Coronary artery bypass surgery

Aim: Pulmonary complications are frequently seen complications following especially after coronary artery bypass grafting. Attempts are made to detect those complications preoperatively by pulmonary function tests and clinical evaluation.In our study, we investigated the effect of computed tomography findings in predicting postoperative complications in patients with normal respiratory function tests. Material and Method: Between January 2012 and

Background: Acute pulmonary edema following cardiopulmonary bypass (CPB) is a serious complication, the etiology of which could be classified into two groups: cardiogenic and noncardiogenic.
Case presentation: We present a 42-year-old male with multiple pulmonary bullae scheduled for mitral valve and aortic valve replacement. Acute pulmonary edema occurred approximately 1 hour after weaning from CPB. The diagnosis of non-cardiogenic pulmonary edema was established with changes in pathophysiology and findings on ultrasound. The patient was promptly treated and transferred to the ICU uneventfully.
Conclusions: This case report highlights the changes in pathophysiology combined with ultrasound findings to establish a diagnosis in the operating room. We also emphasize the perioperative management of noncardiogenic pulmonary edema.

Introduction. The study objective was to determine the effect of coronary artery bypass grafting (CABG) on survival and long term quality of life. Method. Perioperative questionnaire data were collected from eighty patients (mean age 62.4 years; 67 male, 13 female) who underwent on-pump CABG between September 1999 and June 2000. Information was gathered on mortality, disease specific symptoms (chest pain (CCS), breathlessness (NYHA), myocardial infarctions, heart failure), patient satisfaction, health related quality of life (shortform-12), functional status (Barthel's Score, Duke Activity Score, working hours) and neurocognitive function (mini mental score, strokes). Follow-up data were obtained via telephone interview at set intervals from 6 weeks to 10 years postoperatively. Analysis was basic descriptive, Mann-Whitney U, Pearson's correlation and Wilcoxon matched pairs tests using SPSS 16. Results. Survival at 5 years was 91.3% and 70% at ten years. Cardiac health was improved following CABG with just 5 patients having an MI in the following 10 years. There was a significant and sustained reduction in both the prevalence of angina (97.5% pre-CABG versus 14% of survivors at ten years (pϽ0.001)) and also severity (reduction in mean CCS scores from 2.46 pre-CABG to Ͻ1 postoperatively (pϽ0.001)). Although cardiac mortality was the single most common cause it accounted for just 7/19 known causes of death. At 10 years, 17.5% of patients had had a stroke, causing 4 deaths. Other causes of death by 10 years were: cancer (5), respiratory (2) and old age (1); cause is unknown for 5 patients. Patients experienced an improved functional status (pϽ0.05) and cognitive function returned to normal within a year in all patients. SF-12 scores improved following CABG to become comparable with an age matched UK population (pre-CABG scores were significantly lower than the population (pϽ0.001)). Patients who restarted smoking did not show a sustained improvement in functional status or SF-12 score and had a more variable MMSS compared with non-smokers. Conclusion. Survival and quality of life are improved by coronary artery bypass grafting but not in patients who restart smoking.

In patients undergoing coronary artery bypass surgery (CABGS), occurrence of atrial fibrillation (AF) is common in the postoperative period and is associated with increased morbidity with longer intensive unit care (ICU) and hospital stay. Prevention with antiarrhythmic drugs is of limited success and associated with significant side effects. Therefore alternative approaches, such as Bachmann Bundle pacing, are required. : 154 consecutive patients, mean age 58±8.8 years, including 134 males and 20 females, were randomized to three groups; Group I : No pacing n= 54, Group II : RA pacing n= 52, Group III : Bachmann Bundle pacing n= 48. All the groups were well matched with regard to age, left atrial size, ejection fraction and use of beta blockers. Patients in Groups II and III were continually paced at a rate of 100 beats per minute (bpm) or at 10 bpm more than patients' intrinsic heart rate. All the patients were monitored for 72 hours by telemetry and occurrence of AF was noted. Incidence of AF was 0% (none of 48 patients) in Group III as compared to 16.6% in Group I (9 of 54 patients) (p 0.003) and 12.5% in Group II (5 of 52 patients) (p 0.03). There was a trend towards shorter ICU stay in Group III (3.9 days) as compared to Group II (4.5 days) and Group I (4.1 days). Among the three groups, the reduction in mean P wave duration also was greater in Bachmann bundle paced group. In patients undergoing CABGS, Bachmann bundle pacing is superior to right atrial / no pacing in the post operative period for preventing occurrence of AF and reducing ICU stay, commensurate with a reduction in mean P wave duration on surface ECG.

In patients undergoing coronary artery bypass surgery (CABGS), occurrence of atrial fibrillation (AF) is common in the postoperative period and is associated with increased morbidity with longer intensive unit care (ICU) and hospital stay. Prevention with antiarrhythmic drugs is of limited success and associated with significant side effects. Therefore alternative approaches, such as Bachmann Bundle pacing, are required. 154 consecutive patients, mean age 58±8.8 years, including 134 males and 20 females, were randomized to three groups; Group I : No pacing n= 54, Group II : RA pacing n= 52, Group III : Bachmann Bundle pacing n= 48. All the groups were well matched with regard to age, left atrial size, ejection fraction and use of beta blockers. Patients in Groups II and III were continually paced at a rate of 100 beats per minute (bpm) or at 10 bpm more than patients' intrinsic heart rate. All the patients were monitored for 72 hours by telemetry and occurrence of AF was noted. ...

Over the past 3 years, we have developed a polyester mesh stent designed to preserve luminal patency in cases of dissecting aortic aneurysm and to maintain arterial patency after angioplasty. To study the stent's incorporation into the aortic wall and to test its thrombogenicity, we implanted the device in the abdominal aortas of ten dogs. The device was compressed and inserted into a 10-Fr sheath, which was introduced through the femoral artery into the aorta. Once liberated from the sheath and fully expanded within the aorta, the stent measured 10 cm in length and 8 mm in outer diameter. Each animal was followed up clinically until it was killed at intervals ranging from 1 week to 6 months after implantation. The aorta was excised, and tissue incorporation was evaluated grossly, as well as with light and scanning electron microscopy. In all cases, the arteries and side branches were found to be widely patent. At 3 weeks, the stent already had become firmly adherent to the vess...

Background— Ischemia on thallium scanning is a strong predictor of long-term mortality in CAD patients. Whether coronary revascularization (CR) in patients with significant ischemia on preoperative thallium scanning (PTS) improves long-term survival after major vascular surgery has not been determined. Methods and Results— The perioperative data, including PTS and subsequent CR in patients with moderate to severe reversible ischemia on PTS, and long-term survival of 502 consecutive patients who underwent 578 major vascular procedures were analyzed retrospectively. Patients with PTS who ultimately did not undergo the planned vascular operation were also studied. Cox regression and propensity score analyses were used to analyze survival. A total of 407 patients (81.1%) had PTS: 221 (54.3%) had no or mild defects (group I); 50 (12.3%) had moderate-severe fixed defects (group II); 62 (15.2%) had moderate-severe reversible ischemia yet did not undergo CR (group III); and 74 (18.2%) had m...

