Search

Background: The risk assessment for outcomes of older people undergoing cardiac surgery employ scales such as the Euro-Score II, and STS (Society for Thoracic Surgeons), which use clinical and laboratory data. Some studies have suggested a lower accuracy in older patients. Frailty assessment, using functional parameters, has shown promise in this age group. The aim of this study is to compare the validity of risk prediction of Euro-score II, with the Edmonton Frail Scale (EFS), in older patients undergoing elective coronary artery bypass grafting (CABG). Methods: This was a prospective, observational study of a cohort of patients above 60 years scheduled for elective CABG in a single centre. The patients were graded on the Euro-Score II scale and the EFS scales. The primary outcome of 30th day mortality, and the secondary outcome of immediate post-operative complications during hospitalization were recorded. Results: A total of 487 patients were recruited. The mean age was 68 years. Male subjects comprised 81.1% of the study group. Classification of risk as per the EFS placed 76.3 % as low risk, 23.4% as intermediate, and none were considered to be high risk. The EuroScore II classification placed 86% in the intermediate and high risk groups. The AUC in the ROC (receiver operator curve) for the EFS was 0.793 and for the and EuroScoreII it was 0.752. The 30th day mortality threshold fit occurred at 5/6 score for both EuroScore II and EFS. Euroscore-II sensitivity/specificity was 66.7%/75.1% respectively. The EFS had a sensitivity of 66.7% and a specificity of 77.1%. The ROC curves for the secondary outcomes were not significant. Conclusion: Both scales are of modest value in predicting short-term mortality in older patients, and require further refinements for improving clinical decision-making in the individual patient. [ABSTRACT FROM AUTHOR]

Percutaneous coronary intervention (PCI) is increasingly employed in the treatment of complex coronary artery disease. The entrapment or fracture of a coronary angioplasty guidewire is a rare complication of PCI. We herein describe a 61-year-old man who presented with chronic stable angina. The patient's coronary angiogram revealed triple-vessel coronary artery disease, and he was scheduled for primary PCI. During the procedure, the guidewire fractured within the right coronary artery. Despite multiple attempts, the wire could not be retrieved. The wire unraveled in its coils, and its stretching resulted in its eventual snapping in the right radial artery. The initial plan was to attempt guidewire retrieval through a brachial cut-down, and if successful, to manage the obtuse marginal lesion by PCI, thereby precluding general anesthesia and a sternotomy. Unfortunately, the guidewire snapped at the brachial level, necessitating its retrieval by coronary artery bypass surgery. The patient remained asymptomatic and event-free over 6 months of follow-up. [ABSTRACT FROM AUTHOR]

Percutaneous coronary intervention (PCI) is increasingly employed in the treatment of complex coronary artery disease. The entrapment or fracture of a coronary angioplasty guidewire is a rare complication of PCI. We herein describe a 61-year-old man who presented with chronic stable angina. The patient's coronary angiogram revealed triple-vessel coronary artery disease, and he was scheduled for primary PCI. During the procedure, the guidewire fractured within the right coronary artery. Despite multiple attempts, the wire could not be retrieved. The wire unraveled in its coils, and its stretching resulted in its eventual snapping in the right radial artery. The initial plan was to attempt guidewire retrieval through a brachial cut-down, and if successful, to manage the obtuse marginal lesion by PCI, thereby precluding general anesthesia and a sternotomy. Unfortunately, the guidewire snapped at the brachial level, necessitating its retrieval by coronary artery bypass surgery. The patient remained asymptomatic and event-free over 6 months of follow-up., (Copyright © 2021 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

The modified Ozaki technique within a conduit is reproducible and is an alternative to the use of homografts and commercially available conduits which may have special appeal in a low resource setting.

Chordopapillary apparatus preservation was compared with valve-excising mitral valve replacement in a retrospective analysis of 360 patients, of whom 98 had total or partial chordal preservation and 262 had the conventional operation. No significant differences were seen in age, sex, pathology, crossclamp or cardiopulmonary bypass times between the 3 groups. Left ventricular fractional shortening decreased significantly in patients whose valves had been excised completely, whereas it remained unchanged in patients with either partial or total chordal conservation. There was a survival benefit for patients undergoing leaflet preservation (92% vs. 80% for conventional excision at 5 years; p=0.001). Chordal preservation during valve replacement for mitral valve disease improves survival, enhances functional status, preserves left ventricular geometry and function, and improves overall cardiac performance. Preservation of the posterior leaflet alone offers excellent results that are comparable to those of patients with total chordal preservation.