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Aim: The aim of the present study was to analyze retrospectively the results of patients who underwent early-staged, i.e., within 24–48 h, carotid artery stenting (e-s CAS) before coronary artery bypass grafting (CABG). Methods: Between December 2014 and December 2022, 1046 consecutive patients underwent CABG; 31 of these patients (3%) were subjected to e-s CAS prior to CABG (e-s CAS + CABG group). Preoperative and intraoperative variables and early and mid-term results of the e-s CAS + CABG group were compared with those of patients who underwent isolated CABG (CABG group). Results: As compared with the CABG group, the e-s CAS + CABG group showed a worse clinical risk profile due to higher Euroscore-2 values and incidence of obstructive pulmonary disease and bilateral carotid artery and peripheral artery diseases (p < 0.05, for all comparisons). The combined end point of operative mortality, periprocedural myocardial infarction, and stroke was 3.2% (0%/0%/3.2%) in the e-s CAS + CABG group vs. 5.9% (2.2%/2.8%/0.9%) in the CABG group (p > 0.5, for all measurements). At 5 years, actuarial survival was 74% ± 16% in the e-s CAS + CABG group vs. 93% ± 4.0% in the CABG group, freedom from cardiac death was 100% vs. 98% ± 1.0% (p = 0.6), and freedom from MACCEs was 85% ± 15% vs. 97% ± 2.5% (p > 0.1, for all comparisons). Independent predictors of all-causes death were advanced age at the operation (p < 0.0001), a lower value for left ventricular ejection fraction (p = 0.05), and a high Euroscore-2 (p = 0.04). Conclusions: CABG preceded by e-s CAS appears to be associated with satisfactory early outcomes while limiting the risk of myocardial infarction to a very short time interval between the two procedures. Freedom from late all-causes death, cardiac death, and MACCEs were comparable and equally satisfactory, underscoring the positive protective effects of CAS and CABG on the carotid and coronary territories over time. [ABSTRACT FROM AUTHOR]

Different causes have been described for secondary lymphedema as reported in this article. A 75-year-old man was diagnosed with lymphedema about one decade after saphenous harvesting for coronary artery bypass surgery. It took two years for him to find out his diagnosis and receive the proper treatment. After standard complete decongestive therapy, his volume and pain decreased and his quality of life was improved, especially its physical aspect. It is important to recognize the possibility of lymphedema development after saphenous harvesting among patients undergoing coronary artery bypass surgery to prevent significant disturbance of quality of life with timely management. [ABSTRACT FROM AUTHOR]

This article discusses the establishment of a minimally invasive coronary artery bypass program at an academic center. The program follows a stepwise approach, starting with off-pump coronary artery bypass (OPCAB), then progressing to minimally invasive direct coronary artery bypass (MIDCAB), and finally to multivessel (MV-) MIDCAB surgery. The study analyzed the records of 147 patients who underwent these procedures and examined factors such as patient demographics, procedural parameters, and postoperative complications. The results showed that the stepwise approach was feasible and safe, with good early outcomes. The authors recommend this gradual approach for establishing a minimally invasive coronary bypass program. [Extracted from the article]

This article discusses the impact of minimally invasive coronary artery bypass surgery (MICS CABG) as an alternative to traditional surgery. The study analyzes the short-term outcomes of this approach for single- and multi-vessel diseases. The results show that MICS CABG is a safe procedure with low mortality and morbidity rates. The study also found low rates of reoperations and graft-related complications. These findings support the use of MICS CABG as a standard of care in coronary surgery. [Extracted from the article]

This article, titled "Coronary Plaque Quantification Using a New CT Imaging Software¿A Feasibility Study," discusses the potential benefits of using Cinematic Rendering (CR) visualization in detecting nonobstructive coronary plaques. The study included 26 patients who underwent cardiac surgery and had previous cardiac CT scans. The results showed that CR visualization correlated well with intraoperative palpation in quantifying the presence of plaques. The authors suggest that CR has the potential to improve the planning of coronary artery bypass surgery by allowing for easier interpretation of plaque localization. Further research will be conducted to validate these findings. [Extracted from the article]

This article, published in the journal Thoracic & Cardiovascular Surgeon, examines the risk of sternal wound infection (SWI) in patients undergoing coronary artery bypass grafting (CABG) with bilateral internal thoracic artery bypass grafting. The study analyzed 1774 patients who underwent CABG between 2020 and 2023, and after propensity score matching, 591 patients were identified. The results showed that there was no significant difference in the incidence of SWI between patients who received bilateral internal mammary artery (BIMA) grafts and those who received non-BIMA grafts. Risk factors for SWI were identified as female gender, diabetes, peripheral arterial vascular disease, postoperative delirium, and long ICU stay. The study concludes that harvesting bilateral internal mammary arteries in a skeletonized technique for CABG does not carry an additional risk of sternal infection compared to non-BIMA CABG patients. [Extracted from the article]

Background/aim: In this prospective observational study, our goal was to investigate the relationship between serum levels of oxidative stress (OS) parameters and regional cerebral oxygen saturation (rSO2) in addition to evaluating postoperative clinical outcomes among patients undergoing coronary artery bypass graft surgery (CABG). Materials and methods: This study comprised 64 adult patients undergoing elective CABG (on-pump [n = 48] and off-pump [n = 16]) procedures. Serum OS levels and rSO2 values were measured intraoperatively at three specific time points: T1 (after induction), T2 (15 min before aortic cross-clamp removal or the final distal anastomosis), and T3 (15 min after aortic cross-clamp removal or the last distal anastomosis). Results: Serum OS and lactate values demonstrated higher levels at T2 and T3 (p < 0.001), while rSO2 values were lower at T2 (p = 0.024) in the on-pump CABG group compared to the off-pump CABG group. The rSO2 values at T2 exhibited a negative correlation with OS parameters, lactate levels at T2 and T3, aortic clamp time, postoperative mechanical ventilation time, and intensive care unit stay length. In the multivariate linear regression analysis (R2 = 0.181, p = 0.001), lactate values at T2 emerged as the sole factor affecting the OS index at T2 (t = 2.843, p = 0.006). Conclusion: In our study, we observed elevated OS values and relatively low rSO2 values during on-pump CABG procedures, with rSO2 showing an association with increased OS parameters. Close monitoring of the OS response level and rSO2 during CABG could potentially enhance postoperative clinical outcomes. [ABSTRACT FROM AUTHOR]

Coronary artery bypass grafting (CABG) is the most commonly performed and studied major cardiac operation worldwide. An understanding of the evolution of CABG, including the early days of cardiac surgery, the first bypass operation, continuous improvements in techniques, and streamlining of the operation, is important to inform current trends and future innovations. This article will examine how CABG evolved (from techniques to conduits), describe current trends in the field, and explore what lies on the horizon for the future of CABG. [ABSTRACT FROM AUTHOR]

