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Background: The long saphenous vein is routinely used for coronary bypass graft (CABG) surgery, and two primary techniques are commonly utilized: endoscopic vessel harvesting (EVH) and open vessel harvesting (OVH). The aim of this study was to compare the clinical outcomes of the EVH and OVH techniques used for CABG within the confines of a tertiary hospital. Methods: The clinical data of all patients subjected to either EVH or OVH for CABG surgery between 2014 and 2018 were retrospectively analyzed. Statistical analysis was performed to discern variations in the rates of postoperative complications between EVH and OVH. Results: A cohort of 1884 individuals were included in this study, 75.3% of whom underwent EVH. Notably, the incidence of postoperative leg wound complications was significantly different between the patients who underwent OVH and the patients who underwent EVH, with incidence rates of 18.6% and 32%, respectively (p < 0.001). Leg wound complications (p < 0.001; OR 1.946; 95% CI 1.528–2.477) and leg wound infections (p = 0.050, OR 1.517, 95% CI 0.999–2.303) were significantly associated with OVH. Moreover, leg wound hematoma (p = 0.039, OR = 0.402, 95% CI = 0.169–0.957) and EVH were strongly associated. Conclusions: The large sample of patients and the inclusion of a range of Asian ethnic groups provided notable insights into postoperative complications related to different modalities. EVH was associated with a lower incidence of postoperative leg wound complications, which suggests that EVH is a better modality for those undergoing CABG surgery. [ABSTRACT FROM AUTHOR]

Background: Precise identification of coronary arteries and selection of anastomotic sites are critical stages of coronary bypass surgery. Visualization of coronary arteries is occasionally challenging when the heart is covered with a thick layer of fat or scar tissue. In this paper, we review the methods to localize the coronary arteries during coronary surgery. Methods: Prior publications were searched to summarize all available methods for localization of coronary arteries during coronary surgery. Results: Five clinically recognized and three experimental techniques from the literature review are reviewed and summarized. Conclusions: Knowledge of various techniques of coronary artery identification in hard-to-see coronary arteries is an important asset in coronary surgery and especially useful during the most critical option of the most common heart surgery. [ABSTRACT FROM AUTHOR]

Objective: This review assessed evidence on the impact of prior coronary artery bypass grafting (CABG) on outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Methods: PubMed, CENTRAL, Embase, ScienceDirect, and Google Scholar databases were searched from 1st January 1980 up to 10th January 2022 for studies assessing outcomes of CTO-PCI in patients with and without prior-CABG. Results: Eight studies were included. The meta-analysis demonstrated significantly reduced odds of procedural success in patients with prior history of CABG (OR: 0.51 95% CI: 0.41, 0.64 I²=84% p<0.00001). There was a tendency of increased in-hospital mortality (OR: 1.72 95% CI: 0.97, 3.04 I²=26% p=0.06) and major adverse cardiac events (MACE) (OR: 1.30 95% CI: 0.99, 1.69 I²=0% p=0.05), along with a significantly increased risk of myocardial infarction (MI) (OR: 2.56 95% CI: 1.65, 3.97 I²=0% p<0.0001) and coronary perforation (OR: 1.52 95% CI: 1.03, 2.24 I²=70% p=0.04) in patients with history of CABG. There was no difference in the risk of stroke, pericardial tamponade, major bleeding, vascular access complications, and renal failure. Conclusion: Our results suggest that patients with prior history of CABG undergoing PCI for CTO have a 49% reduced chance of procedural success. Such patients are at an increased risk of in-hospital mortality, MACE, MI, and coronary perforation. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic has had a significant impact on global surgery. In particular, deleterious effects of SARS‐CoV‐2 infection on the heart and cardiovascular system have been described. To inform surgical patients, we performed a systematic review and meta‐analysis aiming to characterize outcomes of COVID‐19 positive patients undergoing cardiac surgery. Methods: The study protocol was registered with PROSPERO (CRD42021228533) and conformed with PRISMA 2020 and MOOSE guidelines. PubMed, Ovid MEDLINE and Web of Science were searched between 1 January 2019 to 24 February 2022 for studies reporting outcomes on COVID‐19 positive patients undergoing cardiac surgery. Study screening, data extraction and risk of bias assessment were conducted in duplicate. Meta‐analysis was conducted using a random‐effects model where at least two studies had sufficient data for that variable. Results: Searches identified 4223 articles of which 18 studies were included with a total 44 patients undergoing cardiac surgery. Within these studies, 12 (66.7%) reported populations undergoing coronary artery bypass graft (CABG) surgery, three (16.7%) aortic valve replacements (AVR) and three (16.7%) aortic dissection repairs. Overall mean postoperative length of ICU stay was 3.39 (95% confidence interval (CI): 0.38, 6.39) and mean postoperative length of hospital stay was 17.88 (95% CI: 14.57, 21.19). Conclusion: This systematic review and meta‐analysis investigated studies of limited quality which characterized cardiac surgery in COVID‐19 positive patients and demonstrates that these patients have poor outcomes. Further issues to be explored are effects of COVID‐19 on decision‐making in cardiac surgery, and effects of COVID‐19 on the cardiovascular system at a cellular level. [ABSTRACT FROM AUTHOR]