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether methylene blue (MB) is of benefit in treating adult patients who develop catecholamine-resistant vasoplegic syndrome (VPS) during cardiac surgery. Altogether 47 papers were found in Medline and 107 in Embase using the reported search. A further five papers were found by handsearching reference lists. Four papers represented the best evidence on the subject and details of authors, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. In addition, a further 14 papers are referenced to aid the discussion. We conclude that MB may provide an interesting and novel therapeutic option for adult patients who develop catecholamineresistant VPS during cardiac surgery. Whilst there is currently insufficient evidence to advocate its use as first-line therapy it should be considered as a possible 'rescue therapy' in catecholamine-resistant VPS and some work has suggested that it may have a prophylactic role in preventing VPS. However, further large well-controlled studies are required before its routine use can be recommended.

Um doente de 61 anos de idade portador de cirrose hepática de etiologia alcoólica foi atendido no pronto-socorro com peritonite bacteriana espontânea. Durante a internação, apresentou hemorragia digestiva alta que determinou estado de choque hipovolêmico. Após reposição da volemia com soluções salina e coloide, o paciente se queixou de dor torácica. O eletrocardiograma (ECG) nessas condições (Figura 1) mostrou infradesnivelamento do segmento ST acentuado (com até -6 mm em V4) e difuso, associado a inversão das ondas T na maioria das derivações. Administrouse isossorbida sublingual, porém, as alterações de ST-T permaneceram inalteradas (Figura 2).

Carotid artery stenting (CAS) has emerged as an attractive alternative to carotid endarterectomy (CEA). However, CAS in a high risk patient carries significant morbidity/mortality. We report a successful CAS procedure in an extremely high risk case with a unique underlying comorbid combination not previously reported in the literature.

We report a case of a 67 year-old-male patient admitted to the intensive care unit in the postcoronary bypass surgery period who presented cardiogenic shock, acute renal failure and three episodes of sepsis, the latter with pulmonary distress at the 30th post-operative day. The patient expired within five days in spite of treatment with vancomycin, imipenem, colistimethate and amphotericin B. At autopsy severe adenovirus pneumonia was found. Viral pulmonary infections following cardiovascular surgery are uncommon. We highlight the importance of etiological diagnosis to a correct treatment approach.

Background: A common type of strabismus known as concomitant exotropia (XT) occurs when mismatched eyes deviate outward and the angle of deviation is the same regardless of which eye is fixed. Among ophthalmologists, there is no agreement on non-surgical treatment options for XT. For those who suffer from strabismus, surgery is an option for correcting their visual axis and restoring their ability to see in both eyes simultaneously. Instead, then severing the muscle, muscle plication involves folding the muscle around itself and stitching it in place, essentially shortening and tightening the muscle. Muscle plication has been found to reduce the risk of anterior segment ischemia by protecting the anterior ciliary arteries. Objective: To hallmark the new guidelines options of concomitant exotropia management. Conclusion: Muscle-tightening techniques such as excision, plication, advancement, and transposition have been documented in the literature. Technical simplicity, the ability to reverse it, shorter operating times, reduced surgical trauma, and the preservation of anterior ciliary arteries are only a few of the many advantages of plication.

Objectives In this substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial, we investigated the relationship between chronic kidney disease (CKD) and clinical outcomes, and compared the safety and efficacy of bivalirudin monotherapy versus heparin plus a glycoprotein IIb/IIIa inhibitor (GPI). Background CKD is an important predictor of prognosis in the general population. The outcomes of patients with CKD and acute coronary syndromes (ACS) have not been well studied. In the ACUITY study, 13,819 patients with moderate-and high-risk ACS undergoing an early, invasive strategy were randomly assigned to 1 of 3 antithrombin regimens: a heparin plus a GPI, bivalirudin plus a GPI, or bivalirudin monotherapy. CKD (creatinine clearance Ͻ60 ml/min) was present in 2,469 (19.1%) of 12,939 randomized patients with baseline creatinine clearance data. Results Patients with CKD had worse 30-day and 1-year clinical outcomes than those with normal renal function. There were no significant differences between bivalirudin monotherapy and heparin plus a GPI in rates of 30-day composite ischemia (11.1% vs. 9.4%, p ϭ 0.27) and net clinical adverse outcomes (16.1% vs. 16.9%, p ϭ 0.65). There was remarkably less major bleeding (6.2% vs. 9.8%, p ϭ 0.008) at 30 days, but no significant difference in 1-year composite ischemia (22.0% vs. 18.9%, p ϭ 0.10) or mortality (7.1% vs. 7.3%, p ϭ 0.96). In patients with ACS, CKD is associated with higher 30-day and 1-year adverse event rates. Compared with heparin plus a GPI, the use of bivalirudin monotherapy in patients with CKD results in nonstatistically different ischemic outcomes, but significantly less 30-day major bleeding. (

In earlier studies it has been reported that patients with carcinoid tumours have a relatively good health-related quality of life (HRQoL) and low levels of anxiety and depression. The aims of this study were (a) to investigate the extent to which psychosocial function changes in patients with carcinoid tumours with time from diagnosis and its possible relation to tumour markers, and (b) to compare the HRQoL of patients with carcinoid tumours with that of healthy Swedish adults. Twenty-four patients reported on HRQoL (the EORTC QLQ-C30), anxiety and depression (the Hospital Anxiety and Depression Scale) ve times during their rst year of treatment. After one year, improvement in nausea vomiting, ush and anxiety was reported, but there was deterioration of physical function, an increase in muscular pain and problems with dry skin. Levels of tumour markers were not associated with psychosocial function. Patients reported a lower HRQoL compared with healthy Swedish adults. Thus, deterioration of physical function was not accompanied by a deterioration of emotional function, and levels of tumour markers were not related to patients' HRQoL.

