Coronary artery bypass grafting: Part 2—optimizing outcomes and future prospects

Since first introduced in the mid-1960s, coronary artery bypass grafting (CABG) has become the standard of care for patients with coronary artery disease. Surprisingly, the fundamental surgical technique itself did not change much over time. Nevertheless, outcomes after CABG have dramatically improved over the first 50 years. Randomized trials comparing percutaneous coronary intervention (PCI) to CABG have shown converging outcomes for select patient populations, providing more evidence for wider use of PCI. It is increasingly important to focus on the optimization of the short- and long-term outcomes of CABG and to reduce the level of invasiveness of this procedure. This review provides an overview on how new techniques and widespread consideration of evolving strategies have the potential to optimize outcomes after CABG. Such developments include off-pump CABG, clampless/anaortic CABG, minimally invasive CABG with or without extending to hybrid procedures, arterial revascularization, endoscopic vein harvesting, intraprocedural epiaortic scanning, graft flow assessment, and improved secondary prevention measures. In addition, this review represents a framework for future studies by summarizing the areas that need more rigorous clinical (randomized) evaluatio

Alterations in plasma soluble vascular endothelial growth factor receptor-1 (sFlt-1) concentrations during coronary artery bypass graft surgery: relationships with post-operative complications

<p>Abstract</p> <p>Background</p> <p>Plasma concentrations of sFlt-1, the soluble form of the vascular endothelial growth factor receptor (VEGF), markedly increase during coronary artery bypass graft (CABG) surgery with extracorporeal circulation (ECC). We investigated if plasma sFlt-1 values might be related to the occurrence of surgical complications after CABG.</p> <p>Methods</p> <p>Plasma samples were collected from the radial artery catheter before vascular cannulation and after opening the chest, at the end of ECC just before clamp release, after cross release, after weaning from ECC, at the 6^thand 24^thpost-operative hour. Thirty one patients were investigated. The presence of cardiovascular, haematological and respiratory dysfunctions was prospectively assessed. Plasma sFlt-1 levels were measured with commercially ELISA kits.</p> <p>Results</p> <p>Among the 31 investigated patients, 15 had uneventful surgery. Patients with and without complications had similar pre-operative plasma sFlt-1 levels. Lowered plasma sFlt-1 levels were observed at the end of ECC in patients with haematological (p = 0.001, ANOVA) or cardiovascular (p = 0.006) impairments, but not with respiratory ones (p = 0.053), as compared to patients with uneventful surgery.</p> <p>Conclusion</p> <p>These results identify an association between specific post-CABG complication and the lower release of sFlt-1 during ECC. sFlt-1-induced VEGF neutralisation might, thus, be beneficial to reduce the development of post-operative adverse effects after CABG.</p

Spinglasverhalten des verdünnten Antiferromagneten EuxSr1−xTeEu_{x}Sr_{1-x}Te

Spin-glass properties were investigated in the magnetic phase diagram of the diluted antiferromagnet $Eu_{x}Sr_{1-x}Te$. Measurements of the static magnetization and ac-susceptibility were systematically performed on single-crystalline samples by means of a SQUID-system in a $^{3}$He-$^{4}$He-dilution refrigerator at temperatures T $\geq$ 20 mK 9 ac-field frequencies 5 Hz $\le$ f $\le$ 2 kHz and static external fields $\geq$20 mT. Those measurements:, allow a separation of the phase diagram into three regimese: a) X $\le$ 0.15: superparamagnetic behaviour with small frequency dependence of the ac-suscpetibility and without dc-anomaly. b) 0.15 $\le$ x $\le$ 0.50: spin-glass behaviour, characterized by a kink in the dc-magnetization, strong frequency dependence of the ac-susceptibility maximum, a H$^{2/3}$-T-dependence of the freezing temperature with external static field and irreversibility effects between zero field cooled and field cooled magnetization curves. c) x $\geq$ 0.50: putative antiferromagnetic behaviour; only weak frequency dependence, no irreversibility effects. The properties of $Eu_{x}Sr_{1-x}Te$ in the spin-glass regime are comparable to those of the diluted ferromagnet $Eu_{x}Sr_{1-x}S$. A main difference is the increasing magnetization at low temperatures for $Eu_{x}Sr_{1-x}Te$ with x $\le$ 0.5. Measurements of the thermoremanent magnetization reveal a dependence of the relaxation on the waiting time between freezing in the spie system and switching off the field. Comparable measurements an $Eu_{x}Sr_{1-x}S$ are not yet available. In contrast to $Eu_{x}Sr_{1-x}S$ we could not find any hints of "reentrant spin-glass" behaviour in $Eu_{x}Sr_{1-x}Te$ with our magnetization methods

Meta-analyses with rare outcomes should use adequate methods - A case study from cardiac surgery

T. Whitelegg's Scammell tractor - registration AMR600 Oscar - no date or location. For reference only