Background: The failure of the saphenous vein graft (SVG) is a critical flaw in coronary artery bypass grafting (CABG) that has been associated with bad cardiac outcomes such as the necessity to repeat coronary revascularization, recurrent angina, myocardial infarction, and mortality. Objective: To compare mid-term patency of saphenous vein graft used for revascularization of the RCA when anastomosed to Distal Right Coronary Artery (DRCA) versus Right Posterior Descending Artery (RPDA) in proximal RCA lesion in patients who underwent isolated CABG. Patients and method: 80 patients who underwent isolated CABG with saphenous vein graft utilized for revascularization of RCA with proximal lesions were enrolled. Patients had been randomly allocated into 2 groups depending on the site of RCA anastomosis. In Group A (n=40), SVG was anastomosed to DRCA, while in Group B (n=40) SVG was anastomosed to RPDA. The postoperative multislice coronary angiography (MSCT) was used for evaluation of patency of the SVGs, and the presence of graft occlusion through mid-term follow ups. Results: 30 of the 80 SVGs used for RCA revascularization were found to be occluded, whereas the remaining 50 were determined to be patent. Group A had a significantly greater mean age than Group B (p<0.05); nevertheless, no statistically significant difference between the study groups was detected in terms of cardiovascular disease risk factors (p>0.05). Group A had similar patency rates (50% patent and 50% occluded), while group B had much greater patency rates (75% patent and 25% occluded, p =0.001). Moreover, the target vessel's mean diameter was substantially greater in group A (p-value=0.001). Conclusion: The findings corroborate the hypothesis that SVG anastomosed to RPDA are more patent than those anastomosed to DRCA. [ABSTRACT FROM AUTHOR]

Objectives: To assess the improvement in left ventricular ejection fraction (LVEF) after Coronary artery bypass grafting (CABG) among patients with severe LV dysfunction. Methodology: This Quasi experimental study was conducted at Punjab Institute of Cardiology from January to June 2021. One hundred and thirty four patients of severe LV dysfunction with coronary anatomy suitable for CABG were included in the study. Assessment of LVEF was carried out with echocardiography at baseline. All patients underwent CABG under general anaesthesia and were followed-up on 15th day with repeat echocardiography. Pre-CABG and post-CABG EFs were compared and mean changes in EFs were checked for potential effect modifications with gender, diabetes, CAD duration, age and body weight. Results: The mean LVEFs before and after surgery were 23.63 ± 1.17% and 32.11 ± 1.98% respectively. Mean improvement in LVEF after CABG was 8.5 ± 2.7 % (p < 0.001, 95% CI for difference 8.0 - 8.9) and did not different significantly according to gender, diabetes, CAD duration, age and body weight (P = 0.592, 0.167, 0.506, 0.138 and 0.458 respectively). Conclusion: Patients of CAD who underwent CABG had improved post-operative LVEFs independent of evaluated potential effect modifiers. [ABSTRACT FROM AUTHOR]

We describe a 54-year-old man with neurofibromatosis type 1 who presented with a left-sided neck mass. Computed tomography demonstrated a left common carotid artery aneurysm (51 × 33 mm). Surgery was performed because of the risk of rupture. The left common carotid artery was found to be a huge aneurysmal dilatation, and the arterial wall partially collapsed and extensively adherent to the surrounding tissues. Left common carotid artery to internal carotid artery bypass grafting was performed with a reversed saphenous vein graft. Histopathological examination revealed vascular fragility of the left carotid arterial wall. [ABSTRACT FROM AUTHOR]