N PATIENTS WITH ACUTE CORONARY syndromes (ACS; unstable angina or non-ST-segment elevation myocardial infarction [MI]), an early invasive strategy, consisting of angiography with subsequent triage to either percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery, or medical management, results in reduced rates of death and MI com-For editorial comment see p 636. In patients with moderate-and high-risk acute coronary syndromes (ACS) who undergo an early, invasive treatment strategy, current guidelines recommend administration of platelet glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibitors, either upstream to all patients prior to angiography or deferred for selective use in the catheterization laboratory just prior to angioplasty. The preferred approach is undetermined. Objective To determine the optimal strategy for the use of Gp IIb/IIIa inhibitors in patients with moderate-and high-risk ACS undergoing an early, invasive treatment strategy. Design Prospective, randomized, open-label trial with 30-day clinical follow-up. Setting Four hundred fifty academic and community-based institutions in 17 countries. Patients A total of 9207 patients with moderate-and high-risk ACS undergoing an invasive treatment strategy. Interventions Patientswererandomlyassignedtoreceiveeitherroutineupstream(n=4605) or deferred selective (n=4602) Gp IIb/IIIa inhibitor administration, respectively. The primary outcome was assessment of noninferiority of deferred Gp IIb/IIIa inhibitor use compared with upstream administration for the prevention of composite ischemic events (death, myocardial infarction, or unplanned revascularization for ischemia) at 30 days, using a 1-sided ␣ level of .025. Major secondary end points included noninferiority or superiority of major bleeding and net clinical outcomes (composite ischemia or major bleeding). Glycoprotein IIb/IIIa inhibitors were used more frequently (98.3% vs 55.7%, respectively) and for a significantly longer duration (median, 18.3 vs 13.1 hours; PϽ.001) in patients in the upstream group compared with the deferred group. Composite ischemia at 30 days occurred in 7.9% of patients assigned to deferred use compared with 7.1% of patients assigned to upstream administration (relative risk, 1.12; 95% confidence interval, 0.97-1.29; P=.044 for noninferiority; P=.13 for superiority); as such, the criterion for noninferiority was not met. Deferred use compared with upstream use resulted in reduced 30-day rates of major bleeding (4.9% vs 6.1%, respectively; PϽ.001 for noninferiority; P=.009 for superiority) and similar rates of net clinical outcomes (11.7% vs 11.7%; PϽ.001 for noninferiority; P=.93 for superiority). Conclusions Among patients with moderate-and high-risk ACS undergoing an invasive treatment strategy, deferring the routine upstream use of Gp IIb/IIIa inhibitors for selective administration in the cardiac catheterization laboratory only to patients undergoing percutaneous coronary intervention resulted in a numerical increase in composite ischemia that, while not statistically significant, did not meet the criterion for noninferiority. This finding was offset by a significant reduction in major bleeding.

Objectives: Patients with chest pain and normal coronary arteries often suffer from physical and psychological symptoms. Therefore, this study aimed to examine the incidence of mental symptoms in patients with angiographic exclusion of a coronary heart disease. In 253 patients with angiographic exclusion of a coronary heart disease the type and intensity of their symptoms were evaluated before and after coronary angiography. In addition, the incidence of psychopathological symptoms was quantified by standardised questionnaires such as general anxiety and depression (HADS), heart-focused anxiety (CAQ), hypochondria (Whiteley Index) and somatoform disorder (SOMS) and quality of life (SF-12). Finally, the incidence of psychological symptoms in these patients was compared to the incidence in the normal population. Results: Despite the absence of a coronary artery disease, 70% of patients continue to suffer from cardiac symptoms. The incidence of general anxiety was increased by 37% in women and by 22% in men in comparison to the normal population. Heart-focused anxiety was raised by 27%. Somatoform disorder appeared 120% more often in patients after cardiac catheterisation in comparison to the normal population. In addition, the incidence of hypochondria was elevated by 68% in patients after coronary angiography compared to normal population. This increased appearance of psychological symptoms was reflected in a significantly lower quality of life (SF-12) in patients with inconspicuous coronary angiography. Conclusions: Patients with cardiac symptoms and normal coronary arteries more often suffer from mental symptoms in comparison to the healthy population. ▸ These diagnostic tools may prevent repeated utilisation of the healthcare system and this could help to reduce costs in these patients due to initiation of an early psychosomatic therapy.

Constrictive pericarditis after coronary artery bypass grafting (CABG) is rare and can present as unexplained dyspnea. We report five consecutive cases of post‐CABG constrictive pericarditis seen within a period of 17 months at our institution. All patients presented with heart failure of unknown etiology within a period of 8‐84 months after surgery. During the initial post‐CABG period, two patients had developed postcardiotomy syndrome that was successfully treated with steroids. They were all assessed noninvasively and invasively. In all patients, the diagnosis of constriction was initially suspected clinically (symptoms, high jugular venous pressure with deep “X” and “Y” descents, pericardial knock). Echocardiography showed transmural flow typical of constriction in all patients and hepatic venous flow in two. Two patients showed rapid left ventricular relaxation. In all patients, hemodynamic assessment showed diastolic equalization of pressures in all chambers, “W” shape wavefor...

Coronary artery bypass grafting (CABG) is the most commonly performed type of open heart surgery. For an effective revascularisation procedure, the positioning of the bypass graft (distal anastomosis) is of utmost importance. To assist the surgeon in this matter, a surgical navigation system for the open heart has been developed. Prior to surgery, the optimal distal anastomosis site is planned for each diseased target vessel on the basis of cardiac MSCT (multi-slice computed tomography) data. Intraoperative surgical assistance is provided by image-guided navigation to the planned positions. To enable navigation on the arrested heart, registration of preand intraoperative modalities is required. The registration mechanisms for the arrested heart were validated retrospectively on patient data from CABG procedures. The promising results led to subsequent intraoperative live application of the system during 11 open heart CABG surgeries enabling navigation at the arrested heart on a tota...

Ustalenie ryzyka śmiertelności operacyjnej jest obowiązkowe w przypadku operacji kardiochirurgicznych przeprowadzanych u osób dorosłych. Pacjenci powinni zostać poinformowani o ryzyku operacyjnym przed zabiegiem. Istnieją systemy oceny ryzyka, które porównują i standaryzują wyniki operacji. W ostatnim czasie nastąpiła aktualizacja tychże systemów, która zaowocowała powstaniem systemu EuroSCORE II. Celem niniejszej pracy było potwierdzenie skuteczności tego systemu przez porównanie go z wcześniejszym systemem oceny ryzyka EuroSCORE w grupie obarczonych wysokim ryzykiem pacjentów w 8. dekadzie życia, którzy zostali poddani operacji pomostowania aortalno-wieńcowego (coronary artery bypass grafting -CABG). Materiał i metody: Do badania włączono jedynie pacjentów wysokiego ryzyka w 8. dekadzie życia, którzy zostali poddani izolowanym zabiegom pomostowania aortalno-wieńcowego w ośrodku autorów pomiędzy styczniem 2000 r. a styczniem 2010 r. Z badania wyłączono reoperacje oraz operacje równoczesne. Obserwowana śmiertelność została porównana z oczekiwaną wg systemów oceny EuroSCORE (logistic) oraz EuroSCORE II. Wyniki: Pod uwagę wzięto 105 operacji CABG wykonanych u pacjentów w 8. dekadzie życia pomiędzy styczniem 2000 r. a styczniem 2010 r. Średni wiek pacjentów wyniósł 81,43 ± 2,21 roku (80-89 lat). W badanej grupie znalazło się 39 kobiet (37,1%). Obie skale wykazały dobrą zdolność dyskryminacyjną w całkowitej grupie pacjentów, przy czym wartość AUC (pole powierzchni pod krzywą) była wyższa dla EuroSCORE II (AUC = 0,772; 95% CI: 0,673-0,872). Obie skale wykazały również dobrą zgodność dopasowania. Wnioski: System EuroSCORE II charakteryzuje się lepszymi wartościami AUC (pole powierzchni pod krzywą ROC) w porównaniu z oryginalnym systemem EuroSCORE; niemniej jednak obie CARDIAC SURGERY