Cardiac involvement (CI) is rare in Behçet syndrome (BS), but the important point is that CI may be the first manifestation of the disease. The presence of CI worsens the prognosis of BS, so early diagnosis and early initiation of immunosuppressive treatment (IST) are vital. Coronary aneurysm may develop spontaneously in these patients, or any vascular intervention may cause aneurysm with a pathergy‐like reaction. The risk of restenosis is high after percutaneous coronary intervention or coronary artery bypass surgery applied without IST. Therefore, it should be kept in mind that IST constitutes the main step of treatment. Herein, we present a young male diagnosed with BS after acute coronary syndrome caused by coronary artery aneurysms and thrombosis. [ABSTRACT FROM AUTHOR]

Background Deviations from usual coronary artery anatomy are well documented. The left circumflex artery (LCx) arising from the pulmonary artery is an example of one such deviation which is rarely seen. We present the case of a 26-year-old male with this coronary artery distribution presenting with an episode of ventricular flutter with late gadolinium enhancement and pluri-morphological ventricular arrhythmias. Case summary A 26-year-old male with a history of cardiac surgery presented to his local hospital with an episode of symptomatic broad-complex tachycardia (BCT). It failed to revert to sinus rhythm following intravenous beta-blockers and amiodarone and required external cardioversion. Subsequently, the patient developed a aspiration pneumonia requiring ICU admission, after which he was transferred to our institute for ongoing cardiac management. Cardiac computed tomography CTA and coronary angiography revealed that the LCx was found to originate from the pulmonary artery. He underwent insertion of a subcutaneous pacemaker and was subsequently discharged. Despite the potential for steal syndrome of viable coronary territories. Multidisciplinary team discussion determined him to be fit for conservative management and not for surgical correction of his anomalous coronary artery anatomy. Discussion Aberrant coronary artery anatomy can lead to diverse outcomes for patients in terms of both morbidity and mortality. The need for surgery in these situations varies on a case-by-case basis and little research exists to guide decision-making for healthcare professionals. As such there is a need for further study both to guide treatment and to ensure high-quality outcomes for patients with this condition. [ABSTRACT FROM AUTHOR]

IntroductionChronic depression and anxiety can be a risk factor for coronary aArtery bypass grafting (CABG) and is an emerging factor after coronary artery disease when the patient is admitted to the hospital and after surgery. We aimed to assess the effect of Escitalopram in treating mild to moderate depressive disorder and improving the quality of life in patients undergoing CABG.MethodsIn this randomized clinical trial, 50 patients undergoing CABG referred to Tehran Heart Hospital from January 2021 to May 2021 and were suffering from mild to moderate depression were randomly assigned to one of the two groups of Escitalopram or placebo. The level of depression was assessed based on Beck’s depression inventory and the quality-of-life status and its domains were assessed based on the SF-36 questionnaire in 2 groups. Measurements were obtained at baseline and at four and eight weeks after treatment. Chi-square, Fisher’s exact, paired, and Wilcoxon tests or ANOVA were used as appropriate.ResultsThere was no significant difference between the level of depression between the two study groups at baseline (P=0.312). There was no significant difference between the quality of life and its domains in the two study groups at baseline (P=0.607). However, the most important effect of Escitalopram was reducing depression scores in the intervention group at weeks 4 and 8 after treatment compared to the placebo group (P0.05).ConclusionEscitalopram was effective in treating mild to moderate depressive disorder and improving quality of life in patients undergoing CABG.Clinical trial registrationhttps://irct.behdasht.gov.ir/, identifier IRCT20140126016374N2.

Objective: The Evaluation of Transit-Time Flow in Coronary Artery Disease Surgery (EFCAD) registry aims to assess the influence of transit-time flow measurement (TTFM) in daily practice. Methods: EFCAD is a prospective, multicenter study involving 9 centers performing TTFM during isolated coronary artery bypass grafting. Primary end point was occurrence and risk factors of major adverse cardiac events, including perioperative myocardial infarction, urgent postoperative coronary angiogram and/or revascularization, and hospital mortality. Secondary end points were rate of graft revision during surgery and factors affecting graft flow. We respected the limit values set by the experts: mean graft flow >15 mL/minute and pulsatility index ≤5. Results: Between May 2017 and March 2021, 1616 patients were registered in the EFCAD database. After review, 1414 were included for analyses. Of those, 1176 were eligible for primary end point analysis. Graft revision, mainly due to inadequate TTFM values, occurred in 2% (29 patients). The primary end point occurred in 46 (3.9%) patients, and it was related with left anterior descending artery graft flow ≤15 mL/minute (odds ratio, 3.64; P 0 indicates higher flow), and graft origin (aorta vs Y, β = 9.2; in situ left internal thoracic artery vs Y, β = 3.2; in situ right internal thoracic artery vs Y, β = 2.3; P

Minimally invasive cardiac surgery off-pump coronary artery bypass (MICSOPCAB) has become increasingly prevalent, with devices like the heart positioner aiding in surgical precision. However, rare complications such as epicardial hematoma can occur. Here, we present a case of a 75-year-old man undergoing MICSOPCAB who developed an epicardial hematoma due to the heart positioner. The hematoma was successfully repaired intraoperatively with direct suturing and large felts. Postoperative recovery was uneventful, highlighting the importance of vigilant monitoring and prompt management of such complications. This case underscores the need for careful attention during the use of cardiac positioners to minimize adverse events and ensure favorable patient outcomes. [ABSTRACT FROM AUTHOR]

A 73-year-old male presented with angina symptoms and was diagnosed with three-vessel coronary artery disease by use of computed tomography angiography and coronary angiography. This diagnosis necessitated coronary artery bypass grafting (CABG) surgery. A custom made AI-driven algorithm was used to generate a patient-specific three-dimensional coronary artery model from computed tomography angiography imaging data. This framework enabled precise segmentation and reconstruction of the coronary vasculature, yielding an accurate anatomical and pathological representation. Subsequently, this generated model was integrated into a novel extended reality tool for preoperative planning and intraoperative guidance in CABG surgery. Both preoperatively and intraoperatively, the tool augmented spatial orientation and facilitated precise stenosis localization, thereby enhancing the surgeon's operative proficiency. This case report underscores the utility of advanced extended reality tools in cardiovascular surgery, emphasizing their pivotal role in refining surgical planning and execution. [ABSTRACT FROM AUTHOR]

