Outcomes of coronary artery bypass graft surgery

This review article summarizes the major studies that have investigated the outcomes of coronary artery bypass graft surgery (CABG). The article includes a review of the literature in the areas of: history of CABG; indications for CABG; and measurement of quality of life following CABG, including prolongation of life, physical functioning (ie, relief from angina and dyspnea, physical activity, as well as complications of surgery and re-hospitalization), psychological functioning, and social functioning. Overall, the literature demonstrates that the outcomes of CABG have historically been measured in terms of mortality and morbidity; however, it has now been well recognized that adjustment to CABG is a multidimensional phenomenon that is not fully explained by medical factors. Therefore, in addition to studying mortality and morbidity outcomes following CABG, many recent studies have identified that it is important to investigate various physical, psychological, and social variables that have a significant impact on post-operative adjustment to CABG

A Simple Method of Repairing Wires Fractured During Sternotomy Closure

A simple method for safely repairing a wire broken during sternal closure is described. This method ensures secure closure when other methods may be hazardous

Platelet function after off pump coronary surgery

Background: Little is known about the impact of off pump coronary artery bypass (OPCAB) on platelet function. Although improved platelet function may decrease bleeding and reduce cerebral and pulmonary damage, there is a concern that changes in platelet function may also accentuate bypass graft occlusion or other thrombotic processes. In this pilot study we used a point-of-care test - Hemostatus (Medtronic, Minneapolis, MN, USA) - to assess changes in platelet function after OPCAB. Methods: We analyzed data from 11 adult patients undergoing CAB surgery whose platelet function was assessed before and after OPCAB. A Hemostatus test was conducted prior to heparin administration and after protamine reversal. Results: There was a significant improvement in platelet function as measured in both channels 5 and 6 of the Hemostatus test. Blood loss was 598 ± 244 mL in the first 24 hours. One patient received blood products. Conclusion: This pilot study suggests that platelet function is not diminished but instead is improved after OPCAB. This improvement may be due to the release of newer, larger platelets from the bone marrow into the circulation. This finding has important implications for the use of antiplatelet agents perioperatively. Furthermore, more detailed studies in this field are needed

Ischemia and reperfusion injury of the myocardium

Prolonged interruption of coronary blood flow during\ud heart surgery results in irreversible myocardial cell damage.\ud Interventions such as thrombolysis, emergency percutaneous\ud coronary angioplasty and coronary artery bypass surgery can restore blood flow to affected myocardial tissue.\ud However, restoration of coronary blood flow following\ud acute disruption is also accompanied by a further injurious\ud phenomenon known as myocardial reperfusion injury.\ud This article seeks to highlight the elements involved in this\ud process and possible interventions to reduce its effects

Amelioration of the bleeding tendency of preoperative aspirin after aortocoronary bypass grafting

Background. Aspirin therapy is widely used in the treatment of cardiac disease. It has been recognized as a causative factor for increased bleeding and blood loss after open heart operations. Methods. To determine whether high-dose aprotinin maintained its efficacy in reducing blood loss in the presence of aspirin pretreatment in patients undergoing aortocoronary bypass, we performed a double blind study on 60 adult patients. Half received high- dose aprotinin (Trasylol) and half placebo. Results. Total hemoglobin loss, the primary efficacy variable was reduced from 36.1 ± 31.4 g (mean ± SD) to 14.1 ± 16.0 g (p = 0.002). Blood loss was reduced intraoperatively and total loss was reduced from 837.3 mL ± 404.9 mL to 368.7 mL ± 164.3 mL (p < 0.001). The number of patients who did not receive any donor blood products was significantly higher in the aprotinin-treated patients (56.7% versus 23.3%, p = 0.008). Activation of the clotting cascade was significantly less in the treated patients toward the end of cardiopulmonary bypass both by measurement of thrombin-antithrombin III complex (p < 0.0001) and prothrombin fragment 1 + 2 (p < 0.0001). D-Dimer generation was significantly less from the onset of bypass and after reversal of heparin in the aprotinin-treated patients (p < 0.0001). Conclusions. High-dose aprotinin was highly effective in reducing bleeding in this high-risk group of patients. Biochemical analyses suggest the mechanism by which aspirin increases blood loss after cardiopulmonary bypass is different from the blood-preserving effects of aprotinin, which is acting as an antifibrinolytic agent

Primary Solitary Mediastinal Mass Lesions: A Review of 37 Cases

Background: Primary solitary mass lesions of the mediastinum, although relatively uncommon, encompass an interesting spectrum of pathologies. Methods: A comprehensive retrospective review was undertaken of all cases of mediastinal lesions that presented to the two major thoracic surgical centres in North Queensland, Australia, over a 7-year period. Results: Thirty-seven mediastinal mass lesions were managed over the period of the review. Over one-quarter of all cases were clinically silent, the pathology having been discovered incidentally during investigation for other reasons. Malignant thymoma was the single most common pathology, being present in 13 (35.1%) cases. A variety of other pathologies were encountered, including thymic cyst, bronchogenic cyst, neurofibroma, parathyroid adenoma, and lymphoma. Expeditious surgical resection of the lesions, once discovered, afforded good medium-term survival, even for those patients with malignant pathology. Conclusions: Prompt thoracic surgical referral with view to aggressive, early resection optimizes clinical outcome in the short and medium-term for patients presenting with mass lesions of the mediastinum

Angiosarcoma of the right ventricle: A rare encounter

We report a case of angiosarcoma involving the right ventricle. The patient was seen in our Cardiology Department and subsequently referred to our unit for surgery. He gave a 1-week history of lethargy, chest pain, breathlessness on exertion, fevers, and night sweats. Echocardiography and computed tomography of the chest showed a large pericardial effusion with multiple densities, raising suspicions of a hemorrhagic effusion. Surgical exploration showed an epicardial mass. Histopathology revealed angiosarcoma