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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]

Purpose: To investigate the characteristics of cerebral perfusion and hemodynamics of bypass grafting in the treatment of moyamoya disease (MMD) using the iFlow color-coded flow map in comparison with magnetic resonance imaging–perfusion-weighted imaging (MRI–PWI) and computational fluid dynamic (CFD) analysis. Materials and Methods: Patients with MMD treated with bypass grafting who had undergone MRI PWI and digital subtraction angiography for iFlow color-coded map was retrospectively enrolled and CFD was performed for calculating the hemodynamic stresses around the bypass grafting. Results: Forty-five patients with unilateral MMD treated with bypass surgery were enrolled. The bypass surgery was successful in all patients, with no severe neurological complications during the periprocedural period. Followed up for 4–12 months (median 5.5), the neurological function was good in all patients. The cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP) were significantly (p < 0.05) improved in the middle cerebral artery distribution area on the surgical side before and after vascular bypass, and the difference of TTP (s) measured from the proximal bifurcation of common carotid artery to the confluence of sinus was also significant (p < 0.05). A significant (p < 0.05) positive correlation existed in the perfusion parameters between the iFlow blood perfusion and the MRI–PWI perfusion, with r -value for TTP of 0.765 (p < 0.01). The iFlow color-coded blood flow map showed warm color changes on the diseased side, similar to those on the contralateral side. In CFD analysis, the hemodynamic stresses were all improved, in and around the bypass grafting and distal vessels, which were beneficial to blood flow entering distal arterial branches. Conclusion: The iFlow color-coded flow map can be used to analyze cerebral perfusion after bypass grafting for MMD, similar to MRI–PWI, and CFD can be used to analyze the hemodynamics after bypass grafting, revealing improved hemodynamics to promote blood flow entering distal arteries. [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 Pseudoaneurysms (PSAs) of native coronary arteries are rare but potentially lethal complications occurring after coronary artery graft anastomosis mainly secondary to median sternotomy. Case summary A 61-year-old man underwent coronary artery bypass grafting because of stable angina. After the surgery, the patient was asymptomatic. A routine pre-discharge transthoracic echocardiogram was performed showing a haematoma of the apex partially involving the right ventricle with systolic colour Doppler flow going from the left ventricle to the pericardium. A coronary computed tomography scan was ordered and it revealed the presence of a PSA of the left anterior descending (LAD) artery distal to the graft anastomosis with the left internal mammary artery. An off-pump direct suture of the LAD injury through a redo sternotomy was successfully performed. Discussion The development of a PSA of a native coronary artery after bypass grafting is a very rare and potentially fatal condition. A correct and prompt diagnosis is crucial to avoid lethal complication. [ABSTRACT FROM AUTHOR]

Background Patients undergoing on-pump coronary artery bypass grafting (CABG) are at increased risk of perioperative bleeding and morbidity associated with transfu- sion as a result of acquired and pharmacologically induced impaired platelet function. Settings and Design In this a prospective observational study where 52 patients underwent on-pump CABG were analyzed with ROTEM platelet aggregometry. Materials and Methods Patients were assigned to the “nonexcessive” and “exces- sive” postoperative bleeding groups according to the postoperative chest tube drainage over 24 hours. Platelet function was assessed by ROTEM platelet using three different activators (arachidonic acid, adenosine diphosphate, and thrombin receptor- activating peptide), at two perioperative time points (T1, before heparinization and T2, 5–10 minutes after protamine administration). Results There were no differences regarding demographic, pre–cardiopulmonary bypass (CPB) platelet count and antiplatelet therapy. Platelet function was impaired over the time course in all parameters with three different activators. At T2 point, area under the curve (AUC) of all the three platelet indices, that is, TRAPTEM, ARATEM, and ADPTEM, showed significant difference between excessive and nonexcessive groups. At both T1 and T2 points, the amplitude after 6 minutes (A6) and maximum slope (MS) parameters of TRAPTEM, ARATEM, and ADPTEM tests were not significantly different in excessive and nonexcessive groups. At T1 point, AUC was also not significantly different in all three ROTEM platelet tests. Results after protamine administration showed correlation with postoperative chest tube drainage. Cut-off values, as determined by receiver operating characteristics (ROC) analyses, had a consistently weak positive predictive value for all tests at T2 time point, whereas negative predictive values were higher. Conclusion Platelet function analysis using ROTEM platelet can help to exclude platelet dysfunction as the reason for bleeding after cardiac surgery. Point-of-care platelet function analysis, particularly in combination with viscoelastic testing can reduce perioperative bleeding and transfusion requirements, as well as improve patient outcomes in cardiac surgery. [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]