This case report details the management of a 79-year-old man who developed massive postoperative pneumothorax following redo coronary artery bypass grafting due to severe lung adhesions. We successfully treated the patient using veno-venous extracorporeal membrane oxygenation without femoral cannulation, allowing for early rehabilitation initiation. Veno-venous extracorporeal membrane oxygenation is a reasonable option for cases of severe respiratory failure due to pneumothorax with lung destruction caused by re-sternotomy during re-do cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Diagnosing hypoglycemia is a widely known challenge for anesthesiologists during the perioperative period, especially under general anesthesia, during which many signs and symptoms would be masked. On the other hand, the bispectral index, which has recently been utilized to measure the depth of anesthesia, may be influenced by other factors such as hypo and hyperglycemia. Cases Report: Herein, we have presented a case of a patient who experienced an abrupt decrease in the Bispectral index following hypoglycemia. Conclusion: Although the Bispectral index is widely used to monitor anesthesia depth, it can be utilized to continuously monitor other contributing factors such as glycemic condition, hypothermia, hypovolemia, and cerebral ischemia. [ABSTRACT FROM AUTHOR]

Lung transplantation can greatly improve quality of life and extend survival in those with end-stage lung disease. In order to derive the maximal benefit from such a procedure, patients must be carefully selected and be otherwise healthy enough to survive a high-risk surgery and sometimes prolonged immunosuppressive therapy following surgery. Patients therefore must be critically assessed prior to being listed for transplantation with close attention paid towards assessment of cardiovascular health and operative risk. One of the biggest dictators of this is coronary artery disease. In this review article, we discuss the assessment and management of coronary artery disease in the potential lung transplant candidate. [ABSTRACT FROM AUTHOR]

Although coronary artery disease is a well recognized clinical entity and very common in India, there is paucity of literature on the patients undergoing surgical revascularization in the form of coronary artery bypass grafting (CABG) at a young age (<40 years). The aim of this study is to analyze the details of patients with premature coronary artery disease (PCAD) who underwent CABG at a tertiary care cardiac center in India. A retrospective observational study was conducted for the present study. All patients aged <40 years with Premature Coronary artery disease (PCAD) were registered in the PCAD Registry at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore. The electronic database of case records of all patients with PCAD who underwent CABG at Sri Jayadeva Institute of Cardiovascular Sciences and Research, between April 2018 and March 2019 was analyzed. Patients were selected based on the database of PCAD registry at our institute under CTRI regulation of India (registration number CTRI/2018/03/012544), All patients were diagnosed with Coronary angiogram (CAG) and required further treatment in the form of CABG. Binary logistic regression was used to test the hypothesis (n= 100) cases, out of which LIMA was grafted in 84 cases (n=84), (odd ratio 3.55); of which LIMA to LAD was grafted in 81 cases (n=81); LIMA to RIMA –OM1 was grafted in 2 cases (n=2), and LIMA - Radial - Y was grafted in 1 case (n=1). Off - pump CABG (OPCAB) was done in 79 cases (79%) and the remaining cases were operated On - pump. Most common conduits that were used for grafting in CABG were LIMA (84%); SVG (82%), RIMA (9%) and radial artery (1%). Mean Ejection Fraction was 51.28%, with Standard Deviation (SD) of 5.80. Carotid artery stenosis (> 50%narrowing of the internal carotid artery) was seen in 11% of the cases. Peripheral Arterial Disease (PAD) was seen in 4% of cases (odds 1.18). Mortality rate (CFR) was negatively correlated in the younger population; deaths were seen in only 2 cases (n =2). The extent of CABG characteristics was positively correlated and statistically significant (p=0.001). In conclusion, Cardiovascular Disease (CVD) risk is more common in resource-poor and developing countries. Considering all the research findings, the present study concludes that CABG surgery can be treated with comparable components for the management of patients diagnosed to be suffering from Coronary artery disease below the age of 40 years. Relative long-term survival rate after CABG surgery, regardless of gender needs to be assessed for over a period of time at the population level. [ABSTRACT FROM AUTHOR]

BACKGROUND: The importance of mitochondria in normal heart function are well recognized and recent studies have implicated changes in mitochondrial metabolism with some forms of heart disease. Previous studies demonstrated that knockdown of the mitochondrial ribosomal protein S5 (MRPS5) by small interfering RNA (siRNA) inhibits mitochondrial translation and thereby causes a mitonuclear protein imbalance. Therefore, we decided to examine the effects of MRPS5 loss and the role of these processes on cardiomyocyte proliferation. METHODS: We deleted a single allele of MRPS5 in mice and used left anterior descending coronary artery ligation surgery to induce myocardial damage in these animals. We examined cardiomyocyte proliferation and cardiac regeneration both in vivo and in vitro. Doxycycline treatment was used to inhibit protein translation. Heart function in mice was assessed by echocardiography. Quantitative real-time polymerase chain reaction and RNA sequencing were used to assess changes in transcription and chromatin immunoprecipitation (ChIP) and BioChIP were used to assess chromatin effects. Protein levels were assessed by Western blotting and cell proliferation or death by histology and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assays. Adeno-associated virus was used to overexpress genes. The luciferase reporter assay was used to assess promoter activity. Mitochondrial oxygen consumption rate, ATP levels, and reactive oxygen species were also analyzed. RESULTS: We determined that deletion of a single allele of MRPS5 in mice results in elevated cardiomyocyte proliferation and cardiac regeneration; this observation correlates with improved cardiac function after induction of myocardial infarction. We identified ATF4 (activating transcription factor 4) as a key regulator of the mitochondrial stress response in cardiomyocytes from Mrps5+/- mice; furthermore, ATF4 regulates Knl1 (kinetochore scaffold 1) leading to an increase in cytokinesis during cardiomyocyte proliferation. The increased cardiomyocyte proliferation observed in Mrps5+/- mice was attenuated when one allele of Atf4 was deleted genetically (Mrps5+/-/Atf4+/-), resulting in the loss in the capacity for cardiac regeneration. Either MRPS5 inhibition (or as we also demonstrate, doxycycline treatment) activate a conserved regulatory mechanism that increases the proliferation of human induced pluripotent stem cell–derived cardiomyocytes. CONCLUSIONS: These data highlight a critical role for MRPS5/ATF4 in cardiomyocytes and an exciting new avenue of study for therapies to treat myocardial injury. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the effect of neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width (RDW) values on postoperative mortality and morbidity in patients who underwent off-pump cardiac surgery. Methods: This study included patients who underwent off-pump coronary artery bypass surgery from January 1, 2018 to January 1, 2020. Correlations between the preoperative NLR and RDW values and postoperative complications, extubation time, length of intensive care unit stay, and length of hospital stay were evaluated. Results: A total of 68 patients were evaluated. No correlation was found between preoperative RDW and NLR values and age, ejection fraction, extubation time, or length of hospital stay. The length of stay in the intensive care unit did not correlate with the preoperative RDW value but was correlated with the NLR value (p=0.042). In six patients, postoperative complications were observed. No statistically significant difference was found between patients with and without complications in terms of preoperative RDW and NLR values. Conclusion: In this study, a high preoperative NLR value was associated with a prolonged intensive care unit stay, one of the early complications of cardiac surgery. However, the preoperative RDW value did not have a predictive relationship with early postoperative complications. [ABSTRACT FROM AUTHOR]