The rupture of a sinus of Valsalva aneurysm (SVA) is a rare occurrence in cardiovascular medicine; however, it often severely compromises patients’ physiological functions and poses a life-threatening risk when it occurs [1]. Pseudoaneurysm of the sinus of Valsalva (SVpA) more frequently affects men [2]. However, we report a case of sinus of Valsalva pseudoaneurysm with thrombosis: a 30-year-old female, who experienced no physical discomfort in her daily life, accidentally discovered a ruptured aneurysm of the Valsalva sinus at the non-coronary sinus during a physical examination. The aneurysm had formed a large pseudoaneurysm, measuring 6.3 × 6.0 cm, located in the right atrioventricular sulcus. This pseudoaneurysm exerted significant pressure on the right atrium, and much of it had been filled with thrombus.

The main goal of this study was to evaluate whether the addition of ECG gating to technetium-99m sestamibi single-photon emission tomographic (SPET) perfusion imaging assists the prediction of recovery of regional wall motion abnormalities after revascularization. Thirty-six patients with coronary artery disease were included in the study. All had wall motion abnormalities, and 31 (86%) had a clinical history of myocardial infarction. Coronary artery bypass surgery was performed in 18 patients and angioplasty in the remainder. All underwent ECG-gated and non-gated SPET at rest and after intravenous dipyridamole. Two-dimensional echocardiography was performed at a mean of 27 days before revascularization and at a mean of 69 days following revascularization to assess segmental wall motion changes. Perfusion prior to revascularization was analysed qualitatively and quantitatively on gated and non-gated SPET, and the results compared with those of echocardiography. Bullseye parameters were obtained from a normal database, generated from data in 40 normal volunteers, using dipyridamole ECG-gated and nongated sestamibi SPET. There was good concordance between gated and non-gated qualitative analysis (79% with kappa=0.65) for normal, viable or necrotic segments. Gated SPET predicted functional recovery in 27 of 35 (77%) segments showing echocardiographic improvement while non-gated SPET did so in 30 of 39 (77%) such segments. Gated SPET predicted no functional recovery in 20 of 45 (44%) segments that did not show improved wall motion after revascularization, while with non-gated SPET the figure was 18 of 51 (35%). The positive predictive values of gated and nongated SPET with regard to the recovery of wall motion following revascularization were 52% and 48%, while the negative predictive values were 71% and 67%, respectively. 99mTc-sestamibi had a low predictive value

Background: Pericardial effusion is commonly seen after coronary artery bypass surgery; large pericardial effusion develops at 4 to 10 days postoperatively in 30% of patients undergoing cardiac surgery. However, regional pericardial effusions are often localized posteriorly; one of the recent solutions to reduce this complication is posterior pericardiotomy, which also significantly reduces late pericardial effusion and late posterior tamponade. Aim: our target is to assess the impact and effectiveness of posterior pericardiotomy in reducing post-cardiac surgery pericardial effusion and tamponade. Patients and Methods: This prospective randomized case-controlled study was carried out in 64 patients. They were randomly assigned to one of 2 groups of 32 patients each. Longitudinal incision in the pericardium was made parallel and posterior to the left phrenic nerve in group one and not in group II, then we evaluated the results between the two groups as regards post operative pericardial effusion. Results: There were no statistically significant differences between the groups with respect to demographic or operative characteristics. The pericardiotomy group had lower incidence of postoperative pericardial effusion as 68.75% of the Pericardiotomy group had no effusion in the first seven days, while it was 43.3% in the control group, and none of the Pericardiotomy group developed severe pericardial effusion at any time. Conclusion: posterior pericardiotomy significantly reduce postoperative effusion and tamponade, and we recommend it in all the cases of cardiac surgery operations.

Profound myocardial hypothermia (below 17 degrees C, and more often around 12 degrees C) is imperative in myocardial protection while the aorta is cross-clamped. Based on our experience in more than 800 open-heart operations, profound myocardial hypothermia can be achieved by very efficient topical cooling despite mild systemic hypothermia (30 to 33 degrees C) and a small, single dose of crystaloid K + cardioplegia. Very efficient topical cooling is achieved by a high flow (1 to 1(1/2) L/min) of continuously cooled fluid (+ 0.5 to + 2 degrees C). The great temperature-reducing capacity of the cooling system is due to a 10 to 15 meter long metal coil tube that is immersed in an ice-salt cold bath. The water pump placed in the bath makes heat exchange even more efficient. The described method of myocardial protection with stable profound myocardial hypothermia safely prolongs the ischemic time during operation to more than 2 hours. By repositioning the coil into the warm bath (39 to 40 degrees C), the whole system can be used for topical rewarming of the heart.

There is abundant evidence of health inequities between urban and rural populations. The purpose of this paper is to describe the socioeconomic characteristics of Québec urban and rural populations and the relation between rurality and incidence of myocardial infarction (MI), care management and outcomes. Socioeconomic data by census subdivisions were available from the 1996 Canadian census, representing 7,137,245 individuals. Data on patients with MI were taken from the provincial administrative health database (MED-ECHO), which is managed by the Ministry of Health and contains clinical and demographic information collected when patients are released from acute care hospitals in Québec. We included a total of 37,678 cases compiled over the 3 years of follow-up in the analyses. Residents of rural areas with low urban influence have higher MI incidence rates than all of the other populations in the study. In comparison with urban populations, their observed rural counterparts are at ...

Background and Purpose— High-intensity transient signals (HITS) are the transcranial Doppler representation of both air and solid cerebral emboli. We studied the frequency of HITS associated with different surgical maneuvers during cardiopulmonary bypass for coronary artery bypass graft surgery and their association with postoperative cognitive dysfunction (POCD). Methods— We combined 356 patients undergoing coronary artery bypass graft from 2 clinical trials who had both neuropsychological testing (before, 1 week and 3 months after surgery) and transcranial Doppler during cardiopulmonary bypass. HITS were grouped into periods that included: cannulation, cardiopulmonary bypass onset, aortic crossclamp-on, aortic crossclamp-off, side clamp-on, side clamp-off, and decannulation. POCD was defined by a decreased combined Z-score of at least 2.0 or reduction in Z-scores of at least 2.0 in 20% of the individual tests. Results— Incidence of POCD was 47.3% and 6.3% at 1 week and 3 months af...