The great saphenous vein (GSV) has served as a coronary artery bypass graft (CABG) conduit for over 50 years. Despite prevalent use, first-year failure rates remain high compared to arterial autograft options. Amongst other factors, vein graft failure can be attributed to material and mechanical mismatching that lead to apoptosis, inflammation, and intimal-medial hyperplasia. Through the implementation of the continuum mechanical-based theory of "stress-mediated growth and remodeling," we hypothesize that the mechanical properties of porcine GSV grafts can be favorably tuned for CABG applications prior to implantation using a prolonged but gradual transition from venous to arterial loading conditions in an inflammatory and thrombogenic deficient environment. To test this hypothesis, we used a hemodynamic-mimetic perfusion bioreactor to guide remodeling through stepwise incremental changes in pressure and flow over the course of 21-day cultures. Biaxial mechanical testing of vessels pre- and post-remodeling was performed, with results fit to structurally-motivated constitutive models using non-parametric bootstrapping. The theory of "small-on-large" was used to describe appropriate stiffness moduli, while histology and viability assays confirmed microstructural adaptations and vessel viability. Results suggest that stepwise transition from venous-to-arterial conditions results in a partial restoration of circumferential stretch and circumferential, but not axial, stress through vessel dilation and wall thickening in a primarily outward remodeling process. These remodeled tissues also exhibited decreased mechanical isotropy and circumferential, but not axial, stiffening. In contrast, only increases in axial stiffness were observed using culture under venous perfusion conditions and those tissues experienced moderate intimal resorption. [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]

Purpose: To report the outcomes of bypass grafting (BG) vs endovascular therapy (EVT) in patients with non-dialysis-dependent chronic kidney disease (CKD) and chronic limb-threatening ischemia (CLTI). Materials and Methods: The CRITISCH Registry is a prospective, national, interdisciplinary, multicenter registry evaluating the current practice of all available treatment options in 1200 consecutive CLTI patients. For the purposes of this analysis, only the 337 patients with non-dialysis-dependent CKD treated by either BG (n=86; median 78 years, 48 men) or EVT (n=251; median age 80 years, 135 men) were analyzed. The primary composite outcome was amputation-free survival (AFS); secondary outcomes were overall survival (OS) and amputation-free time (AFT). All outcomes were evaluated in Cox proportional hazards models; the results are reported as the hazard ratio (HR) and 95% confidence interval (CI). Results: The Cox regression analysis revealed a significantly greater hazard of amputation or death after BG (HR 1.78, 95% CI 1.05 to 3.03, p=0.028). The models for AFT and overall survival also suggested a higher hazard for BG, but the differences were not significant (AFT: HR 1.66, 95% CI 0.78 to 3.53, p=0.188; OS: HR 1.41, 95% CI 0.80 to 2.47, p=0.348). The absence of runoff vessels (HR 1.73, 95% CI 1.15 to 2.60, p=0.008) was associated with a decreased AFS. The likelihood of amputation was higher in male patients (HR 2.21, 95% CI 1.10 to 4.45, p=0.027) and was associated with a lack of runoff vessels (HR 1.95, 95% CI 0.96 to 3.95, p=0.065) and myocardial infarction (HR 3.74, 95% CI 1.23 to 11.35, p=0.020). Death was more likely in patients without runoff vessels (HR 1.76, 95% CI 1.11 to 2.80, p=0.016) and those with a higher risk score (HR 1.73, 95% CI 1.03 to 2.91, p=0.038). Conclusion: This analysis suggested that BG was associated with poorer AFS than EVT in patients with non-dialysis-dependent CKD and CLTI. Male sex, previous myocardial infarction, and the absence of runoff vessels were additionally identified as predictors of poorer outcomes. [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]