To review the available literature on the use of coronary artery bypass grafting (CABG) as a treatment option for anomalous origin of coronary artery in adults. A systematic literature search was performed in March 2023 (including Ovid MEDLINE, Ovid Embase, and the Cochrane Library databases) to identify studies reporting the use of CABG in adult patients with anomalous origin of coronary artery. A total of 31 studies and 62 patients were included, 32 patients (52%) were women, and the mean age was 45.1±16.1 years. The most common coronary anomaly was the right coronary artery arising from the left coronary sinus in 26 patients (42%), followed by an anomalous left coronary artery from the pulmonary artery in 23 patients (37%). A total of 65 conduits were used in 61 patients, and 1 case report did not report conduit type. Reported grafts included saphenous vein (23 of 65 [35.4%]), left internal thoracic artery (15 of 65 [23.1%]), right internal thoracic artery (23 of 65 [35.4%]), and radial artery (2 of 65 [3.1%]); right gastroepiploic artery and basilic vein were used once (1.5%) each. Ligation of the native coronary artery was performed in 42 (67.7%) patients. Patient follow-up was available in 19 studies with a mean of 31.2 months. Only 1 operative mortality was reported. Based on the limited available data, CABG can be performed with good early results. Use of arterial conduits and ligation of the native coronary artery may improve long-term graft patency. [Display omitted] [ABSTRACT FROM AUTHOR]

The European System for Cardiac Operative Risk Evaluation (EuroSCORE II) is a well-established scoring system for predicting mortality in cardiac surgery. This system was derived predominantly from a European patient cohort; however, no validation of this system has been conducted in Taiwan. We sought to assess the performance of EuroSCORE II at a tertiary centre. The 2161 adult patients receiving cardiac surgery between 2017 and 2020 in our institution were included. Overall, the in-hospital mortality rate was 7.89%. The performance of EuroSCORE II was assessed using the area under the receiver operator curve (AUC) for discrimination and the Hosmer–Lemeshow (H–L) test for calibration. Data were analysed for type of surgery, risk stratification, and status of the operation. EuroSCORE II had good discriminative power (AUC=0.854, 95% Confidence Interval (CI): 0.822–0.885) and good calibration (χ2=5.19, p=0.82) for all types of surgery except ventricular assist devices (AUC=0.618, 95% CI: 0.497–0.738). EuroSCORE II also showed good calibration for most types of surgery except coronary artery bypass surgery (CABG) combined procedure (P=0.033), heart transplantation (HT) (P=0.017), and urgent operation (P=0.041). EuroSCORE II significantly underestimated the risk for CABG combined procedure and urgent operations, and overestimated the risk for HT. EuroSCORE II had satisfactory discrimination and calibration power to predict surgical mortality in Taiwan. However, the model is poorly calibrated for CABG combined procedure, HT, urgent operation, and, likely, lower- and higher-risk patients. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is the most common postoperative complication adding significantly to the morbidity rate and cost of coronary artery bypass surgery (CABG). AF is a superventricular tachyarrhythmia diagnosed through irregular atrial activities and disappearance of atria mechanical function. In electrocardiogram (EGG), AF appears as quick vibrating waves replaced by P-waves and often accompanied by quick and irregular ventricular response. AF may occur in isolation or along with other arrhythmias. Incidence of atrial fibrillation after CABG is between 20% and 40%. This arrhythmia is often benign and transient, but can cause hemodynamic disorders, thromboembolic complications, longer time of hospital stay and serious complications including cerebral apoplexy, and increase in the length of hospitalization. Digoxin, calcium blockers, magnesium, glucose-insulin, potassium solution, and various cardioplegia are ineffective at preventing atrial fibrillation after CABG.Amiodarone is a multifaceted antiarrhythmic with a proven record of effectiveness in the treatment of atrial arrhythmias in a variety of clinical settings. Daud et al showed a significant reduction in postoperative atrial fibrillation with oral amiodarone in patients undergoing either CABG or valvular surgery. In this current study we evaluated the effects of amiodarone in preventing intra and post op arrhythmias and compared it to subjects not receiving amiodarone preoperatively. [ABSTRACT FROM AUTHOR]

Background: del Nido cardioplegia (DN) has been shown to be safe in adult patients undergoing isolated coronary artery bypass grafting with normal left ventricular ejection fraction. We sought to determine whether it was also safe in adult patients with diminished left ventricular function. Methods: All patients with preoperative left ventricular ejection fraction ≤ 40% undergoing isolated coronary artery bypass grafting between 1/1/2019 and 7/10/2022 were retrospectively analyzed. Off-pump and beating heart cases were excluded. Patients were divided by surgeon preference between conventional cardioplegia (CCP) and DN. Baseline and intraoperative characteristics and short-term postoperative outcomes were compared. Results: Six surgeons performed 829 isolated coronary artery bypass operations during the study. Two-hundred seventy-two met study criteria. Three surgeons used exclusively CCP for the duration of the study, two used exclusively DN and one switched from CCP to DN mid-way through. Group totals were: CCP n = 181 and DN n = 91. There were no significant differences in baseline characteristics including mean left ventricular ejection fraction (CCP 32.5 ± 7.4% vs. DN 33.4 ± 7.29%, p = 0.939). Other than a significant decrease in bypass time for DN (113.20 ± 37.2 vs. 122.43 ± 34.3 min, p = 0.043) there were no intergroup differences in urgency, number of grafts, ischemic time or incidence of blood transfusion. Postoperative outcomes between CCP and DN were similar including incidence of atrial fibrillation (12.2% vs. 8.8%, p = 0.403), intensive care length of stay (3.7 ± 2.3 vs. 4.3 ± 3.7 days, p = 0.886), total length of stay (5.7 ± 3.7 vs. 6.3 ± 4.4 days, p = 0.922) and 30-day mortality (3.85% vs. 1.10%, p = 0.205). Conclusion: Compared to conventional cardioplegia, del Nido cardioplegia provides equivalent short-term outcomes in patients with low left ventricular ejection fraction undergoing isolated coronary artery bypass grafting. [ABSTRACT FROM AUTHOR]