Koroner arter bypass cerrahisi günümüzde diğer miyokardiyal revaskülarizasyon yöntemleriyle beraber yaygın olarak uygulanmaktadır. Miyokardiyal revaskülarizasyon yöntemlerinde amaç en düşük morbidite ve mortaliteyle en uzun süreli ve kaliteli sürviyi elde etmekdir.

Açık kalp cerrahisi sonrası gastrointestinal sisteme ait komplikasyonlar nadir görülmekle beraber, yüksek mortaliteye sahiptir. Çeşitli çalışmalarda, açık kalp cerrahisi sonrası hastaların %0,6-%2,9'unda gastrointestinal komplikasyon geliştiği bildirilmiştir. Ancak bu komplikasyonlarda, bildirilen mortalite oranları ise %14-%59 arasında değişmektedir (1-5). Gastrointestinal komplikasyonlardan paralitik ileus, eroziv gastrit, üst veya alt gastrointestinal kanamalar daha sık görülürken, intestinal iskemi, akut divertikülit, akut kolesistit, hepatik disfonksiyon ve akut pankreatit gibi komplikasyonlara daha seyrek rastlanmaktadır (1,3). Bu komplikasyonlar içinde en mortal seyirli olanı mezenter iskemidir,

Amaç: Kardiyopulmoner baypasın oluşturduğu zararlı etkiler ve miyokardiyal iskemi reperfüzyon hasarı, açık kalp cerrahisi sonrası önemli morbidite ve mortaliteye neden olan ve temelde sistemik inflamatuar yanıtın oluşturduğu fenomenlerdir. Bu olayların önlenmesi ve tedavisi amacı ile steroidler ve antioksidanların kombine kullanımı postoperatif morbiditeyi azaltabilir. Gereç ve Yöntem: Koroner baypas operasyonu planlanan, ve EuroScore risk faktörlerinden en az 2'sini taşıyan 100 hasta, perioperatif dönemde yüksek doz metilprednizolon, Allopürinol, Vitamin C ve E kombinasyonu verilen bir çalışma ile plasebo kullanılan kontrol grubuna randomize edildiler. Uygulanan tedavilerin hastalardaki klinik etkileri analiz edildi. Bulgular: Çalışma grubu hastalarında mortalite daha düşük idi (%2'e karşı %4, p>0.05). Bu hastalarda düşük kalp debisi sendromu (%30 a karşı %50, p=0.04), inotrop ihtiyacı (%42 e karşı %64, p=0.02), postoperatif kanama miktarı (783.7±250,9 mL'e karşı 862.5±204 mL, p=0,045), yapılan kan transfüzyonları (2.5±1.3 Ü'e karşı 3.2±1 Ü, p=0.003), ĐABP kullanımı (%4'e karşı %16, p=0.045), entübasyon süresi (11.5±3.9 sa.'e karşı 13.2±4.4 sa., p=0.021), postoperatif 2. saatteki a-A O2 gradiyenti (172.3±41.5'e karşı 201.6±67.1, p=0.01), miyokardiyal enzimler (CK-MB, 143.6±45.9'e karşı 165.4±72.4, p=0.03; Troponin I, 4.5±1.8'e karşı 5.7±2.1, p=0.002), yoğunbakım (41.1±2.6 sa. e karşı 47.9±17.3 sa., p=0.003) ve hastanede kalış süreleri (7.2±3.4 g.'e karşı 8.9±3.8 g., p=0.02) daha düşük idi. Çalışma grubu hastalarında intraoperatif insülin kullanılmasını gerektiren hiperglisemi insidansı daha yüksek idi (%38'e karşı %20, p=0.047). Sonuç: Yüksek riskli koroner baypas cerrahisi uygulanan hastalarda, perioperatif dönemde yüksek doz steroid ve antioksidan kombinasyonu, güvenli bir seçenektir ve, KPB ve miyokardiyal iskemi-reperfüzyonun yol açtığı inflamatuar yanıtın önlenmesi ve tedavisinde başarılı bir şekilde kullanılabilir.

This research analyzes the Da Vinci Surgical System, examining its technological features, clinical outcomes, and global impact. The study reviews the system's robotic arms, 3D high-definition vision capabilities, and surgical instruments, while evaluating success rates compared to traditional surgical methods. Findings indicate a 98% success rate versus 70% for conventional approaches, with reduced patient recovery time and improved precision. The analysis covers costs, global distribution, and both benefits and limitations of robotic-assisted surgery technology.

Introduction: Coronary artery bypass grafting (CABG) is commonly performed for treating coronary artery disease (CAD) in octogenarians. Tis entails higher risk and resource utilization compared to younger patients. Tis retrospective multicenter study evaluates CABG outcomes in octogenarians, with a particular focus on the impact of of-pump (OPCAB) versus on-pump (ONCAB) CABG techniques. Methods: We conducted a retrospective analysis of isolated OPCAB and ONCAB procedures in octogenarians from January 1, 2015, to June 30, 2023, across 8 centers within a single health system. All cases submitted to the Society of Toracic Surgeons (STS) Adult Cardiac Surgery Database were included. Te primary outcome was 30-day mortality; secondary outcomes included STSdefned postoperative complications. We performed a stabilized inverse probability treatment weighted (sIPTW) matching technique to balance baseline covariates between the two groups. Results: Across eight centers, 470 (7%) CABG procedures were performed in octogenarians, with 207 (44%) underwent OPCAB and 263 (56%) ONCAB. Prior to matching, overall 30-day all-cause mortality rate was 6.6% in octogenarians. After sIPTW matching, 30-day mortality (primary outcome) rates were comparable between OPCAB and ONCAB (2.4% vs. 4.4%; p � 0.71). However, OPCAB was associated with lower rates of composite complications (28% relative risk reduction (RRR), p � 0.003), including pneumonia (89% RRR, p � 0.023), atrial fbrillation (30% RRR, p � 0.013), and discharge-toacute care facilities (ACFs) (36% RRR, p � 0.003). Resource utilization was also lower in the OPCAB group, with shorter median hospital stays (6 [3-7] vs. 7 [6-9] days, p � 0.002) and reduced ventilator time (4.3 [0.8-9] vs. 8.4 [4.7-21] hours, p � 0.009). Conclusion: In octogenarians, OPCAB and ONCAB found comparable 30-day mortality. However, OPCAB was associated with fewer complications, shorter hospital stays, reduced ventilator hours, lower blood transfusion requirements, and higher dischargeto-home rates, suggesting potential advantages in resource utilization and patient recovery.