Stroke and other ischemic neurological events are among the most dreaded adverse events following cardiac surgery. The stroke risk in patients undergoing coronary artery bypass graft surgery (CABG) is estimated at 2%. We performed a retrospective analysis of patients with and without severe carotid artery disease who were scheduled for CABG to determine what variables were associated with severe carotid artery stenosis. This is a case control study. 49 patients with carotid stenosis =70% identified by duplex ultrasound and coronary artery disease (CAD) scheduled for CABG at the University Hospital Centre "Mother Theresa" were matched by age and gender with 49 patients with carotid stenosis <50%. In univariate analysis, a statistically significant difference was found between cases and controls regarding the CAD extent (p=0.03), hypertriglyceridemia (p<0.001) and carotid bruit (p<0.001). In multivariate analysis by logistic regression, independent risk factors associated with stenosis were smoking (p=0.03) and carotid bruit (p<0.001). All patients with CAS should have medical management that includes control of hypertension, cholesterol levels, and diabetes, administration of antiplatelet agents, and smoking cessation. [ABSTRACT FROM AUTHOR]

Purpose: To examine the outcomes of all first-line strategies for the treatment of critical limb ischemia (CLI), identify factors that influenced the treatment choice, and determine the risk of amputation or death after each treatment. Methods: CRITISCH (ClinicalTrials.gov identifier NCT01877252) is a multicenter, national, prospective registry evaluating all available treatment strategies applied in 1200 consecutive CLI patients in 27 vascular centers in Germany. The recruitment started in January 2013 and was completed in September 2014. Treatment options were endovascular revascularization (642, 53.5%), bypass surgery (284, 23.7%), femoral artery patchplasty (126, 10.5%) with or without concomitant peripheral intervention, conservative treatment (118, 9.8%), and primary major amputation (30, 2.5%). The primary endpoint of this study was amputation-free survival (AFS). The Society of Vascular Surgery's suggested objective performance goal (OPG) for AFS (71%) was used as the effectiveness criterion. Multivariable regression methods were employed to identify variables that influenced the treatment selection and AFS after each treatment; results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results: The 12-month AFS estimates following endovascular therapy, bypass grafting, femoral patchplasty, and conservative treatment were 75%, 72%, 73%, and 72%, respectively. Factors influencing treatment choice were age, chronic kidney disease (CKD), diabetes, smoking, prior vascular procedures in the index leg, TransAtlantic Inter- Society Consensus II C/D lesions, and absence of runoff vessels. Cox regression analysis identified CKD (HR 2.07, 95% CI 1.26 to 3.41, p=0.004), the use of a prosthetic bypass conduit (HR 1.97, 95% CI 1.23 to 3.14, p=0.004), and previous vascular intervention in the index limb (HR 1.52, 95% CI 0.94 to 2.43, p=0.085) as independent risk factors for diminished AFS after bypass surgery. CKD (HR 1.47, 95% CI 1.09 to 1.99, p=0.012) and Rutherford category 6 (HR 1.81, 95% CI 1.30 to 2.52, p<0.001) compromised the performance of endovascular revascularization. Conclusion: CRITISCH registry data revealed that all first-line treatment strategies selected and indicated by the treating physicians met the suggested OPGs. CKD was an important determinant of patient prognosis after treatment regardless of the revascularization method. [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]

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]

Objectives: First external validation of a preoperative scoring system (Guy's) in patient selection for femoro-distal bypass grafting to single calf or pedal artery in critical limb ischemia (Fontaine III & IV/Rutherford grade IV, V & VI).Material and Methods: A prospective study of 76 (n = 76) consecutive femoro-crural/pedal bypass grafts on 72 individuals (n = 72) from 2008 to 2011 with 36 months mean follow-up was performed. All cases were scored against a previously designed and published scoring system (ranging from 0 to 10) based on: inflow, outflow, graft material, flow type, patent pedal vessels and diabetes mellitus.Results: Preoperative score of 0-4 (n = 37) demonstrated the primary patency of 27% at 10.3 months. This value for intermediate group 5-7 (n = 34) was 70.6% at 18.9 months. The high-score group 8-10 (n = 4) showed the longest primary patency (80%) at 27.3 months. Kaplan-Meier survival analysis exhibited a consistent and significant difference in primary assisted, secondary patency and overall limb/foot salvage amongst all individual scoring groups (p < 0.001).Conclusion: This study validates and complements the Guy's scoring system and provides a platform for the identification of critical limb ischemia patients in whom the result of femoro-crural/distal bypass grafting is so poor that primary amputation may be both clinically and economically more justified. [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]

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]

We briefly and comprehensively present some of the novel findings in the field of revascularization therapy and management of ST-segment-elevation myocardial infarction (STEMI). We highlight the latest evidence-based advancements in the pharmacological and mechanical treatment of patients who presented with STEMI. Since the last updates to the international guidelines (American College of Cardiology/American Heart Association and the European Society of Cardiology) were published in 2011 and 2012, there have been changes and several important studies have presented their final outcomes. We also highlight some controversial approaches as part of the current debates in the cardiology community. In addition, we share our recent experience in the field of biodegradable scaffold stents as a treatment strategy in STEMI. [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]