In patients with 3-vessel coronary artery disease (CAD) and/or left main CAD, individual risk prediction plays a key role in deciding between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The aim of this study was to assess whether these individualized revascularization decisions can be improved by applying machine learning (ML) algorithms and integrating clinical, biological, and anatomical factors. In the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) study, ML algorithms (Lasso regression, gradient boosting) were used to develop a prognostic index for 5-year death, which was combined, in the second stage, with assigned treatment (PCI or CABG) and prespecified effect-modifiers: disease type (3-vessel or left main CAD) and anatomical SYNTAX score. The model's discriminative ability to predict the risk of 5-year death and treatment benefit between PCI and CABG was cross-validated in the SYNTAX trial (n = 1,800) and externally validated in the CREDO-Kyoto (Coronary REvascularization Demonstrating Outcome Study in Kyoto) registry (n = 7,362), and then compared with the original SYNTAX score II 2020 (SSII-2020). The hybrid gradient boosting model performed best for predicting 5-year all-cause death with C-indexes of 0.78 (95% CI: 0.75-0.81) in cross-validation and 0.77 (95% CI: 0.76-0.79) in external validation. The ML models discriminated 5-year mortality better than the SSII-2020 in the external validation cohort and identified heterogeneity in the treatment benefit of CABG vs PCI. An ML-based approach for identifying individuals who benefit from CABG or PCI is feasible and effective. Implementation of this model in health care systems—trained to collect large numbers of parameters—may harmonize decision making globally. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050 ; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries; NCT00114972) [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Re-opening the chest is an unwanted and potentially morbid complication after open heart surgery, most commonly required for refractory bleeding or tamponade. In this report, we present a unique case of a postoperative coronary artery bypass patient, demonstrating clinical features of cardiac tamponade of the right atrium and ventricle with inconclusive findings on imaging. Case presentation: A 62 year-old male presented to hospital with exertional angina and a coronary angiogram found severe three-vessel coronary artery disease with preserved left ventricular function. He underwent an uncomplicated triple coronary artery bypass surgery. Over the following hours in the cardiac intensive care unit, the patient had a climbing serum lactate level and increasing vasopressor requirements. On investigations, there was evidence of compression of the right heart. The patient was taken back to the operating room where very little clot or bleeding was identified, rather there was significant amounts of mediastinal fat surrounding the heart which was subsequently resected with wide margins. The patient had complete resolution of their symptoms and an uncomplicated postoperative course thereafter. Conclusions: To our knowledge, this case is the first reported occurrence of cardiac constriction from excessive mediastinal fat after open heart surgery. Identifying patients at high-risk for excessive pericardial fat, as well as considering alternative modalities of imaging appear to be the main stay in diagnosis at this point. Current treatment is a mediastinal lipectomy with wide margins, avoiding injury to surrounding structures such as the phrenic nerve and innominate vein. Future study might consider the value of prophylactic mediastinal lipectomy at time of surgery, and methods to improve detection with current and future imaging modalities. [ABSTRACT FROM AUTHOR]

Background: The impact of sex hormones on right and left auricular contractile apparatus function is largely unknown. We evaluated the impact of sex hormones on left and right heart contractility at the level of myocardial filaments harvested from left and right auricles during elective coronary artery bypass surgery. Methods: 150 patients (132 male; 18 female) were enrolled. Preoperative testosterone and estradiol levels were measured with Immunoassay. Calcium induced force measurements were performed with left- and right auricular myofilaments in a skinned fiber model. Correlation analysis was used for comparison of force values and levels of sex hormones and their ratio. Results: Low testosterone was associated with higher top force values in right-sided myofilaments but not in left-sided myofilaments for both sexes (p = 0.000 in males, p = 0.001 in females). Low estradiol levels were associated with higher top force values in right-sided myofilaments (p 0.000) in females and only borderline significantly associated with higher top force values in males (p 0.056). In females, low estradiol levels correlated with higher top force values in left sided myofilaments (p 0.000). In males, higher Estradiol/Testosterone ratio (E/T ratio) was only associated with higher top force values from right auricular myofilaments (p 0.04) In contrast, in females higher E/T ratio was associated with lower right auricular myofilament top force values (p 0.03) and higher top force values in left-sided myofilaments (p 0.000). Conclusions: This study shows that patients' comorbidities influence left and right sided contractility and may blur results concerning influence of sex hormones if not eliminated. A sex hormone dependent influence is obvious with different effects on the left and right ventricle. The E/T ratio and its impact on myofilament top force showed divergent results between genders, and may partially explain gender differences in patients with cardiovascular disease. [ABSTRACT FROM AUTHOR]

The global prevalence of diabetes mellitus (DM) has led to a pandemic, with significant microvascular and macrovascular complications including coronary artery disease (CAD), which worsen clinical outcomes and cardiovascular prognosis. Patients with both acute coronary syndrome (ACS) and DM have worse prognosis and several pathophysiologic mechanisms have been implicated including, insulin resistance, hyperglycemia, endothelial dysfunction, platelet activation and aggregations as well as plaque characteristics and extent of coronary lesions. Therefore, regarding reperfusion strategies in the more complex anatomies coronary artery bypass surgery may be the preferred therapeutic strategy over percutaneous coronary intervention while both hyperglycemia and hypoglycemia should be avoided with closed monitoring of glycemic status during the acute phase of myocardial infraction. However, the best treatment strategy remains undefined. Non-insulin therapies, due to the low risk of hypoglycemia concurrently with the multifactorial CV protective effects, may be proved to be the best treatment option in the future. Nevertheless, evidence for the beneficial effects of glucagon like peptide-1 receptor agonists, dipeptidyl-peptidase 4 inhibitors and sodium glycose cotransporter 2 inhibitors, despite accumulating, is not robust and future randomized control trials may provide more definitive data. [ABSTRACT FROM AUTHOR]

Background: Glutamate plays a key role for post‐ischaemic recovery of myocardial metabolism. According to post hoc analyses of the two GLUTAMICS trials, patients without diabetes benefit from glutamate with less myocardial dysfunction after coronary artery bypass surgery (CABG). Copeptin reflects activation of the Arginine Vasopressin system and is a reliable marker of heart failure but available studies in cardiac surgery are limited. We investigated whether glutamate infusion is associated with reduced postoperative rises of plasma Copeptin (p‐Copeptin) after CABG. Methods: A prespecified randomised double‐blind substudy of GLUTAMICS II. Patients had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0 and underwent CABG ± valve procedure. Intravenous infusion of 0.125 M L‐glutamic acid or saline at 1.65 mL/kg/h was commenced 10–20 min before the release of the aortic cross‐clamp and then continued for another 150 min P‐Copeptin was measured preoperatively and postoperatively on day one (POD1) and day three. The primary endpoint was an increase in p‐Copeptin from the preoperative level to POD1. Postoperative stroke ≤24 h and mortality ≤30 days were safety outcomes. Results: We included 181 patients of whom 48% had diabetes. The incidence of postoperative mortality ≤30 days (0% vs. 2.1%; p =.50) and stroke ≤24 h (0% vs. 3.2%; p =.25) did not differ between the glutamate group and controls. P‐Copeptin increased postoperatively with the highest values recorded on POD1 without significant inter‐group differences. Among patients without diabetes, p‐Copeptin did not differ preoperatively but postoperative rise from preoperative level to POD1 was significantly reduced in the glutamate group (73 ± 66 vs. 115 ± 102 pmol/L; p =.02). P‐Copeptin was significantly lower in the Glutamate group on POD1 (p =.02) and POD 3 (p =.02). Conclusions: Glutamate did not reduce rises of p‐Copeptin significantly after moderate to high‐risk CABG. However, glutamate was associated with reduced rises of p‐Copeptin among patients without diabetes. These results agree with previous observations suggesting that glutamate mitigates myocardial dysfunction after CABG in patients without diabetes. Given the exploratory nature of these findings, they need to be confirmed in future studies. [ABSTRACT FROM AUTHOR]

