Early clinical experience with a new sutureless anastomotic device for proximal anastomosis of the saphenous vein to the aorta.

Background: Avoiding aortic side clamping is useful to avoid local particulate embolization. A device that allows a saphenous vein graft to be anastomosed to the aorta without aortic manipulation is clinically evaluated.

Methods And Results: From July 1999 to March 2000, 17 patients who underwent myocardial revascularization had an aorta-saphenous vein graft anastomosis performed by means of an aortic anastomotic device.

Mitral valve procedure in dilated cardiomyopathy: repair or replacement?

Background: Mitral valve (MV) procedure for dilated cardiomyopathy is becoming popular. We analyzed the indications to MV repair or replacement according to our 10-year experience.

Methods: From January 1990 to May 2000, 49 patients with dilated cardiomyopathy (12 idiopathic and 37 ischemic) underwent MV operation, 29 repair and 20 replacement.

Recent advances in multivessel coronary grafting without cardiopulmonary bypass.

Background: Coronary artery bypass grafting (CABG) without the heart lung machine has been possible for easily accessible targets such as the anterior descending or proximal right coronary. Until now technical difficulty in reaching lateral and inferior wall targets imposed significant barriers to multivessel off-pump grafting. To expand the potential for off-pump CABG the authors have devised new exposure and stabilization techniques suitable for all target vessels.

Percutaneous interventions on arterial conduits.

Because of the extensive use of arterial conduits for coronary surgery and the increased risk of repeat surgery in cases of graft failure, there is a growing interest in percutaneous interventions (PI) for patients with conduit dysfunction. PI on arterial conduits is a challenge for the interventional cardiologist, due to anatomic and functional characteristics of the graft. There are no large-scale multicenter or randomized studies focusing on PI of arterial conduits.

Anthracycline metabolism and toxicity in human myocardium: comparisons between doxorubicin, epirubicin, and a novel disaccharide analogue with a reduced level of formation and [4Fe-4S] reactivity of its secondary alcohol metabolite.

Secondary alcohol metabolites have been proposed to mediate chronic cardiotoxicity induced by doxorubicin (DOX) and other anticancer anthracyclines. In this study, NADPH-supplemented human cardiac cytosol was found to reduce the carbonyl group in the side chain of the tetracyclic ring of DOX, producing the secondary alcohol metabolite doxorubicinol (DOXol). A decrease in the level of alcohol metabolite formation was observed by replacing DOX with epirubicin (EPI), a less cardiotoxic analogue characterized by an axial-to-equatorial epimerization of the hydroxyl group at C-4 in the amino sugar bound to the tetracyclic ring (daunosamine).

Bilateral internal thoracic artery grafting: long-term clinical and angiographic results of in situ versus Y grafts.

Background: We evaluated whether bilateral internal thoracic arteries provide the same long-term results when used as in situ grafts and as Y grafts.

Methods And Results: From October 1991 to February 2000, 1818 patients had bilateral internal thoracic arteries used as in situ (n = 1378, group A) or as Y grafts (n = 440, group B). The number of anastomoses per patient and the number of bilateral internal thoracic artery anastomoses per patient were higher in group B (3.

Intravascular physiologic evaluation of the left anterior small thoracotomy operation: a novel approach to left anterior descending artery revascularization.

Background: Efficacy and long-term patency rate of the left internal mammary artery (LIMA) conduits for revascularization of the left anterior descending coronary artery (LAD) has been demonstrated, with improved results as compared to the saphenous vein graft operation. Novel approaches to LAD revascularization including the use of the left anterior small thoracotomy (LAST) operation with persistence of the intercostal arteries compared to the traditional LIMA operation have not been reported. This study evaluated flow characteristics of LAST operation.

Color duplex scanning for the identification of extracranial atherosclerosis in patients with suspected coronary artery disease.

Background: The presence of extracranial artery disease has been used as a predictor of coronary artery disease (CAD). The present study was conducted to test the prevalence of extracranial artery disease among patients with suspected CAD.

Methods: Among candidates for coronary arteriography, 400 consecutive patients (mean age 63 +/- 11 years, 78% males, 22% females) underwent color duplex ultrasound of carotid arteries.

Angiographic anatomy of the grafted left internal mammary artery.

Background: The hypothesis that persistence of undivided branches is a common finding after myocardial revascularization using the left internal mammary artery was explored.