True aneurysm formation in arterialized autologous veins is an unusual complication. A saccular aneurysmal degeneration of 53 mm (maximal diameter) of a saphenous vein graft inserted for repair of a popliteal aneurysm, four years after implantation, is reported. The patient (with prior history of abdominal aortic aneurysm) had been initially treated through a posterior approach. A new saphenous vein bypass grafting (medial approach) was performed. Histological examination revealed myointimal fibrosis, medial degeneration and inflammation. In spite of the widespread use of the autologous saphenous vein as an arterial substitute, this complication is extremely rare and its etiology remains unclear. Atherosclerosis is considered to be the main cause of aneurysm formation in vein grafts, but current data suggest that additional etiopathogenic factors should be further investigated. We note the rarity of this finding and review the literature for true aneurysm formation within vein grafts used for bypass procedures. True aneurysm formation in arterialized autologous veins is an unusual complication. A saccular aneurysmal degeneration of 53 mm (maximal diameter) of a saphenous vein graft inserted for repair of a popliteal aneurysm, four years after implantation, is reported. The patient (with prior history of abdominal aortic aneurysm) had been initially treated through a posterior approach. A new saphenous vein bypass grafting (medial approach) was performed. Histological examination revealed myointimal fibrosis, medial degeneration and inflammation. In spite of the widespread use of the autologous saphenous vein as an arterial substitute, this complication is extremely rare and its etiology remains unclear. Atherosclerosis is considered to be the main cause of aneurysm formation in vein grafts, but current data suggest that additional etiopathogenic factors should be further investigated. We note the rarity of this finding and review the literature for true aneurysm formation within vein grafts used for bypass procedures. [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]

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]

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]

We report our strategy for malperfusion accompanying acute aortic dissection, especially that involving the abdominal organs, which is based on the mechanism and includes percutaneous management. From 1991 through October 2005, a total of 38 of 135 (28%) patients with acute dissection presented with organ malperfusion. Altogether, 31 had type A dissection. The involved vascular territories were coronary in 8, brain in 16, celiac and superior mesenteric in 6, renal in 10, and lower limb in 13. For the abdominal organs, the mechanisms of the malperfusion were classified into the aortic type ( n = 3) and the branch type ( n = 13). The branch type was further divided into the orifice type ( n = 8) and distal type ( n = 5). All but one patient with type A dissection underwent a central aortic operation with resection of the entry site. Revascularization of the ischemic organ was added by bypass grafting or direct reconstruction. Distal organ malperfusion accompanying type B dissection was treated by the mechanism-specific approach. That is, the aortic type was treated by surgical fenestration, whereas the branch type was treated by percutaneous stenting. The one hospital death (2.6%) was due to brain infarction. Although a central aortic operation alone successfully reversed aortic-type malperfusion in all three patients, it was not effective for branch-type malperfusion in five of six vascular territories. Surgical fenestration did not successfully reverse branch-type renal malperfusion in two patients. Percutaneous stenting was successful in all three vessels with branch-type malperfusion. Central aortic operation or fenestration is effective for aortic-type malperfusion, whereas the branch type may require stenting or bypass grafting. [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]

Purpose: To examine the feasibility and clinical outcome of a novel, minimally invasive technique for harvesting the great saphenous vein (GSV) for use in peripheral arterial bypass surgery. Methods: Between May 2001 through March 2003, 27 patients (15 men; mean age 71+/-10 years) underwent extremity bypass procedures for limb salvage (88%) or disabling claudication (12%) using the inversion technique to harvest the GSV. The veins were turned "inside out" using a unique catheter and guidewire system. With the endothelial surface exposed, valve leaflets were excised, and adherent thrombus was washed away. Veins were inverted again to turn the endothelial surface back inside the lumen for use as a bypass conduit. Results: Inversion vein harvesting and arterial bypass were completed in 24 (89%) of 27 patients; 2 patients were treated with synthetic grafts because of small GSVs. Another patient was found after vein harvesting to have inadequate arterial outflow despite a good quality conduit. The average vein length was 45+/-10 cm; a mean 4+/-1 incisions were made, including those for arterial exposure. Incisions made to divide vein tributaries averaged 2 cm in length. Duration of vein harvesting was 25 minutes (range 5-80). Wound complications were minor (2 hematomas, 2 cases of erythema, 2 seromas). Of 6 grafts that occluded after 30 days, 5 involved small-diameter vein grafts (< 3.5 mm). At a mean 12 months, primary and assisted primary graft patency rates were 88% (14/16) and 94% (15/ 16), respectively, for grafts with minimum diameters > or = 4 mm versus 38% (3/8) primary patency for veins < 4 mm (n = 8, p < 0.001). The limb salvage rate was 92% (22/24). Conclusions: Over-the-wire inversion saphenectomy is a simple and reliable minimally invasive technique for arterial bypass. Incisions are small and cosmetically superior to those of the traditional long incision method. One-year follow-up suggests that grafts harvested by inversion technique have excellent durability when the minimum vein diameter is > or = 4 mm, as determined by preoperative vein mapping. [ABSTRACT FROM AUTHOR]

