerosis under the MB, yet generating abnormal ...

BACKGROUND: The advantages of the use of the internal thoracic artery (ITA) over that of the saphenous vein (SV) for revascularization of the circumflex (Cx) or right coronary artery (RCA) are still debated. METHODS: Serial intraoperative flow measurements were carried out in 306 consecutive patients (mean age 64 years, mean ...

BACKGROUND: Coronary Artery Bypass Graft operation for ischemic heart disease provides improved quality of life and, in some patients, prolonged survival. Concern has, however, been raised about complications that may be related to the use of cardiopulmonary by-pass (CPB) and aortic cross-clamping. It has been hypothesized that when coronary artery ...

The Cabrol technique is used to reimplant coronary arteries after aortic root replacement using a Dacron graft interposed between the aortic root graft and the native coronary artery. Although stenosis of the graft-coronary anastomosis has been described, there have been few reports of percutaneous intervention to these stenoses. An understanding ...

The aim of this study is to evaluate the effect of fetal cardiac bypass on the production and secretion of fetal atrial natriuretic peptide (ANP) in the goat. Eighteen pregnant goats, at days 120 to 140 of gestation, were randomly divided into control (n = 8) and bypass (n = ...

The aim of the study was to compare platelet activity between patients with an occlusion of bypass graft after coronary artery bypass graft surgery and restenosis after percutaneous coronary intervention (PCI); that is, between patients with reappearance of ischemia after two different kinds of coronary revascularization. Thirty patients were studied ...

To verify whether low-dose aprotinin reduces blood loss and blood product usage in patients with clopidogrel exposure within 5 days before off-pump coronary artery bypass, 51 patients with clopidogrel exposure were randomized in a double-blind fashion to receive low-dose aprotinin (25 patients), or placebo (26 patients). The baseline characteristics and ...

Experience of on- and off-pump coronary artery bypass in 379 patients with significant left main coronary artery stenosis was retrospectively reviewed. Beating-heart operations were performed on 219 patients between January 2001 and October 2007. Their results were compared with 160 who underwent revascularization under cardiopulmonary bypass during the same period. ...

OBJECTIVE: Coronary artery bypass grafting (CABG) is associated with significant cerebral morbidity, usually manifested as cognitive decline or stroke. The underlying mechanism leading to cognitive decline is still unclear. Presence of coronary collateral arteries, which may reflect an overall better cardiovascular condition, recently appeared to relate to a better cardiac ...

BACKGROUND: Off-pump coronary artery bypass graft surgery (OPCAB) is still associated with a marked systemic inflammatory response. The aim of this study was to investigate whether pre-emptive, low dose of ketamine, which has been reported to have anti-inflammatory activity in on-pump coronary artery bypass surgery, could reduce inflammatory response in ...

BACKGROUND: When composite arterial T-grafts are used, uncertainty persists as to whether the RIMA will be long enough to reach the RCA. We present a formula for the preoperative estimation of the required conduit length. METHODS: The following formula was created to estimate the required conduit length for a sequential ...

All volatile anesthetics have cardiac depressant effects that decrease myocardial oxygen demand and may thus improve the myocardial oxygen balance during ischemia. Recent experimental evidence has clearly demonstrated that, in addition to these indirect effects, volatile anesthetic agents also directly protect from ischemic myocardial damage. Implementation of these effects during ...

Bilateral phrenic nerve palsy is an extremely rare but serious complication of open cardiac surgery. We report the case of a 78-year-old female who underwent elective aortic valve replacement and coronary artery bypass grafting under hypothermic cardiopulmonary bypass. Despite otherwise unremarkable postoperative recovery, the patient could not be weaned off ...

We report the one-stage surgical management of a 68-year-old patient with renal cell carcinoma and serious hematuria combined with coronary artery disease and unstable angina. After the accomplishment of coronary revascularization without cardiopulmonary bypass, we proceeded to nephrectomy and resection of the renal tumor at the same time. The patient's ...

This is Part II of a two-part article on treatment of acute coronary syndrome in the older population. Part I (published in the October issue of Clinical Geriatrics) analyzed the differential utilization of invasive therapies with respect to age and heart disease. Part II summarizes information from the literature on ...

BACKGROUND: We aim to present a patient with coronary-coronary bypass grafting (CCBG), left anterior descending-left anterior descending (LAD-LAD) coronary artery bypass with left internal thoracic artery (LITA), and provide the 12-year follow-up angiogram to confirm the longest reported patency. METHODS AND RESULTS: A 57-year-old man with three vessel disease where ...

OBJECTIVES: Coronary artery bypass graft surgery may result in perioperative myocardial injury during cardioplegic arrest. Angiotensin-converting enzyme (ACE) inhibitors protect the myocardium from ischemia in several clinical conditions, but no previous study has attempted to evaluate the impact of preoperative ACE inhibitor therapy on myocardial protection in patients undergoing coronary ...

BACKGROUND: Drug-eluting stents (DESs) have challenged coronary bypass grafting as the gold standard for 3-vessel coronary artery disease. This study compared the clinical results between percutaneous intervention with DESs vs off-pump coronary bypass surgery (OPCAB). METHODS: The study included 388 matched patients with 3-vessel coronary artery diseases who were treated ...

PURPOSE OF REVIEW: Off-pump coronary artery bypass (OPCAB) grafting has been increasingly adopted in an effort to prevent deleterious effects of cardiopulmonary bypass, including the associated inflammatory response, global myocardial ischemia and the risks of aortic manipulation. In many studies, the greatest benefit of OPCAB has been in high-risk patients. ...

The diffusely diseased coronary artery is a challenge for cardiac surgeons. Although coronary endarterectomy is an option for surgical reconstruction of a diffusely diseased vessel, it has not been widely used. We assessed the early clinical and angiographic outcomes of patients undergoing coronary endarterectomy of the left anterior descending artery ...

This is Part I of a two-part article on treatment of acute coronary syndrome in the older population. Part I analyzes the differential utilization of invasive therapies with respect to age and heart disease. Part II (to be published in the next issue of Clinical Geriatrics) will summarize information from ...

We report a successful surgical management of postinfarction ventricular septal perforation by infarction-exclusion technique with the on-pump beating heart approach and concomitant coronary artery bypass grafting. The identification of the suture line by direct inspection and finger palpation could be more accurate in determining contractile, thus viable myocardium supporting the ...

OBJECTIVE: To compare the effects of a bolus of milrinone, 50 microg/kg, versus placebo on flow in coronary artery bypass grafts after cardiopulmonary bypass (CPB). DESIGN: A prospective, randomized, double-blind study. SETTING: A university hospital. PARTICIPANTS: Forty-four patients with stable angina and left ventricular ejection fraction >30% scheduled for elective ...

Animal models are still essential for studying effects of cardiopulmonary bypass. We describe modifications in cannulation technique for a neonatal piglet model, which may also serve as an "everyday" technique in congenital cardiac surgery (age of animals <7 days; mean body weight 2.9 +/- 0.5 kg). Surgical approach through median ...

Many new surgical technologies are being developed, with the overall aim of improving outcomes. One common feature of many new technologies is that they offer a safer approach than previous techniques; one of the greatest forces for change over the last 30 years is risk reduction. Cardiac surgery risk has ...

Emergency surgery for acute vein graft perforation and balloon entrapment during percutaneous angioplasty is reported here. Prompt extracorporeal circulation through peripheral cannulation enabled the control of systemic perfusion despite cardiac arrest. Vein graft repair was achieved by an autologous pericardial patch. Appropriate and tailored mechanical circulatory support allowed successful extracorporeal ...