Background: An anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva with an interarterial course is a rare congenital anomaly. We aimed to assess midterm results after coronary artery bypass grafting (CABG) for the treatment of anomalous RCA arising from the left sinus of Valsalva.Methods: From 2008 to 2012, 16 patients underwent CABG for treatment of an anomalous origin of the RCA from the left sinus of Valsalva. Details such as risk factors, operative details, and results of multislice coronary angiography follow-up were assessed.Results: The mean age of the patients was 34.8 ± 4.68 years, and most of them were male (15 out of 16, 93.75%). They received a mean of 1.5 ± 0.87 grafts. Closure of the RCA was completed in all patients except one (15 out of 16), who developed ischemic symptoms upon closing the proximal part of the RCA. One in-hospital death occurred. Among the remaining patients, symptoms persisted in 2 out of 15. The mean follow-up time was 63.4 ± 28.6 months. All patients had patent vessels on 5-year follow-up multislice computed tomography scans, except one patient who showed RCA graft occlusion on the 1-year follow-up scan.Conclusion: The CABG of the RCA with anomalous origin can be done safely with excellent early and midterm results. Proximal RCA ligation is an essential step to the success of CABG, but intraoperative challenge testing is required to confirm the sufficiency of the internal thoracic artery graft to reperfuse the supplied territory. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Our goal was to compare the rates of in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) including death, stroke, myocardial infarction and repeat revascularization in patients with multivessel disease undergoing multiarterial (MultArt) coronary artery bypass grafting (CABG) with the left internal mammary artery/saphenous vein (LIMA/SV) CABG or percutaneous coronary intervention (PCI). METHODS: From 1 January 1993 to 31 December 2009, 12 615 consecutive patients underwent isolated primary CABG (n = 6667) with LIMA/SV (n = 5712) or MultArt (n = 955) or were treated by PCI (n = 5948) with balloon angioplasty (n = 1020), bare metal stent (n = 3242), and drug-eluting stent (n = 1686). We excluded patients with acute myocardial infarction. We matched the CABG group with the 3 PCI subgroups, and the PCI group with the 2 CABG subgroups. Multivariable analyses were used to evaluate the impact of CABG versus PCI and their subgroups on early MACCE. RESULTS: Unadjusted early MACCE were lower for MultArt (1.5%) than for LIMA/SV (4.5%, P < 0.001) and PCI (8.5%, P < 0.001). In matched analysis, CABG had lower early MACCE versus balloon angioplasty (4.7% vs 13.2%, P < 0.001), bare metal stent (4.3% vs 8.3%, P < 0.001), and drug-eluting stent (2.9% vs 5.5%, P = 0.008), as well as LIMA/SV versus PCI (4.6% vs 9.2%, P < 0.001) and MultArt versus PCI (1.8% vs 7.8%, P < 0.001). Stroke rate was similar in MultArt versus PCI (0.8% vs 0.3%, P = 0.18) but higher with LIMA/SV versus PCI (2.3% vs 0.4%, P < 0.001). In multivariable analysis, PCI (odds ratio 4.53, 95% confidence interval: 2.62-7.83; P < 0.001) and LIMA/SV (odds ratio 2.04, 95% confidence interval: 1.18-3.53; P < 0.011) were strong predictors of early MACCE compared with MultArt. [ABSTRACT FROM AUTHOR]

Stroke is a major adverse event in patients developing atrial fibrillation (AF) after cardiac surgery. Surgical left atrial appendage amputation/ligation (LAA-A/L) during off-pump coronary artery bypass grafting (OPCAB) is routinely performed in our institution. We analyzed 578 consecutive patients (mean age 69 years, male 82%) undergoing OPCAB with or without concomitant LAA-A/L from 2011 to 2014 at our institution in a prospective observational manner. The safety and efficacy of the concomitant LAA-A/L on preventing early (<30 days) and overall postoperative stroke were examined. A total of 193 patients (33.4%) underwent LAA-A/L, consisting of amputation in 154 and ligation in 39 patients (80 and 20% of the cases, respectively). Preoperative characteristics, operative time, requirement of blood transfusion, and 30-day mortality were not significantly different between those with and without LAA-A/L. The incidences of postoperative AF and early and overall stroke were not significantly different between the groups in the analysis based on a total cohort. In a subanalysis of patients without LAA-A/L, early and overall stroke occurred more frequently in those developing postoperative AF than those without AF (2.8 vs. 0%; p = 0.005, 6.2 vs. 1.5%; p = 0.017, respectively), while in patients receiving LAA-A/L, stroke incidences did not differ between those with and without AF. Multivariate logistic regression showed postoperative AF without LAA-A/L as the only independent positive predictor of overall stroke (OR 3.69, p = 0.03). Concomitant LAA-A/L with OPCAB can safely prevent postoperative stroke occurrence in case patients develop AF, the most common arrhythmia associated with stroke. [ABSTRACT FROM AUTHOR]

Background: There is an ongoing debate on the benefits and risks of off-pump coronary artery bypass grafting (CABG) surgery. The fate of patients who start with their procedure being an off-pump one and then have to undergo conversion to an onpump procedure is debated with regard to in-hospital mortality and unknown with regard to long-term survival. We investigated the in-hospital mortality and long-term survival of patients who underwent conversion from off- to on-pump surgery. Methods: We performed a multivariate and propensity analysis on in-hospital mortality and long-term survival of postisolated CABG patients in a single institution having 15,704 patients of which 5,353 who underwent off-pump CABG were analyzed. Results: In-hospital mortality was 2.15% for the study cohort, and 73 (1.4%) off-pump cases were converted. Univariate analysis demonstrated that patients undergoing conversion had a significantly increased in-hospital mortality (p < 0.001) and reduced long-term survival (p = 0.002). Logistic regression (receiver operating curve 0.77, Hosmer-Lemeshow test 0.46) and Cox analysis demonstrated that in-hospital mortality and long-term survival were not significantly affected by conversion. Propensity analysis (one:many match) demonstrated that in-hospital mortality was not significantly affected (p = 0.7), and long-term survival - univariate, and multivariate were also not significantly reduced in patients undergoing conversion. Conclusion: Conversion from off- to on-pump by a team of surgeons and anesthetists who are dedicated off-pump specialists does not have an impact on in-hospitalmortality or long-term survival. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to investigate health-related quality of life (QOL) an the impact of demographic factors after bypass grafting (BG) in patients with critical limb ischemia (CLI). Material and Method: A total of 33 patients with CLI underwent BG over a period of 18 months. Quality of life data were collected before and three months after BG with the Short-Form 36 (SF-36) questionnaire. Demographic data and information about the disease presentation were evaluated with another form. Results: There were 32 male patients and one female patient. The SF-36 questionnaire was completed by all patients before and after BG. There was an improvement in all categories of QOL, and statistically significant changes were observed in the pain and physical role restriction subdomains after the operation (p=0.020 and p=0.012, respectively). Education level was found to be associated with post-operative pain. The attitude of the patient after diagnosis (quitting smoking, obeying diet and regularly taking medicine) affected post-operative physical function, energy, general health and emotional role restriction. Proximal artery interventions (aorto-femoral, ilio-femoraland cross-femoral) resulted in more improvements in pain and mental health subdomains than distal interventions (femoropopliteal and crural) (p=0.027 and p=0.017, respectively). Conclusion: Most patients with CLI smoked and had low or intermediate income. Pain and physical role restriction, which are subdomains of QOL, were improved by BG, and post-operative pain was affected by the education level of the patient. Proximal interventions were related with better QOL. [ABSTRACT FROM AUTHOR]

Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral artery disease, but minimal data exist comparing outcomes performed at and below the knee. The purpose of this study was to compare outcomes following infrageniculate lower extremity open bypass (LEB) versus peripheral vascular intervention (PVI) in patients with critical limb ischemia. Using data from the 2008–2014 Vascular Quality Initiative, 1-year primary patency, major amputation, and mortality were compared among all patients undergoing LEB versus PVI at or below the knee for rest pain or tissue loss. Overall, 2566 patients were included (LEB=500, PVI=2066). One-year primary patency was significantly worse following LEB (73% vs 81%; p<0.001). One-year major amputation (14% vs 12%; p=0.18) and mortality (4% vs 6%; p=0.15) were similar regardless of revascularization approach. Multivariable analysis adjusting for baseline differences between groups confirmed inferior primary patency following LEB versus PVI (HR 0.74; 95% CI, 0.60–0.90; p=0.004), but no significant differences in 1-year major amputation (HR 1.06; 95% CI, 0.80–1.40; p=0.67) or mortality (HR 0.71; 95% CI, 0.44–1.14; p=0.16). Based on these data, we conclude that endovascular revascularization is a viable treatment approach for critical limb ischemia resulting from infrageniculate arterial occlusive disease. [ABSTRACT FROM AUTHOR]

We investigate the dynamics of a bypass in terms of determining the optimal parameters of shunt operation. The equations that describe the propagation of pressure pulse waves in blood vessels are presented in differential form and in approximate form for the averaged values based on the conservation laws. The correspondence of these forms is shown from the solution of the initial-boundary-value problem for vascular junction. The influence of the parameters such as various diameters, wall thicknesses, and elastic properties of blood vessels on the shunt effectiveness is investigated. In particular, we investigate the influence of the shunt form and junction area, as well as the angle of the shunt connection with the vessel, on the passage of the coronary vessels and blood coagulation. On the basis of the calculations, conclusions about the influence of various parameters on the dynamics of bypass are made. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of increased fibrinolysis after coronary artery bypass grafting (CABG). Study Design: Descriptive study. Place and Duration of Study: One year duration conducted in the Department of Pathology, Army Medical College in collaboration with Armed Forces Institute of Cardiology (AFIC) from December 2013 to November 2014. Material and Methods: Sixty patients were selected who were admitted to AFIC for CABG surgery. Venous samples were drawn from the patients immediately after surgery when the patients were shifted to post operative ward. Patients were selected by non probability purposive sampling technique. D-dimers were analysed by rapid agglutination assay. Results: Out of 60 patients included in the study, 50 (83.3%) were males and 10 (16.7%) were females. Ddimers level more than 200ng/ml were considered to show increased fibrinolysis. Raised D-dimers were present in 40 (66.6 %) patients while they were normal in 20 (33.3 %) patients.Twenty (33.3%) patients had Ddimers< 200ng/ml, 27 (45%) patients had D-dimers between 200-400ng/ml, 7 (11.7%) patients had D-dimers between 400-800ng/ml and 6 (10%) had D-dimers between 800-1600ng/ml. Conclusion: Increased fibrinolysis was present in 40 (66.7%) patients. It is more common in older age than younger ones. [ABSTRACT FROM AUTHOR]