Methods: Three hundred seven consecutive postoperative angiographies of the left internal mammary artery were considered. Seven were excluded because of occlusion or malfunction of the conduit or the anastomosis.

Off or on bypass: what is the safety threshold?

Background: To identify the technical profile of the patients operated on without cardiopulmonary bypass (CPB) and the benefit of the procedure.

Methods: From May 21, 1997, to December 31, 1998, 785 patients had coronary artery bypass grafting through a median sternotomy (group A: 472 without CPB; group B: 290 with CPB; group C: 23 converted). Technical aspects, mortality rate, cerebrovascular accident (CVA) incidence (crude and risk-adjusted), and incidence of major complications were recorded.

Surgical treatment of dilated cardiomyopathy with conventional techniques.

Objective: We review our surgical experience using different conventional surgical techniques in the surgical treatment of the dilated cardiomyopathy (DCMP) in non-transplant eligible patients.

Methods: In this series we included patients who fit the following criteria: ejection fraction < 35%; end diastolic volume > or = 110 ml/m2; enlargement of the base of the heart (maximal mitral diameter > or = 22 mm/m2) with functional mitral regurgitation; mitral surgery to be performed in every case. Moreover, two groups were considered.

Current results in off pump surgery.

Objective: We reviewed our experience with myocardial revascularization without cardiopulmonary by-pass (CPB) to evaluate early- and mid-term results compared with those obtained using CPB.

Methods: From May 21, 1997 to November 1998, 747 patients had isolated myocardial revascularization, 480 without CPB (Group A) and 267 with CPB (Group B). Exposure of the target vessels was obtained with four slings (two passed through the transverse sinus and two behind the inferior vena cava) and four deep pericardial sutures on the mobile pericardium around the left atrium (Lima stitches).

Integrated left anterior small thoracotomy and angioplasty for coronary artery revascularization.

Background: The minimal access surgical technique of a left anterior small thoracotomy (LAST) for coronary artery bypass grafting is now well established. This procedure however, does not allow multivessel revascularization. We present our early experience of an integrated approach using LAST and percutaneous transluminal coronary angioplasty (PTCA), either staged or simultaneous.

Bilateral internal mammary artery grafting: midterm results of pedicled versus skeletonized conduits.

Background: To increase the number of anastomoses per patient, bilateral internal mammary arteries (BIMAs) were harvested with a skeletonized approach instead of a pedicled one.

Methods: One thousand one hundred forty-six patients underwent isolated myocardial revascularization using BIMAs, 304 receiving pedicled grafts (group A, October 1991 through May 1994) and 842 receiving skeletonized conduits (group B, June 1994 through June 1998). Group B had a higher incidence of patients with diabetes (223 versus 40, p < 0.

Left anterior small thoracotomy (LAST): mid-term results in single vessel disease.

Background: Left anterior descending artery grafting using the left internal mammary artery via a left anterior small thoracotomy (LAST) gained new popularity in 1994. We review our experience in 250 of 512 patients who underwent a LAST in single vessel left anterior descending artery disease from November 1994 to October 1997.

Methods: Left anterior descending artery stabilization was obtained pharmacologically and mechanically.

Multiple arterial conduits without cardiopulmonary bypass: early angiographic results.

Background: Lack of angiographic results and technical difficulty in grafting the vessels in the lateral and posterior walls have reduced interest in myocardial revascularization without cardiopulmonary bypass (CPB). We describe our experience to demonstrate the feasibility of coronary surgical intervention without CPB in multivessel disease.

Methods: From May 21, 1997, through February 1998, 227 patients underwent revascularization with two or more arterial conduits as the first operation: 122 without CPB (group A) and 105 with CPB (group B).

Intermittent antegrade hyperkalaemic warm blood cardioplegia supplemented with magnesium prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery.

Objective: The influence of the addition of magnesium on myocardial protection with intermittent antegrade warm blood hyperkalaemic cardioplegia in patients undergoing coronary artery surgery was investigated and compared with intermittent antegrade warm blood hyperkalaemic cardioplegia only.

Methods: Twenty-three patients undergoing primary elective coronary revascularization were randomized to one of two different techniques of myocardial protection. In the first group, myocardial protection was induced using intermittent antegrade warm blood hyperkalaemic cardioplegia.