Objective: Internal thoracic artery (ITA) grafts provide better early and long-term patency than saphenous vein (SV) grafts. Furthermore, bilateral ITA grafting has recently demonstrated better long-term results than unilateral ITA grafting. However, its use in the elderly is controversial. Methods: From March 1991 through November 2001, 307 consecutive patients aged 65 years or over undergoing isolated coronary artery bypass grafting (CABG) were reviewed, and the influence of bilateral ITA grafting on the early and long-term results was evaluated. All ITA grafts were harvested as a pedicle, and almost all of which were used as in-situ grafts. Results: Operative mortality in 138 patients undergoing bilateral ITA grafting was 1.4%, and in 108 patients undergoing unilateral ITA grafting, the rate was 0.9%. Predischarge angiography conducted in 97% of the subjects showed that the patency rate of all the ITA grafts (98.9%) was superior (p<0.0001) to that of all the SV grafts (93.6%). In comparisons of survival and freedom from cardiac events at 10 years after CABG, the bilateral use of ITA grafts was proved to be more beneficial than the unilateral use (p<0.05). Conclusions: It was demonstrated that bilateral ITA grafting could be performed with acceptable mortality and morbidity. Moreover, it offers better long-term survival and freedom from cardiac events than either unilateral ITA grafting or no ITA grafting. Bilateral ITA grafting thus can serve as a favorable procedure even in elderly patients. [ABSTRACT FROM AUTHOR]

Background Among other preoperative parameters, extremely low or extremely high body mass index (BMI) has been discussed as a substantial risk factor for postoperative complications after cardiac surgery. However, the exact relationship between BMI and postoperative risk has not yet been defined.Methods We retrospectively investigated consecutive patients (n=22 666) who underwent coronary artery bypass grafting with or without concomitant valve surgery between 1990 and 2001 in our institution. A number of preoperative and intraoperative variables and BMI (as a quadratic term) were used in a logistic regression model as covariates. Further, the patients were divided into 20 groups each with an increase in BMI of 1kg/m2(BMI as a categorical variable). The calculations of odds ratios (ORs) for re-intubation, infection, re-exploration, prolonged stay (>1 day) on the intensive care unit (ICU) and 30-day mortality were adjusted for age, gender and type of surgery.Results In the multivariate analysis only age (OR between 1.01 and 1.038, P<0.01), additional aortic valve (OR between 1.335 and 2.977, P<0.01) or mitral valve surgery (OR between 2.123 and 3.301, P<0.01) showed significant impact on all five end-points. Patients with BMI between 25 and 35kg/m2were not at elevated risk for any of the investigated end-points, except for infection. Patients with BMI between 21 and 27kg/m2were not at elevated risk for infection. The ORs for postoperative complications were significantly higher in underweight patients compared with obese or severely obese patients, except those for infection. Further, the underweight patients presented significantly more comorbidity.Conclusion Patients with low BMI are at higher risk after cardiac surgery than obese or severely obese patients. We hypothesize that a preoperative focus on avoiding and/or reversing cachexia may be more efficacious than reducing obesity in reducing the overall risk associated with heart surgery. [ABSTRACT FROM PUBLISHER]