Aim To evaluate the usefulness of echocardiography in the diagnosis of complete rupture of papillary muscle. Methods Transthoracic (TTE) and transesophageal echocardiography (TEE) was performed with the ATL 3000 HDI Ultrasound Inc (Bothell, WA, USA) with a 2.5 MHz transducer and 5-7 MHz multiplane phased array transducer. We are reporting about two patients (a 45 and a 51-year old male) with complete ruptures of papillary muscle following acute myocardial infarction (AMI). Results Both patients were previously treated with fibrinolysis in their local hospitals, 400 and 300 km, respectively, away from our hospital. Massive mitral regurgitation developed in both followed by rapid deterioration of hemodynamic state and severe heart failure, because of which both were transferred by helicopter to the Coronary Care Unit of our clinic. The diagnosis of complete papillary muscle rupture was confirmed in both patients by TTE and TEE. Due to the significant deterioration in their hemodynamic state, vasoactive drugs and intra-aortic balloon pump support were applied. Both patients then underwent mitral valve replacement, accompanied by concomitant coronary artery bypass grafting in one case. Conclusion Transesophageal echocardiography is a more accurate and rapid diagnostic method in patients with mechanical complications of AMI than TTE. Cilj Procijeniti korisnost ehokardiografije u dijagnostici kompletne rupture papilarnog mišića. Metode Za transtorakalnu (TTE) i transezofagusnu ehokardiografiju (TEE) korišten je aparat ATL 3000 HDI Ultrasound Inc. (Bothell, WA, USA), sondama od 2,5 MHz i od 5 do 7 MHz. Opisana su dva muška bolesnika u dobi 45 i 51 godine s kompletnom rupturom papilarnog mišića u akutnom infarktu miokarda (AIM). Rezultati Oba bolesnika liječena su trombolitičkom terapijom zbog AIM-a u dvije lokalne bolnice udaljene 400, odnosno 300 km. Zbog masivne mitralne regurgitacije koja je uzrokovala hemodinamsku nestabilnost i zatajivanje srca teškog stupnja bolesnici su helikopterom transportirani u koronarnu jedinicu naše Klinike. Dijagnozu kompletne rupture papilarnog mišića potvrdili smo u oba bolesnika pomoću TTE-a i TEE-a. Zbog teškog općeg stanja i hemodinamske nestabilnosti bolesnici su primali vazoaktivu terapiju i priključeni su na intraaortalnu balon-crpku. U oba bolesnika implantirana je umjetna mitralna valvula, a aortokoronarno premoštenje učinjeno je u jednog bolesnika. Zaključak Transezofagusna ehokardiografija u odnosu na TTE je točna i brza dijagnostička metoda u bolesnika s mehaničkim komplikacijama u akutnom infarktu miokarda. [ABSTRACT FROM AUTHOR]

Coronary artery ectasia ( CAE) or aneurysm is usually defined as dilation ≥1.5-fold the normal vessel diameter. It has an incidence of 1.4-5.3% and is associated with a wide variety of etiologies-mainly congenital, atherosclerotic, and inflammatory ones. CAE is very common in sickle cell disease, and possibly sickle cell trait, with an incidence of 17.7%. It is likely related to the inflammatory process associated with hemoglobin S. Prognosis depends mainly on the underlying etiology. Atherosclerotic CAE does not carry additional risks compared to atherosclerotic coronary artery disease ( ACAD) without ectasia. However, isolated CAE in the absence of ACAD carries an increased risk of myocardial infarction ( MI) due to vasospasm, slower coronary blood flow, and thrombosis, typically within the dilated segments. Due to lack of studies and guidelines, management recommendations are based on personal experiences. Therapy should be tailored to each individual case after assessment of severity, history of complications, underlying etiology, and comorbidities. Treatment of underlying condition and avoidance of exacerbating factors are essential. Medical therapy in general may include antiplatelets, β-blockers, angiotensin-converting enzyme inhibitors statins, and dihydropyridine calcium channel blockers. In severe CAE or history of MI, the addition of anticoagulation therapy after assessing bleeding risk may be warranted. In acute MI, the large thrombus burden in the dilated segment makes the percutaneous approach very challenging. Aspiration attempts can result in distal thromboembolization. Survival is better in bypass grafting than with medical therapy. Nonetheless, bypass grafting does not improve survival in atherosclerotic CAE. Depending on the physical characteristics of aneurysm, different surgical approaches can be sought; however, the ideal one is unclear. [ABSTRACT FROM AUTHOR]

Cystic adventitial disease (CAD) of the popliteal artery is a rare vascular disorder in which a mucin-containing cyst develops in the adventitial layer of the artery. We report two such cases, each of which was treated differently. The first case was of a 49-year-old man, treated by excision of the involved arterial segment and interposition of an autologous saphenous vein graft. The second case was of a 36-year-old man, treated by local excision of the affected arterial segment and interposition with prosthetic bypass grafting. Both patients presented with rapidly progressing intermittent claudication of the lower extremities, but without remarkable evidence of atherosclerotic disease. Physical examination revealed diminished or absent popliteal, posterior tibial and dorsalis pedis pulses in the lower extremities. Color Doppler ultrasound of the popliteal artery revealed hypoechoic cystic lesions surrounding the vessel, and popliteal arterial stenosis, in both patients. Surgery resulted in immediate improvement of the arterial pulse distal to the lesion. Both patients recovered uneventfully. Thus, resection of the involved artery segment and interposition bypass grafting, using either patient or prosthetic veins, offers favorable results for CAD of the popliteal artery. [ABSTRACT FROM AUTHOR]

We report a case of axillary artery aneurysm with brachial artery embolism in a 60-year-old man who had walked with the assistance of axillary crutches all of his life since poliomyelitis during infancy had left him with lower limb paralysis. We performed bypass grafting from the axillary to brachial artery with exclusion of the aneurysm. An axillary artery aneurysm is rare, but potentially lethal for the upper extremity; therefore, surgical treatment should be considered. [ABSTRACT FROM AUTHOR]