Background: Long-term use of proton-pump inhibitors (PPI) can result in hypomagnesemia and arrhythmia. This study aimed to compare the effect of PPI and histamine 2-receptor antagonists (H2 RA) on the incidence of hypomagnesemia and arrhythmia in patients following off-pump coronary artery bypass surgery (CABG). Method: In this randomized-controlled clinical trial 290 patients admitted to the ICU after off-pump CABG were randomly divided into two groups of H2 RA (n=145) and PPI (n=145). For patients in the H2 RA group, 50 mg intravenous ranitidine was prescribed every 8 hours after the nothing by mouth (NPO) period, followed by 40 mg famotidine tablets after starting the oral regimen (PO). The PPI group received 40 mg pantozol IV injections every 12 hours during the NPO period and 40 mg pantozol tablets once daily after becoming PO. The patients were investigated for the development of hypomagnesemia and associated arrhythmia. Results: In total 271 patients with a mean age of 59.3±10 years completed the study (female/male=32.8%). Hypomagnesemia occurred in 60.1% of the patients, 76 (56.7%) in the H2 RA group and 87 (63.5%) in the PPI group (P=0.245), whereas arrhythmia had a prevalence of 12 (9.6%) and 15 (11.1%) cases, respectively (P=0.690). The mean time of occurrence of hypomagnesemia and arrhythmia was 1.75±1.08 and 3.0±0.9 days after the operation in the H2 RA group (P=0.111) and 1.47±0.7 and 2.9±1.5 days in the PPI group (P=0.897), respectively. Conclusion: Our study revealed that the short-term use of PPIs does not result in higher rates of hypomagnesemia and associated arrhythmia in comparison to H2 RA consumption after off-pump CABG. [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]

End-stage renal disease (ESRD) patients have a high prevalence of coronary artery disease, and coronary artery bypass graft (CABG) is one of the essential treatments. ESRD patients undergoing CABG surgery have an increased risk of postoperative complications, including acute pancreatitis. Here, we present the unique case of an exceptionally large pancreatic pseudocyst caused by pancreatitis in an ESRD patient after CABG surgery. A 45-year-old male with ESRD under maintenance hemodialysis received CABG surgery for significant coronary artery disease. Two weeks later, he experienced worsening abdominal pain and a palpable mass was noticed in the epigastric region. Computer tomography revealed an unusually large pseudocyst measuring 21 × 17 cm in the retroperitoneum due to necrotizing pancreatitis. The patient underwent percutaneous cystic drainage, and the symptoms were significantly improved without surgical intervention. Factors such as prolonged cardiopulmonary bypass time, postoperative hypotension, and intradialytic hypotension appeared to have contributed to the development of severe pancreatitis in this case. This report highlights the rarity of a giant pancreatic pseudocyst in an ESRD patient after CABG surgery and emphasizes the importance of vigilant postoperative care. [ABSTRACT FROM AUTHOR]

Background: The use of crystalloid priming for extracorporeal circuit in adult cardiac surgery causes inevitable haemodilution. The haemodilution can be reduced by using methods such as retrograde autologous priming (RAP) with the patient's blood. This study compares the RAP technique with standard priming with regards to safety and the impact on haemodilution. Methods: This was a retrospective cohort study between a control group (n = 100) consisting of consecutive patients undergoing first time isolated coronary artery bypass surgery (CABG) with crystalloid priming solution in the circuit, and the RAP group (n = 100) consisting of patients undergoing isolated first time CABG with the RAP method. All demographics, procedure and perfusion data were gathered from the local surgical and perfusion database. Results: Despite starting with comparable mean pre‐operative haemoglobin (Hb) levels (control 127 mg/dL versus RAP 129 mg/dL), the RAP group had significantly higher mean post‐op Hb level (109 mg/dL versus 92 mg/dL, P < 0.01). Crystalloid use was also significantly lower in RAP group (3.15 L versus 4.17 L P < 0.02). Freedom from red blood cell transfusion (86% versus 76% P = 0.038) and freedom from blood products (78% versus 66%, P = 0.032) was also significantly better in the RAP group. Conclusions: This study demonstrates that retrograde autologous priming is a safe and effective method for priming the cardiopulmonary bypass circuit in adult cardiac surgery, with significantly beneficial effects on transfusion rates and intra operative fluid requirements. Given these results the RAP method should be considered as a routine step in priming an extracorporeal circuit for adult cardiac operations. [ABSTRACT FROM AUTHOR]

The aim of the study was to perform a comprehensive fundamental analysis of the factors of inflammation, oxidative stress, fibrosis, myocardial dysfunction, ischemia and omega-3 index associated with postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG) surgery in patients with coronary artery disease. The study involved 158 patients who were admitted to the hospital to undergo CABG surgery. Patients were divided into two groups: group 1 comprised 111 patients without POAF (82% males, median age—62.0 (56.0; 66.0) years), and group 2 comprised 47 patients with POAF (84.4% males, median age—65.0 (61.0; 70.0) years). POAF occurred 5.2 (2.0; 7.0) days after CABG. In all the patients, we evaluated laboratory tests before and 3–4 days after CABG. All the patients also underwent echocardiography. According to results of multifactorial regression analysis, the odds ratio of POAF development for left atrial diameter >41 mm was 4.3 (95% confidence interval (CI) 2.0–9.7, p < 0.001), interleukin (IL)-6 postoperative levels >22.07 pg/mL—3.0 (95% CI 1.4–8.2, p = 0.006), IL-8 postoperative levels >9.67 pg/mL—2.3 (95% CI 1.2–7.3, p = 0.006), superoxide dismutase postoperative levels in plasma >1100.5 U/g—3.2 (95% CI 1.4–9.2, p = 0.03), glutathione postoperative levels ≤0.194 micromole/g of hemoglobin—1.9 (95% CI 1.2–6.3, p < 0.001), glutathione peroxidase postoperative levels ≤17.36 millimole/g of hemoglobin—2.2 (95% CI 1.1–8.2, p < 0.001), glutathione reductase postoperative levels ≤2.99 millimole/g of hemoglobin—2.3 (95% CI, 1.1–5.7, p < 0.001), malondialdehyde postoperative levels >1.25 micromole/g of hemoglobin—2.0 (95% CI, 1.2–7.9, p < 0.001), NO postoperative levels in plasma >36.4 micromole/L—1.5 (95% CI, 1.1–5.9, p < 0.001) and omega-3 index ≤1.59%—2.6 (95% CI 1.5–9.1, p < 0.001). Our study showed that increased left atrial diameter, high postoperative levels of inflammatory factors, oxidative stress, fibrosis indicators and omega-3 index were associated with POAF in patients who underwent CABG. [ABSTRACT FROM AUTHOR]