Objective.To report the results of a surveillance study on surgical site infections (SSIs) conducted by the International Nosocomial Infection Control Consortium (INICC).Design.Cohort prospective multinational multicenter surveillance study.Setting.Eighty-two hospitals of 66 cities in 30 countries (Argentina, Brazil, Colombia, Cuba, Dominican Republic, Egypt, Greece, India, Kosovo, Lebanon, Lithuania, Macedonia, Malaysia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Poland, Salvador, Saudi Arabia, Serbia, Singapore, Slovakia, Sudan, Thailand, Turkey, Uruguay, and Vietnam) from 4 continents (America, Asia, Africa, and Europe).Patients.Patients undergoing surgical procedures (SPs) from January 2005 to December 2010.Methods.Data were gathered and recorded from patients hospitalized in INICC member hospitals by using the methods and definitions of the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) for SSI. SPs were classified into 31 ty...

To compare the clinical characteristics, at the time of admission and after coronary revascularization by bypass surgery, among British patients of Indo-Asian and white Caucasian descent. Method One hundred and ninety-four pairs of patients admitted between November 1994 and January 1997 were matched for age (within 3 years), sex and date of admission (within 3 months). Their clinical characteristics at the time of admission for coronary artery bypass grafting surgery, and the incidence of hospital morbidity, hospital mortality and length of stay in the intensive therapy unit or hospital following coronary artery bypass grafting were determined. Results A higher proportion of Indo-Asian patients underwent coronary revascularization on a non-elective basis (43% vs 32% white Caucasian patients, P=0•018), had a higher prevalence of diabetes (39% vs 12%, P=0•0001), a lower prevalence of smoking (36% vs 80%, P=0•0001) and a lower rate of previous myocardial infarction (47% vs 62%, P=0•012). As regards revascularization, although there was no significant difference in the number of vessels revascularized, there was a lower use of the arterial conduit (internal mammary artery) in the Indo-Asian patients (72% vs 81%, P=0•028) particularly for those undergoing emergency/urgent surgery (59% vs 72%, P=0•001) and with a previous myocardial infarction (65% vs 81%; P=0•01) when compared with their white Caucasian counterparts. Following surgery there were no differences in the types of support required for vital functions. There was no signifi-cant difference in the proportion of major post-operative complications, that is, haemorrhage, cerebrovascular accident, renal failure requiring dialysis or respiratory failure. Similarly, there were no differences in the length of intensive therapy unit stay (median stay 1 day vs 1 day, P=0•4) and hospital stay following surgery (median stay 6 days vs 6 days, P=0•5) between the two groups. Although there was a trend towards a higher in-hospital (30 day) mortality (6•7% [95% confidence intervals CI 3•18-10•21] vs 2•6% [CI 0•35-4•9; P=0•0618]), in Indo-Asians compared to white Caucasians this trend disappeared when patients in the two groups undergoing non-elective surgery only were compared (9% vs 7%; P=0•7). Conclusions A higher proportion of Indo-Asians underwent non-elective coronary revascularization, with a significantly lower use of the arterial conduit and a relatively higher in-hospital mortality. Following coronary revascularization the medical management, length of stay and hospital morbidity in Indo-Asian patients was no different from that of their white Caucasian counterparts. This is despite a perceived poorer outcome in Indo-Asians compared to white Caucasians.

To compare the clinical characteristics, at the time of admission and after coronary revascularization by bypass surgery, among British patients of Indo-Asian and white Caucasian descent. Method One hundred and ninety-four pairs of patients admitted between November 1994 and January 1997 were matched for age (within 3 years), sex and date of admission (within 3 months). Their clinical characteristics at the time of admission for coronary artery bypass grafting surgery, and the incidence of hospital morbidity, hospital mortality and length of stay in the intensive therapy unit or hospital following coronary artery bypass grafting were determined. Results A higher proportion of Indo-Asian patients underwent coronary revascularization on a non-elective basis (43% vs 32% white Caucasian patients, P=0•018), had a higher prevalence of diabetes (39% vs 12%, P=0•0001), a lower prevalence of smoking (36% vs 80%, P=0•0001) and a lower rate of previous myocardial infarction (47% vs 62%, P=0•012). As regards revascularization, although there was no significant difference in the number of vessels revascularized, there was a lower use of the arterial conduit (internal mammary artery) in the Indo-Asian patients (72% vs 81%, P=0•028) particularly for those undergoing emergency/urgent surgery (59% vs 72%, P=0•001) and with a previous myocardial infarction (65% vs 81%; P=0•01) when compared with their white Caucasian counterparts. Following surgery there were no differences in the types of support required for vital functions. There was no signifi-cant difference in the proportion of major post-operative complications, that is, haemorrhage, cerebrovascular accident, renal failure requiring dialysis or respiratory failure. Similarly, there were no differences in the length of intensive therapy unit stay (median stay 1 day vs 1 day, P=0•4) and hospital stay following surgery (median stay 6 days vs 6 days, P=0•5) between the two groups. Although there was a trend towards a higher in-hospital (30 day) mortality (6•7% [95% confidence intervals CI 3•18-10•21] vs 2•6% [CI 0•35-4•9; P=0•0618]), in Indo-Asians compared to white Caucasians this trend disappeared when patients in the two groups undergoing non-elective surgery only were compared (9% vs 7%; P=0•7). Conclusions A higher proportion of Indo-Asians underwent non-elective coronary revascularization, with a significantly lower use of the arterial conduit and a relatively higher in-hospital mortality. Following coronary revascularization the medical management, length of stay and hospital morbidity in Indo-Asian patients was no different from that of their white Caucasian counterparts. This is despite a perceived poorer outcome in Indo-Asians compared to white Caucasians.

The purpose of this study was to investigate movement and its associated outcome variability for three levels of Olympic weightlifters performing the clean. Elite (n= 2) experienced (n= 5) and novice (n= 5) weightlifters performed 12 lifts of the clean at 80% 1RM with 120s rest between each lift. Variability of relative phase, relative hip and knee angles and ground reaction force was calculated for each subject for the 12 trials. No significant differences were reported between groups for coordination, kinematic or ...