Purpose: In this study we evaluated the diagnostic performance of Tc-HMPAO-leucocyte (Tc-HMPAO-WBC) scintigraphy in a consecutive series of 55 patients (46 men and 9 women, mean age 71 ± 9 years, range 50 - 88 years) with a suspected late or a low-grade late vascular prosthesis infection (VPI), also comparing the diagnostic accuracy of WBC with that of other radiological imaging methods. Methods: All patients suspected of having VPI underwent clinical examination, blood tests, microbiology, US and CT, and were classified according to the Fitzgerald criteria. A final diagnosis of VPI was established in 47 of the 55 patients, with microbiological confirmation after surgical removal of the prosthesis in 36 of the 47. In the 11 patients with major contraindications to surgery, the final diagnosis was based on microbiology and clinical follow-up of at least 18 months. Results: Tc-HMPAO-WBC planar, SPECT and SPECT/CT imaging identified VPI in 43 of 47 patients (20 of these also showed infection at extra-prosthetic sites). In the remaining eight patients without VPI, different sites of infections were found. The use of SPECT/CT images led to a significant reduction in the number of false-positive findings in 37 % of patients (sensitivity and specificity 100 %, versus 85.1 % and 62.5 % for stand-alone SPECT). Sensitivity and specificity were 34 % and 75 % for US, 48.9 % and 83.3 % for CT, and 68.1 % and 62.5 % for the FitzGerald classification. Perioperative mortality was 5.5 %, mid-term mortality 12 %, and long-term mortality 27 %. Survival rates were similar in patients treated with surgery and antimicrobial therapy compared to patients treated with antimicrobial therapy alone (61 % versus 63 %, respectively), while infection eradication at 12 months was significantly higher following surgery (83.3 % versus 45.5 %). Conclusion: Tc-HMPAO-WBC SPECT/CT is useful for detecting, localizing and defining the extent of graft infection in patients with late and low-grade late VPI with inconclusive radiological findings. Tc-HMPAO-WBC SPECT/CT might be used to optimize patient management. [ABSTRACT FROM AUTHOR]

BACKGROUND: Atrial fibrillation occurs after approximately 25% to 45% of coronary artery bypass graft (CABG) surgeries. Oxidative stress and related electrophysiological remodeling has been proposed as a potential cause of this atrial fibrillation. Perioperative supplementation of the antioxidant ascorbic acid has been evaluated as a preventive agent. The current investigation was conducted to evaluate the efficacy of ascorbic acid in reducing atrial fibrillation in CABG patients. METHODS: A prospective, randomized, placebo-controlled, triple-blind, single-institution study was conducted in nonemergency CABG patients. Subjects were monitored for episodes of arrhythmia and other complications. RESULTS: Eighty-nine treatment and 96 control subjects completed the study protocol. Demograph-ics, comorbidities, and preoperative drugs were similar between groups. Surgical characteristics and postoperative medication use also were similar. The incidence of atrial fibrillation was 30.3% in the treatment group and 30.2% in the control group (P = .985). No difference was found in postoperative complications or mortality. CONCLUSIONS: Our data indicate that supplementation of ascorbic acid in addition to routine postoperative care does not reduce atrial fibrillation after coronary artery bypass grafting. [ABSTRACT FROM AUTHOR]

We herein report the case of a patient demonstrating both coronary artery and peripheral artery occlusive disease with neurofibromatosis, which were successfully treated during the same session with coronary artery bypass graft surgery and a femoropopliteal bypass graft surgery procedure. The recognition of a possible association between neurofibromatosis and coronary artery and other vascular structures will further facilitate the successful surgery and clinical management of this rare clinical entity. [ABSTRACT FROM AUTHOR]

Background: In patients with stable coronary artery disease, there are very few studies that compare the value of optimal medical therapy with revascularization therapy in reducing the risk of cardiovascular events. Aim: To compare three therapeutic options for stable angina pectoris: percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medication alone. Methods: We studied 98 randomized patients with stable angina pectoris who underwent coronarography and had objective evidence of significant coronary disease. We assigned 36 patients to undergo PCI, 28 patients to undergo CABG, both subgroups with optimal medical therapy, and 34 patients with optimal medical therapy alone. Primary outcomes were cardiac death and non fatal myocardial infarction, during a follow-up period of 3 years. Results: There were 3 primary events in the medical-therapy group, 1 event in the CABG group and 1 event in the PCI group. The 3-year cumulative primary-event rates were 2.8% in the PCI group, 3.6% in the CABG group and 11.8% in the medical-therapy group (P = 0.16). Conclusion: In patients with disabling stable angina pectoris without high-risk criteria, the revascularization has the advantage of improving the long-term quality of life. In some patients with high-risk criteria, the percutaneous coronary intervention using drug-eluting stents can be a viable alternative to surgical revascularization. [ABSTRACT FROM AUTHOR]