The EC-IC Bypass Study Group could not detect any benefit from surgery compared to medical management in the prevention of stroke in 1985 [15]. During the past years surgical revascularization was re-evaluated and considered as an appropriate treatment for a small subgroup of patients with recurrent focal cerebral ischaemia and impaired haemodynamics. This retrospective study examines the long-term benefit and patency rate of bypass. We present a follow-up of 5.6 years of 47 patients, all of whom underwent byupass surgery after 1985. Forty patients suffered recurring transient ischaemic attacks due to uni- or bilateral internal carotid artery occlusion. Examination included neurologic status, TCD with CO or Diamox challenge, angiography, CT and SPECT scans. Neurological improvement was seen in 23% of patients with better results after early surgery, a worsening in 22% suffering further ischaemic events on a postoperative average of 2.8 years. Patency rate for vein graft material was 50%, for the STA-MCA procedure 91%. Occlusion of the vein graft occurred on an average after 1.4 years, other anastomosis after 2.7 years. We conclude that only few patients derived long-term benefit from EC-IC bypasses. Functioning of the bypass worsens over time, suggesting a role for surgery predominantly in the first year of ischaemic events due to insufficient collateral supply. Actual indications for bypass surgery may be patients with failure of maximal medical therapy and progressive ischaemia and haemodynamic compromise. [ABSTRACT FROM AUTHOR]

Oral anticoagulant therapy with warfarin commenced pre-operatively (n = 102) to prevent coronary artery vein graft occlusions was compared in terms of efficacy and safety with dipyridamole and aspirin (n = 130) in a randomized consecutive series of patients. Anticoagulant therapy was started at least 2 weeks before coronary artery bypass surgery (CA BG) and antiplatelet therapy was started at least 3 days before CA BG with dipyridamole followed by a combination of 250 mg aspirin once a day via a nasogastric tube 6 h after CABG. Overall, vein graft patency at 3 months after surgery did not differ significantly between the anticoagulant group (203/275, 74%) and dipyridamole-aspirin group (238/311, 77%), but the occlusion rate for grafts with endarterectomy was higher in the anticoagulant (46%) than in the dipyridamole and aspirin group (16%), (P<0·05). The rate of peri-operative complications including deaths, re-operation and myocardial infarction was higher in the anticoagulant than antiplatelet group (26·5% vs 13·8%, P < 0·05). The occurrence of postoperative bleeding complications did not differ significantly between the groups. Thus, oral anticoagulant therapy commenced pre-operatively has no advantages over conventional antiplatelet therapy in patients who undergo CABG. Neither antithrombotic regimens proved to be satisfactory for preventing acute bypass vein graft occlusions in this patient population with advanced coronary artery disease. [ABSTRACT FROM PUBLISHER]

From 1967 to 1981, 294 patients (group A) with aortic stenosis and coronary atherosclerosis underwent aortic valve replacement (AVR) combined with bypass grafting; there were 13 (4·4%) in-hospital deaths. Follow-up of the in-hospital survivors documented late survival of 89%, 79%, and 52% at 2, 5, and 10 postoperative years, respectively. Univariate and multivariate testing identified age ≥70 years (P=0·02) and Class IV symptoms (P=0·002) as factors decreasing late survival. Patients with bioprostheses who did not take warfarin had the best late survival (P=0·03) and event-free survival (P=0·05) and patients with mechanical prostheses who did not take warfarin had the worst (P<0·0001) (P=0·001). From 1981 to 1986, 375further patients (group B) with aortic stenosis and coronary artery disease underwent AVR and bypass grafting with 20 (5·3%) in-hospital deaths. Group B contained more patients ≥70 years (35% vs. 16%) than did group A. Logistic regression analysis identified patients with moderate or severe impairment of left ventricular function and women as sub-groups with increased in-hospital mortality in group B. Patients with aortic stenosis and coronary artery disease can undergo AVR and bypass grafting with a risk slightly increased over that for isolated AVR. Bioprostheses enhance late survival and event-free survival. [ABSTRACT FROM PUBLISHER]

From 1974 to 1976, four patients with juxtarenal aortic occlusion were operated upon with no surgical mortality. Thromboendarterectomy (TEA) of the aorta with renal revascularization was performed in one patient, and TEA with grafting in three. Intraoperative renal protection was particularly important, since suprarenal aortic clamping was often required in these cases. Possible renal embolism developed in one patient postoperatively. In order to prevent renal embolism and to minimize ischemic insult to the kidney, the value of the following procedures was stressed; (a) irrigation of aortic lumen with saline after TEA under suprarenal aortic clamping with renal arteries kept occluded, and (b) re-application of aortic clamp below the renal arteries after irrigation. Since the most distal level of occlusive process was the common femoral artery in our series, the patient with this desease entity should be treated more actively. [ABSTRACT FROM AUTHOR]

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]