Objective: An animal model has been developed to compare the effects of suture technique on the luminal dimensions and compliance of end-to-side vascular anastomoses. Methods: Carotid and internal mammalian arteries (IMAs) were exposed in three pigs (90 kg). IMAs were sectioned distally to perform end-to-side anastomoses on carotid arteries. One anastomosis was performed with 7/0 polypropylene running suture. The other was performed with the automated suture delivery device (Perclose/Abbott Labs Inc.) that makes a 7/0 polypropylene interrupted suture. Four piezoelectric crystals were sutured on toe, heel and both lateral sides of each anastomosis to measure anastomotic axes. Anastomotic cross-sectional area (CSAA) was calculated with: CSAA p £ mM=4 where m and M are the minor and major axes of the elliptical anastomosis. Cross-sectional anastomotic compliance (CSAC) was calculated as CSAC DCSAA=DP where DP is the mean pulse pressure and DCSAA is the mean CSAA during cardiac cycle. Results: We collected a total of 1 200 000 pressure-length data per animal. For running suture we had a mean systolic CSAA of 26.94 ^0.4 mm 2 and a mean CSAA in diastole of 26.30 ^0.5 mm 2 (mean DCSAA was 0.64 mm 2 ). CSAC for running suture was 4.5 £ 10 26 m 2 /kPa. For interrupted suture we had a mean CSAA in systole of 21.98 ^0.2 mm 2 and a mean CSAA in diastole of 17.38 ^0.3 mm 2 (mean DCSAA was 4.6 ^0.1 mm 2 ). CSAC for interrupted suture was 11 £ 10 26 m 2 /kPa. Conclusions: This model, even with some limitations, can be a reliable source of information improving the outcome of vascular anastomoses. The study demonstrates that suture technique has a substantial effect on cross-sectional anastomotic compliance of end-to-side anastomoses. Interrupted suture may maximise the anastomotic lumen and provides a considerably higher CSAC than continuous suture, that reduces ¯ow turbulence, shear stress and intimal hyperplasia. The Heart¯oe anastomosis device is a reliable instrument that facilitates performance of interrupted suture anastomoses.

The precise mechanisms underlying post-surgical neurological injury in CABG patients with carotid artery stenoses remain obscure. Low flow, embolic, or thrombotic strokes may occur, or changes in flow hemodynamics, coagulation, or homeostasis regulation may alter stenosed artery behavior during or after CPB. Perioperative stroke risk is unpredictable. Patients with bilateral carotid disease, especially those with unilateral stenosis and contralateral occlusion, are at a particularly high risk for perioperative neurologic events, regardless of whether carotid artery disease is treated surgically at the time of the cardiac procedure w4, 9, 10x. However, strokes from the carotid artery are improbable, since the bilateral carotid arteries are totally occluded in these patients. Our case studies and others strongly indicate that the cerebral collateral circulation functionality predicts the neurological outcome after coronary revascularization better than the specific occlusive anatomy of the carotid arteries. Use of appropriate preoperative evaluation and surgical strategies may allow CABG to be safely performed in patients with bilateral carotid occlusions.

Objectives: To describe morbidity and mortality in patients waiting for coronary artery bypass graft (CABG) surgery and to assess determinants for the occurrence of these complications. Methods: A prospective cohort study was carried out in a tertiary referral general teaching hospital. Three hundred and sixty consecutive patients with a priority of routine or urgent who were accepted for CABG or CABG with additional valve surgery were evaluated. Follow-up began from the moment of acceptance until the procedure took place for cardiac death, myocardial infarction and unstable angina requiring hospital admission. Results: The median (25±75th percentile) waiting time in the two priority groups was 100 (79±119) days for the routine group and 69 (38±91) days for the urgent group. Overall, eight patients died, seven suffered a myocardial infarction, and 33 episodes of unstable angina requiring immediate hospitalization occurred. The majority of events took place during the ®rst 30 days on the waiting list. Unstable angina less than 3 months before acceptance was identi®ed as an independent predictor (hazard ratio 2.5, 95% con®dence interval 1.2±5.1) for complications during the wait. The prognostic value of smoking and familial cardiovascular disease was found to vary depending on the priority assigned to the patient. Conclusions: Complications occur relatively early during the time on the waiting list. If complications in coronary heart disease cannot be predicted more accurately, the only way to diminish the complication rate is drastic reduction of waiting times.

Objective: To assess the determinants of poor mid-term health related quality of life (HRQoL) at one year after primary isolated coronary artery bypass grafting (CABG). Methods: 463 patients who underwent primary isolated CABG for multivessel disease and came for their annual follow up at the outpatient clinic during one year at Harefield Hospital, Middlesex, were approached to participate in the present study. Prospective clinical data were collected as part of the clinical care of the patients and were retrospectively analysed when the patients consented to participate in the study at their outpatient visit. After their consent they were given three HRQoL assessment questionnaires. Scores, together with clinical data, were analysed by both univariate and multivariate analyses with regard to poor HRQoL outcome. Results: 437 (94.4%) patients consented to participate in the study and filled in the HRQoL questionnaires. Ten variables were identified in the univariate analysis as potential predictors of poor scores of the physical element of HRQoL; however, only three variables-gastrointestinal problems, congestive heart failure, and type D personality trait-predicted poor physical scores independently. Eleven variables were identified in the univariate analysis as potential predictors of poor scores of the mental element of HRQoL; however, only three variables-peripheral vascular disease, infective complications, and type D personality trait-predicted poor physical scores independently. Conclusion: Preoperative gastrointestinal problems, preoperative congestive heart failure, and type D personality trait were independent predictors of the poor physical component of HRQoL. Peripheral vascular disease, infective complications, and type D personality trait were independent predictors of the poor mental component of HRQoL. Interestingly, patients with type D personality were more than twice as likely to have poor physical HRQoL and more than five times as likely to have poor mental HRQoL.

Objective: Techniques aimed at improving the performance of arterial conduits will maximize the clinical benefit achievable with coronary artery bypass surgery. Controlling oxidant stress could be a strategy for preventing early graft deterioration. We tested the effect of a free radical scavenger, ascorbic acid (vitamin C), on preserving the endothelium-dependent vasodilatation function in vitro of radial artery and internal thoracic artery. We also tested its effect on the amount of reactive oxygen species (ROS) generated by each graft. Methods: Radial artery (RA, n ¼ 25) and internal thoracic (ITA, n ¼ 19) segments were obtained from coronary artery bypass grafting patients. Each segment was divided into 3 -4 mm vascular rings and incubated with or without ascorbic acid (10 23 mol/l) for 1 h or 72 h. Using the organ bath technique, the endothelium-dependent vasodilatation function was tested in vitro by the addition of cumulative concentrations of acetylcholine (10 29 -10 25 mol/l) following vasocontraction by endothelin-1 (3 £ 10 28 mol/l). ROS were measured by using chemiluminescence technique at 1-h and after 72 h incubation with or without ascorbic acid. Results: There were no differences in the vasodilatation function between control and ascorbic acid group of both arteries in the 1-hour incubation experiment. However, in the 72 h incubation experiment, ascorbic acid preserved the endothelium-dependent vasodilatation function of RA compared with control group (35.8 ^2.2% vs. 25.9 ^2.1%; P ¼ 0:005), but not ITA (39 ^3.5% vs. 40.5 ^9.3%; P ¼ 0:438). After 72 h incubation, RA generated significantly more free radicals compared with 1 h (133.7 ^151.5 vs. 16.8 ^16.8 cps=mg £ 100; P ¼ 0:01); however, AA has no statistically significant effect on decreasing the amount of free radicals generated by both arteries. Conclusions: In RA, ascorbic acid is able to preserve the endothelium-dependent vasodilatation function after 72 h incubation, but not after 1 h. However, the mechanism of action of AA is not completely understood. This finding could open the door for understanding the role of oxidant stress and antioxidants in preserving the endothelial function of coronary artery bypass grafts.