During the last decade, minimized extracorporeal circulation (MECC) systems have shown beneficial effects to the patients over the conventional cardiopulmonary bypass (CECC) circuits. This is a prospective randomized study of 99 patients who underwent coronary artery bypass grafting (CABG) surgery, evaluating the postoperative haematological effects of these systems. Less haemodilution (p=0.001) and markedly less haemolysis (p<0.001), as well as better preservation of the coagulation system integrity (p=0.01), favouring the MECC group, was found. As a clinical result, less bank blood requirements were noted and a quicker recovery, as far as mechanical ventilation support and ICU stay are concerned, was evident with the use of MECC systems. As a conclusion, minimized extracorporeal circulation systems may attenuate the adverse effects of conventional circuits on the haematological profile of patients undergoing CABG surgery. [ABSTRACT FROM AUTHOR]

We describe successful anesthetic management during living-donor liver transplantation in a 63-year-old man with previous coronary artery bypass grafting (CABG) that employed an in situ right gastroepiploic artery (RGEA). Anesthesia was maintained with 1.5% isoflurane in air/oxygen and fentanyl. A five-lead electrocardiogram, transesophageal echocardiogram, and pacing pulmonary artery catheter evaluated cardiac function. A pacing wire was inserted through the catheter to prepare for intraoperative severe bradyarrhythmia. Olprinone and nicorandil were continuously infused to prevent decrease in coronary arterial blood flow and the collapse of cardiac function. Avoiding disruption of circulation to coronary arteries through injury or spasm of the RGEA graft and preparing for cardiac insufficiency during liver transplantation of a patient with previous CABG using an in situ RGEA is critical. [ABSTRACT FROM AUTHOR]

Abstract: Vascular smooth muscle cell (VSMC) proliferation remains a major cause of veno-arterial graft failure. We hypothesised that exposure of venous SMCs to arterial pressure would increase KLF5 expression and that of cell cycle genes. Porcine jugular veins were perfused at arterial or venous pressure in the absence of growth factors. The KLF5, c-myc, cyclin-D and cyclin-E expression were elevated within 24h of perfusion at arterial pressure but not at venous pressure. Arterial pressure also reduced the decline in SM-myosin heavy chain expression. These data suggest a role for KLF5 in initiating venous SMCs proliferation in response to arterial pressure. [Copyright &y& Elsevier]

Abstract: Cardiovascular disease continues to be the leading cause of death worldwide, and the prevalence of cardiovascular disease has reached epidemic proportions worldwide. Not surprisingly this has led to an increasing number of vascular procedures annually. Unfortunately, the success of these procedures over time continues to limit their long-term effects. Biomedical engineering approaches to improve upon current prosthetic grafts, developing new prosthetic grafts, and creating tissue engineered blood vessels for clinical application offer hope of improving the durability of vascular interventions and improving patients’ treatment for cardiovascular disease. [Copyright &y& Elsevier]

Perioperative risk during coronary artery bypass grafting (CABG) is high in patients with chronic renal disease. We aimed to determine postoperative two-year mortality and identify the preoperative risk factors of mortality during CABG surgery in hemodialysis (HD)-dependent and HD-non-dependent CRF patients. We included 102 CRF patients who underwent CABG in Baskent University Hospital between 2000 and 2005. There were 47 patients with CRF undergoing HD (Group I) and 55 CRF patients without dialysis requirement (Group II). We retrospectively retrieved demographic variables; clinical, operative, and echocardiographic data; and biochemical parameters at the time of the operation and six months postoperation. Postoperative HD requirement in Group II patients and infectious complications were recorded. In the second postoperative year, mortality rate was 27.7% in group I and 16.4% in group II (p > .05). When preoperative risk factors evaluated by univariate Cox analysis, only age (RR = 1.06, p = .04) was a significant determinant of survival in Group I patients. Among the operative and postoperative risk factors of mortality such as duration of operation, numbers of coronary vessel bypass, HD requirement, and infection were investigated in Group I and II patients. Rate of infectious complication (including mediastinitis) was found to be a major determinant of mortality by multivariate Cox analyses in both group I (RR = 4.42, p ≤ .05) and group II (RR = 9.39, p ≤ .05). HD dependency did not increase mortality if the patients are younger and were electively prepared for CABG surgery. High infection rates have increased the postoperative mortality and hospitalization in CRF patients. Early diagnosis of infections in CRF patients is important for early recovery, shorter hospitalization, and lower mortality after CABG operation [ABSTRACT FROM AUTHOR]