This study aimed to compare the long-term outcomes in a propensity matched population receiving total arterial grafting (TAG) and multiple arterial grafts (MAG) in addition to saphenous vein graft (SVG) following multivessel coronary artery bypass grafting requiring at least three distal anastomoses. In this retrospective study, 655 patients from two centers met the inclusion criteria and were divided into two groups: TAG group (n = 231) and MAG + SVG group (n = 424). Propensity score matching was performed resulting in 231 pairs. No significant differences were observed between both groups in terms of early outcomes. Survival probabilities at 5, 10, and 15 y were 89.1% versus 94.2%, 76.2% versus 76.1%, and 66.7% versus 69.8% in the TAG and MAG + SVG groups, respectively (hazard ratio stratified on matched pairs: 0.90; 95% confidence interval [0.45-1.77]; P = 0.754). Freedom from major adverse cardiac and cerebral events (MACCE) in the matched cohort did not show any significant difference between both groups. Probabilities at 5, 10, and 15 y were 82.7% versus 85.6%, 62.2% versus 75.3%, and 48.8% versus 59.5% in the TAG and MAG + SVG groups, respectively (hazard ratio stratified on matched pairs: 1.12; 95% confidence interval [0.65-1.92]; P = 0.679). Subgroup analyses of the matched cohort showed no significant difference between TAR with three arterial conduits compared to TAR with two arterial conduits with sequential grafting and MAG + SVG in terms of long-term survival and freedom from MACCE. Multiple arterial revascularizations in addition to SVG may yield comparable long-term outcomes in terms of survival and freedom from MACCE compared to total arterial revascularization. [ABSTRACT FROM AUTHOR]

Pneumoconioses are parenchymal lung diseases caused by dust accumulation in the lungs and the resulting tissue reaction. A 60-year-old male patient was admitted to our clinic with complaints for 3 months of weakness, fatigue and constant pain in the right arm that did not change with movement. His professional history revealed employment in glazing processes in the ceramics industry for 28 years, while his medical history included pneumoconiosis and coronary artery bypass surgery in 2015. A recent postero-anterior chest X-ray had revealed increased opacity in the apical region of the right lung compared to a radiograph taken 3 years earlier. A highresolution thorax computed tomography of the lungs was performed revealing a 5 cm diameter mass lesion in the upper lobe of the right lung, although no differentiation between the mass and progressive massive fibrosis (PMF) could be made. Thoracic magnetic resonance imaging was performed after mass development was suspected on the basis of PMF, and a malignant lesion that was hyperintense compared to muscle and PMF tissue was observed in the apical segment of the right lung upper lobe on T2W images. No endobronchial lesion was observed in the patient on bronchoscopy, while a transthoracic biopsy performed on the hyperintense area was reported as adenocarcinoma. We present a case of PMF pneumoconiosis presenting with lung cancer. [ABSTRACT FROM AUTHOR]

We report the incidence, patient characteristic with clinical outcomes in patients with homozygous familial hypercholesterolemia (HoFH) in Saudi Arabia. This is a retrospective and prospective, single center study which included 37 patients 14 years and older enrolled and followed up between 2018-2021 for three years. 46% were females, 78% were offspring of consanguineous marriage. LDLR mutation was in 78% and LDL-C/LDLRAP in 3% of patients. Mean LDL-C at the first presentation was 14.2±3.7 mmol/L, average Dutch lipid score was 20.9±6.24. LDL apheresis was performed on 70% of patients. Most patients were on ezetimibe (92%), high-dose statins (84%) and PCSK9 inhibitors (32%); 48.6% had aortic stenosis, out of which 30% had severe aortic stenosis. Ten underwent aortic valve surgery (5 mechanical valve, 3 Ross procedure, 1 aortic valve repair, 1 bioprosthetic valve) and one had transcatheter aortic valve implantation (TAVI). Coronary artery bypass surgery (CABG) was performed on 32% and percutaneous intervention (PCI) on 11% of patients. HoFH patients have complex diseases with high morbidity and mortality, and benefit from a highly specialized multidisciplinary clinic to address their clinical needs. Although there are several therapeutic agents on the horizon, early diagnosis, and treatment of HoFH remain critical to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the evolution of coronary surgery, particularly focusing on the development of coronary bypass surgery. It highlights the key milestones in the history of bypass surgery, from its inception in the late 1950s to the advancements in the 1980s and 1990s. The text emphasizes the importance of coronary bypass surgery in prolonging the survival of patients with severe coronary artery disease and compares it to percutaneous coronary intervention (PCI). The article concludes by stressing the significance of ongoing improvements in bypass surgery to ensure safety and effectiveness. [Extracted from the article]

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Lung air cysts and bullae are airborne cavities larger than 1 cm in diameter, surrounded by a thin wall, localized within the lung tissue. The bullae are often located apically in the lung. They are usually asymptomatic unless they are very large in size and are detected on chest X-ray or lung tomography. In this article, we present an asymptomatic 79-year-old male patient who was randomly detected as having an air cyst in the anterior segment of the upper lobe of the left lung during the preparation for coronary bypass. We did not find similar cases in PUBMED literature review. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary disease not involving the left main have shown significantly lower rates of death, myocardial infarction (MI), or stroke after CABG. These studies did not routinely use current-generation drug-eluting stents or fractional flow reserve (FFR) to guide PCI. METHODS: FAME 3 (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) is an investigator-initiated, multicenter, international, randomized trial involving patients with 3-vessel coronary artery disease (not involving the left main coronary artery) in 48 centers worldwide. Patients were randomly assigned to receive FFR-guided PCI using zotarolimus drug-eluting stents or CABG. The prespecified key secondary end point of the trial reported here is the 3-year incidence of the composite of death, MI, or stroke. RESULTS: A total of 1500 patients were randomized to FFR-guided PCI or CABG. Follow-up was achieved in >96% of patients in both groups. There was no difference in the incidence of the composite of death, MI, or stroke after FFRguided PCI compared with CABG (12.0% versus 9.2%; hazard ratio [HR], 1.3 [95% CI, 0.98-1.83]; P=0.07). The rates of death (4.1% versus 3.9%; HR, 1.0 [95% CI, 0.6-1.7]; P=0.88) and stroke (1.6% versus 2.0%; HR, 0.8 [95% CI, 0.4-1.7]; P=0.56) were not different. MI occurred more frequently after PCI (7.0% versus 4.2%; HR, 1.7 [95% CI, 1.1-2.7]; P=0.02). CONCLUSIONS: At 3-year follow-up, there was no difference in the incidence of the composite of death, MI, or stroke after FFR-guided PCI with current-generation drug-eluting stents compared with CABG. There was a higher incidence of MI after PCI compared with CABG, with no difference in death or stroke. These results provide contemporary data to allow improved shared decision-making between physicians and patients with 3-vessel coronary artery disease. [ABSTRACT FROM AUTHOR]