Objectives: A detailed analysis of coronary artery bypass graft (CABG) surgical cases performed at the University Hospital of the West Indies (UHWI) has never been conducted. We present the demographic profile, clinical characteristics, and outcome of cases performed during the period March 2010 to March Methods: Data from consecutive CABG surgeries performed during the study period were collected prospectively, entered into a computerized database and then analyzed. Outcome measures were 30-day operative mortality, ICU length of stay (ICU LOS) and total postoperative length of stay (PostOp LOS). Results: Of the 190 patients comprising the study population, 68.9% were males, and mean age (SD) was 61.3 (±10.2) years. The most frequent co-morbidities and risk factors were hypertension (82.1%) and diabetes (55.3%), cigarette smoking (33.7%) and hyperlipidaemia (89%). Left ventricular ejection fraction (LVEF) was found to be grades 1(good), 2(moderate), and 3(poor) in 50%, 44.2%, and 5.8% of patients, respectively. The majority (83%) were diagnosed with triple vessel disease. The crude, unadjusted 30-day mortality rate was 8.4%. Using the Canadian Risk Index Model, the mortality rates were: low risk (0-3), 5.5%; medium risk (4-7), 14.3%; and high risk (>8), 100%. The median ICU LOS and median postoperative LOS were 3 days (IQR, 2-4), and 8 days (IQR,, respectively. Logistic regression analysis revealed that grade 2 LVEF and urgent/emergent operations were predictors of mortality, female gender predictive of prolonged ICU LOS, and advanced age and female gender of borderline significance for prolonged PostOp LOS. This analysis of outcome of CABG cases performed at the UHWI provides an indication of current performance and serves as a benchmark against which future studies may be compared to determine the efficacy of future quality improvement initiatives.

In addition to the clinical outcome, a patient's perspective and satisfaction with their health status have become important indicators. One of the most common measures to assess the quality of life is Short Form (SF)-36. The objective of the present study was to measure the functional status of elderly patients who had undergone coronary bypass surgery and to evaluate the impact of that surgery on their quality of life. The study involved 120 nonsmoking patients who underwent coronary bypass surgery between January 1, 2001 and January 1, 2003 at the Sevket Demirel Heart Center. Assessments were made using physical, clinical, and laboratory findings. We used the Turkish version of the Short Form (SF)-36 preoperatively and 18 months after surgery. The paired t test, two-tailed correlation, and variant analysis were used for statistical analysis. Of the 120 patients, 108 could be followed during the study period. Significant physical and mental improvements were seen in all areas, especially in the items of vitality and mental health. Females seemed to benefit from surgery more than males. Cardiac surgery substantially improved the quality of life of our patients. The findings allowed us to determine the patient's perspective of his or her outcome. With this knowledge, health care workers can provide information to the patient regarding functional limitations after cardiac surgery. (

Introduction Tissue deformation imaging enables the objective assessment of regional myocardial deformation assessed by ultrasound-based strain and strain rate. There are two ways to compute myocardial deformation (strain) using echocardiography: One-dimensional tissue Doppler (DTI)-derived strain and two-dimensional (2D) strain derived from B-mode images (speckle tracking, 2D-ST). This study compares the myocardial deformation parameter (i.e., strain) by these two techniques in the perioperative period using transesophageal echocardiography (TEE) in patients undergoing surgery for coronary artery bypass graft (CABG). Materials and methods We performed preoperative global longitudinal strain (GLS) of left ventricle (LV) using 2D-ST and DTI, three-dimensional (3D) left ventricular ejection fraction (LVEF) and 2D LVEF in a consecutive series of 50 adult patients scheduled for on-pump CABG. Result There was no difference between 2D and 3D LVEF (p < 0.0001), GLS using 2D-ST and DTI (...

size at TOMCAT beamline (SLS-PSI, Switzerland). The heart was rotated over 360°and seven acquisitions were necessary to cover the whole heart along its long axis. The projection sets were reconstructed using the Gridrec algorithm. The reconstructed volumes were merged into a single dataset covering the whole heart in 3D. Results: Different cardiac structures (atria, ventricles, valves, papillary muscles, coronary arteries) were clearly identified in the X-PCI images (Figure ). The infarct zone was easily recognised in the thinner LV wall composed of mainly fibrotic tissue. Interestingly, there is a thin endocardial layer of preserved fibres and the peri-infarct shows clear fibre disarray. Conclusions: We have obtained novel, high-resolution, datasets of a whole rat heart with MI providing structural and tissue-type information on microscopic level without the need of slicing.

size at TOMCAT beamline (SLS-PSI, Switzerland). The heart was rotated over 360°and seven acquisitions were necessary to cover the whole heart along its long axis. The projection sets were reconstructed using the Gridrec algorithm. The reconstructed volumes were merged into a single dataset covering the whole heart in 3D. Results: Different cardiac structures (atria, ventricles, valves, papillary muscles, coronary arteries) were clearly identified in the X-PCI images (Figure ). The infarct zone was easily recognised in the thinner LV wall composed of mainly fibrotic tissue. Interestingly, there is a thin endocardial layer of preserved fibres and the peri-infarct shows clear fibre disarray. Conclusions: We have obtained novel, high-resolution, datasets of a whole rat heart with MI providing structural and tissue-type information on microscopic level without the need of slicing.

Background: Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery. This study involving cardiac surgery patients was primarily aimed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting. Secondary aims were to evaluate the effect of these programs on quality of life (QOL), rates of postoperative atrial fibrillation (AF) and length of stay (LOS) in hospital. Methods: Elective patients scheduled for coronary artery bypass graft and/or valve surgery at a public hospital in Melbourne, Australia were enrolled. Patients were randomized to receive either holistic therapy (HT) or usual care (UC). HT consisted of a series of light physical exercise sessions together with a mental stress reduction program administered in an outpatient setting for the first two weeks after placement on the waiting list for surgery. A selfadministered SF-36 questionnaire was used to measure QOL and hospital records to collect data on LOS and rate of postoperative AF. Results: The study population comprised 117 patients of whom 60 received HT and 57 received UC. Both programs were able to be delivered within the hospital setting but ongoing therapy beyond the two week duration of the program was not carried out due to long waiting periods and insufficient resources. HT, as delivered in this study, compared to UC did not result in significant changes in QOL, LOS or AF incidence. Conclusions: Preoperative holistic therapy can be delivered in the hospital setting, although two weeks is insufficient to provide benefits beyond usual care on QOL, LOS or postoperative AF. Further research is now required to determine whether a similar program of longer duration, or targeted to high risk patients can provide measurable benefits. Trial registration: This trial was conducted as part of a larger study and according to the principles contained in the CONSORT statement 2001.

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