The poor patency rates for coronary artery bypass grafting (CABG) using autologous saphenous vein necessitate the need for continued research into the potential clinical utility of gene therapy. Bypass grafting is ideally suited for gene therapy, as graft can be genetically modified ex vivo prior to grafting in the coronary vasculature. Research to date has demonstrated effective blockade of late vein graft failure through overexpression of a variety of transgenes that modulate the proliferative, migratory and/or apoptotic indexes of cells in the graft wall. This has resulted in a substantial wealth of preclinical data that support advancement to clinical trials. Future translation into clinical trials will ensure that this exciting and highly relevant area of gene therapy is fully evaluated for potential routine clinical practice to improve patency rates of bypass graft procedures involving saphenous vein. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Operation for aortic recoarctation and/or residual hypoplastic arch represents a surgical challenge because of surrounding scar tissue in the coarctation area, hazard of spinal cord ischemia due to aortic cross-clamping, laceration of the recurrent nerve, and the choice of the best approach. We demonstrate the results of 52 operations of an extra anatomically bypass technique via right thoracotomy approach without establishment of cardiopulmonary bypass. Methods: Since 1987, 52 patients underwent extra anatomically positioned ascending–descending bypass grafting. Indication was aortic recoarctation with concomitant hypoplastic aortic arch (45 patients), atypical coarctation of aortic arch (2 patients), congenital anomalies of aortic arch (2 patients) and concomitant aortic coarctation and associated cardiac problems that required surgical repair (2 patient), infected stent-graft of descending aorta (1 patient). Mean age was 19.3 years. Systolic pressure gradients at rest ranged from 35 to 90mmHg; upper extremity hypertension was present in all patients. Operative technique consisted of performing aorta ascending–descending bypass graft size 16 or 18mm in diameter, via right thoracotomy (in 51 patient) or sternotomy (in 1 patient). Results: The mortality rate was 1.9% (1/52). Five patients returned to the operating room (in 3–5 days after operation) for a lymphorrhea complication. An arterial pressure gradient in the limbs was totally corrected. During a follow-up period of actually 79±54 months, no adverse event was noticed and antihypertensive medication was stopped in all patients. Conclusions: Ascending-to-descending aortic bypass via right thoracotomy is a safe and effective method for management complex (re-) coarctation and hypoplastic aortic arch. [Copyright &y& Elsevier]

The purpose of this study was to ascertain the amount of in-hospital social support received by coronary artery bypass grafting patients and the impact of this support on their feelings of fear and anxiety. As adapted from Kahn''s theory, social support was understood as emotional, informational and tangible support. The bypass grafting fear scale was developed to measure the fear, and the hospital anxiety and depression scale and the state anxiety inventory were used to measure the anxiety. Data were collected pre-operatively with a questionnaire from in-patients (N=193) and analysed using logistic regression analysis and one-way ANOVA. The majority of patients received plenty of social support from nurses and a great deal of multiprofessional counselling. When the amount of social support was high, patients experienced lower levels of fear and anxiety. It is concluded that social support from nurses can effectively reduce pre-operative fear and anxiety, but that the amount of support should be high. [Copyright &y& Elsevier]

Objective To summarize the clinical experience, operation indicators and curative effect of 142 cases of coronary artery bypass grafting (CABG) surgery. Methods We retrospectively analyzed the clinical data of 142 cases of CABG from January 2012 to July 2013 in the Department of Cardiovascular Surgery of Affiliated Yan 'an Hospital of Kunming Medical University. The patients included 92 cases of male, 50 cases of female, aged 24 to 78 years old, average (59.5 ± 5.8) gears. Surgery was performed within the thoracic artery on the left of the left anterior descending branch and right coronary artery and convolution using great saphenous vein arterial anastomosis, treatment of valvular disease and aneurysm at same period, the average bypass 3.89/person. Results Two patients died after the operation, the motality rate was 1.41%. Postoperative complications included low cardiac arrhythmia, cardiac, renal insufficiency, respiratory failure, cerebral infarction/cerebral hemorrhage, open chest again stop bleeding, poor healing of incision, the incidence was 11.2%. The hospital total cost was (68.9 ± 23.4) thousand yuan per patient, the postoperative follow-up time was (8.9 ± 8.9) months, the follow-up rate was 96%, the postoperative patients were reviewed by echocardiography, suggesting left ventricular end-diastolic diameter and left ventricular ejection fraction were improved by different degrees. Conclusion Application of the mulitivessel transplantation methods can reduce the surgical mortality improve the cardiac function and decrease the hospital costs of patients. [ABSTRACT FROM AUTHOR]

Background Aberrant internal carotid artery (aICA) is an anatomic anomaly whereby the internal carotid artery courses through the tympanic cavity without separation by bone. Because aICA is rare, there are no definite treatment strategies for aICA and its complications. Case Description We report a case of aICA accompanied by pseudoaneurysm formation and massive bleeding. The patient was a 31-year-old woman with a 2-year history of hearing loss, ear fullness, and pulsatile tinnitus in her left ear. After a diagnosis of otitis media with effusion, she underwent a myringotomy and massive arterial bleeding occurred. After the bleeding was temporarily stopped, aICA and pseudoaneurysm formation on the aICA were shown. To prevent rebleeding, we performed endovascular internal trapping around the pseudoaneurysm after performing common carotid artery to radial artery to middle cerebral artery bypass grafting. After surgery, the aneurysm disappeared. In addition, no new neurologic complications were observed, and the patient's hearing improved and the tinnitus diminished. Conclusions This is the first case report of an aICA complicated by pseudoaneurysm formation successfully treated with simultaneous endovascular trapping and high-flow bypass in a hybrid operating room. [ABSTRACT FROM AUTHOR]

Abstract: We present the case of a 53-year-old man who underwent a total arch replacement for descending thoracic aortic aneurysm of distal anastomosis site after bypass grafting for coarctation of the aorta at 26 years of age. [Copyright &y& Elsevier]