A giant coronary artery aneurysm (GCAA) concurrent with coronary artery fistula is a rare condition, and it becomes even more unusual when combined with a single coronary artery (SCA) anomaly. Here, we report such an extremely rare case, who is a 35‐year‐old woman presenting with severe chest distress. A GCAA with fistula to the right ventricle was noted, occurring in a single coronary artery, diagnosed by multimodality cardiovascular imaging techniques. Both GCAA and coronary artery fistula can cause severe cardiac complications, which jeopardize life. While an SCA is mostly asymptomatic, it may also lead to sudden cardiac death as well. Therefore, surgical intervention was recommended. We chose a novel thrombus‐inducing strategy to eliminate the GCAA and repair the fistula. Symptoms were relieved after the surgery, and the patient remained asymptomatic over 8 months of follow‐up. [ABSTRACT FROM AUTHOR]

Objectives: Cardiovascular surgery advancements have emerged with various minimally invasive approaches for treating multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. We present our clinical experience and minimally invasive coronary bypass techniques through minithoracotomy, which we apply without selection to patients who have decided to have elective surgery for multivessel isolated coronary artery disease. Methods: It consists of 230 consecutive patients operated by the same team with this method between July 2020 and September 2022. The patients were assigned to one of the two methods preoperatively to their accompanying comorbidities and operated on either with blood cardioplegia via 5 to 7 cm left anterior minithoracotomy, with on-pump clamped technique or without pump via left anterolateral minithoracotomy. Results: Mortality was observed in two of our patients (0.9%), but myocardial infarction was not observed in our patients in the early postoperative period. None of our patients required conversion to sternotomy (0%). Five patients' needed reoperation from the same incision due to postoperative bleeding (2.2%), and atrial fibrillation developed in 17 patients in the postoperative period (7.4%). The mean number of bypasses was found to be 3.0 ± 0.9. Conclusions: Minimally invasive coronary artery bypass surgery via minithoracotomy can be routinely reproduced safely. More long-term results and more multicenter studies are needed for more widespread acceptance of the technique. [ABSTRACT FROM AUTHOR]

Introduction: The distal end anastomosis is critical to the entire sequential grafts in coronary artery bypass grafting (CABG), but caliber mismatch diminishes the quality of the anastomosis. We aimed to introduce a modified distal end side-to-side (deSTS) anastomosis to handle the size mismatch and compared with classic distal end end-to-side (deETS) anastomosis. Methods: From January 2014 to December 2018, 185 patients who underwent off-pump CABG with size mismatched sequential vein grafts (≥3.5 mm) and target coronaries (1.0–1.5 mm) at the distal end anastomoses were included. We retrospectively reviewed the data of the patients, perioperative and follow-up outcomes were analyzed. Results: The deSTS group (n = 67) showed higher anastomotic flow (19.8 ± 8.0 vs 14.9±6.8 mL/min; p < 0.001) and lower pulsatility index (2.7 ± 0.8 vs 3.2 ± 1.0; p = 0.001) than the deETS group (n = 118). Higher incidence of in-hospital myocardial infarction (MI) was found in the deETS group but without significant difference (9.0% vs. 15.3%; p = 0.220). Kaplan-Meier analysis illustrated a relatively lower MI and major adverse cardiovascular and cerebrovascular events (MACCE) incidence in the deSTS group, and the deSTS group was associated with a reduction in long-term death, MI and MACCE in the adjusted Cox regression model. In addition, relatively higher graft patency was found in the deSTS group. Conclusions: The deSTS anastomosis showed superiority in solving size mismatch in sequential CABG, including better intraoperative flow dynamics, ideal long-term graft patency and reduced the incidence of perioperative and follow-up adverse events especially in MI. [ABSTRACT FROM AUTHOR]

Background: Significant economic consequences can lead to various problems and complications, including medical complications. Coronary artery disease (CAD), a serious health threat with increasing prevalence, is a major cause of death and mortality worldwide. This study aimed to investigate the effects of a special training program on cytochrome P450 (CYP) gene expression and reactive oxygen species (ROS) levels in patients with coronary artery bypass surgery. Methods: This semi-experimental study was conducted on 16 patients who underwent coronary artery surgery in Babol City, Iran. The patients were selected using a random sampling method and divided into 2 groups: experimental and control groups. The experimental group engaged in an exercise program consisting of 3 sessions per week for a duration of 8 weeks. The expression levels of CYP and ROS genes were measured by the real-time polymerase chain reaction (PCR) method. The analysis was performed by comparing covariances and means. Results: ROS gene expression levels significantly decreased in the experimental group than in the control group (P=0.003). However, there was no significant difference in P450 levels between the experimental and control groups (P=0.99). Conclusion: Special exercises reduced ROS expression and increased P450 expression in patients who had coronary bypass surgery. There is a probability that special exercises, can effectively prevent heart damage by increasing antioxidant capacity and reducing ROS. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Remimazolam is a new benzodiazepine sedative and has the characteristic of causing minimal effects on circulation. This case indicates that it can be considered as an option for anesthesia management of patients with decreased cardiac function. Some patients who undergo cardiac surgery have reduced cardiac function, which can often make anesthesia management difficult owing to severe hypotension at the time of anesthesia induction. Therefore, it is important to select drugs that cause minimal circulatory depression. On the other hand, in 2020, the use of remimazolam, a short‐acting benzodiazepine sedative, was approved in Japan, and reports of its use in various patients have been increasing. This drug has the characteristic of causing minimal effects on circulation. We here report the safe use of remimazolam in the anesthesia management of a patient with decreased cardiac function who was diagnosed as having angina pectoris. The patient was a 73‐year‐old man scheduled for coronary artery bypass graft (CABG) surgery. Remimazolam was used for sedation purposes during anesthesia induction. During surgery, there were no significant hemodynamic changes and the patient remained in stable cardiovascular condition. Our present case indicates that remimazolam can be considered as an option for anesthesia management in CABG for patients with decreased cardiac function. [ABSTRACT FROM AUTHOR]

ALCAPA is a rare congenital heart disease. Presentation varies from asymptomatic to progressive heart failure and death. Surgical repair is indicated in all patients with a goal of restoring two coronary systems. Data was analysed in regard to presenting features, echocardiographic findings, various surgical approaches used and immediate, early and midterm post-operative results. Most common presentation was growth failure and seen in 6 patients. One patient was taken for elective PDA ligation and diagnosis of ALCAPA was made on table after PDA ligation as patient crashed subsequently. Aortocoronary button transfer was most commonly used surgical technique while 2 patients needed interposition grafting. LV function improved in 5 out of 8 patients with regression of MR. A median improvement of 5+-2% was observed in ejection fraction of 5 patients. Early surgery with aortocoronary transfer offers good results with gradual improvement in LV dysfunction and mitral regurgitation. [ABSTRACT FROM AUTHOR]