Indocyanine green clearance as an outcome prediction tool in cardiac surgery: a prospective study.

Purpose: To evaluate the role of plasma disappearance rate of indocyanine green (PDR-ICG) as an outcome prediction tool in cardiac surgery.

Patients And Methods: One hundred ninety patients undergoing coronary artery bypass grafting, valve surgery or combined procedures were enrolled. PDR-ICG measurements along with standard lab values were performed preoperative and on postoperative days 1, 2, and on discharge from the intensive care unit.

Deep pericardial traction suture versus vacuum-assisted apical suction to expose the posterior wall of the heart in off-pump coronary artery bypass: a prospective, randomized study.

Background: Displacement of the heart to expose the posterior vessels during off-pump coronary artery bypass (OPCAB) may cause hemodynamic instability. Deep pericardial traction suture (DPTS) and vacuum-assisted apical suction (VAS) with the Starfish positioning device help to provide good exposure without relevant hemodynamic changes. Our aim was to compare these two methods in patients undergoing multivessel OPCAB.

An uncommon cause of myocardial ischemia after coronary artery bypass grafting: "the dangerous drainage".

The most common causes of myocardial ischemia and myocardial infarction early after coronary artery bypass grafting surgery are early graft occlusion/thrombosis or occlusion/ thrombosis of coronary arteries due to advanced coronary heart disease. We describe a case of postoperative myocardial ischemia due to an uncommon and quickly reversible cause: mechanical compression of a vein graft by a 19F flexible silicone mediastinal drainage tube.

Interrupted nitinol U-Clips versus standard running suture for the central arterial T-graft anastomosis: a prospective randomized study.

Objectives: Studies carried out to date suggest that the interrupted suture technique using U-Clips for anastomoses in coronary surgery may be superior to the standard running polypropylene suture. The purpose of this study was to compare safety and effectiveness of a central T-graft anastomosis constructed with the left internal thoracic artery (LITA) in situ (to the left anterior descending (LAD)) in which the free right internal thoracic artery (to the circumflex branch of the right coronary artery (RCX)) was implanted (RITA-to-LITA) using either self-closing nitinol U-Clips or simple continuous suture. We hypothesized that internal thoracic arteries could adapt their diameter to the blood flow.

Off-pump coronary surgery for allograft vasculopathy 8 years after heart transplant.

Cardiac allograft vasculopathy is a severe complication after heart transplant, and is the major cause of death in patients surviving 1 year after transplant. We present a 59-year-old patient undergoing off-pump, coronary artery bypass surgery, 8 years after heart transplant. Owing to toxic liver disease, the lipid lowering therapy with statins had to be stopped 6 years after transplant, and coronary artery disease developed rapidly within 2 years.

Myocardial transfection of hypoxia inducible factor-1alpha via an adenoviral vector during coronary artery bypass grafting. - A multicenter phase I and safety study -.

Background: Increasing numbers of patients with advanced coronary artery disease have limited options for percutaneous and/or surgical revascularization. A prospective, randomized, phase I clinical multicenter trial was performed to assess the feasibility and safety of delivering a pro-angiogenic transcription factor termed "hypoxia inducible factor-1alpha", delivered to ischemic cardiac muscle via a type 2 adenoviral (Ad2HIF) vector.

Methods And Results: The 13 patients were included under the following criteria: 1 hypoperfused area of viable ventricular muscle without options for revascularization and left ventricular ejection fraction > or =30%.

Off-pump coronary artery bypass in a patient with congenital absence of the left pericardium and an extremely left-rotated heart.

Congenital anomalies of the pericardium are extremely rare and often difficult to diagnose. We describe a 66-year-old woman presenting with multivessel coronary artery disease and right heart insufficiency complicated by an extremely left-rotated heart due to a congenital absence of left pericardium. A multidetector row computerized tomographic study was performed to evaluate the torsion of the heart as well as the physical relationship between the left internal thoracic artery and the left coronary system.

Minimizing cardiac surgery risks in a Hepatitis C patient: Changing surgical strategy after evaluation by modern imaging technologies.

Minimizing operative risks for the surgical team in infectious patients is crucial. We report on a patient suffering from Hepatitis C undergoing re-operative aortic valve and ascending aorta replacement for aortic aneurysm and paravalvular leakage due to recurrent endocarditis of a Smeloff-Cutter aortic ball prosthesis. Preoperative multi-slice computed tomography and real-time three-dimensional echocardiography proved helpful in changing operative strategy by detecting a previously unknown aortic aneurysm, assessing its extent, and demonstrating the close proximity of the right coronary artery, right ventricle, and the aortic aneurysm to the sternum.

Tentacles: a novel device for exposing the heart for the insertion of left apical assist device cannulae.

Background: The implantation of ventricular assist devices is a well-established procedure for the treatment of imminent heart failure. The exact positioning of the left ventricular apical inflow cannula is crucial, because inflow restrictions might occur when the cannula is placed too close to the interventricular septum or a papillary muscle. We report a novel technique using the Tentacles 3-point fixation device for the exposure of the left ventricular apex during ventricular fibrillation under cardiopulmonary bypass.

Long-term results after ablation for long-standing atrial fibrillation concomitant to surgery for organic heart disease: is microwave energy reliable?

Objective: Microwave ablation has been reported as efficient for the surgical treatment of long-standing atrial fibrillation. However, the influence of ablation lesions on long-term results is not known.

Methods: From August of 2000 to November of 2003, 41 patients underwent a left atrial endocardial microwave ablation procedure after a Cox-Maze-like lesion set for long-standing atrial fibrillation concomitant to surgery for valvular or coronary artery disease.

Donor-specific HLA alloantibodies: long-term impact on cardiac allograft vasculopathy and mortality after heart transplant.

Objectives: The clinical significance of anti-HLA-alloantibodies remains controversial. Recent studies have linked development of donor-specific HLA-antibodies to chronic allograft rejection and graft loss after heart, kidney, and lung transplants. We investigated the clinical impact of donor-specific humoral alloreactivity during the follow-up of heart transplant recipients.

Three-dimensional printing creates models for surgical planning of aortic valve replacement after previous coronary bypass grafting.

Purpose: Resternotomy for aortic valve replacement in patients with previous coronary artery bypass grafting and an internal mammary artery graft may be a surgical problem. Thus, we are exploring the effect of using rapid prototyping techniques for surgical planning and intraoperative orientation during aortic valve replacement after previous coronary artery bypass grafting (CABG).

Description: As a proof of concept, we studied a patient who had undergone CABG 5 years earlier.

34-year durability of a DeBakey Surgitool mechanical aortic valve prosthesis.

Background: The DeBakey Surgitool mechanical aortic valve prosthesis was the first mechanical prosthetic valve in which pyrolitic carbon was used. This valve was on the market from 1969 to 1978 and approximately 3300 valves were implanted in this lapse worldwide.

Report: We present a DeBakey Surgitool mechanical aortic valve prosthesis implanted in 1972, which has been functioning for almost 34 years and still presents a good performance.

Does wrapping of the right internal thoracic artery to the left anterior descending artery always protect?

We report about a 72-year-old woman with coronary artery disease. Surgical revascularization was performed using three grafts. One of them was the right internal thoracic artery (RITA) to left anterior descending.

Daptomycin for eradication of a systemic infection with a methicillin-resistant-Staphylococcus aureus in a biventricular assist device recipient.

The rate of infection in patients who require ventricular assist devices is estimated at more than 35%. Infections with multi-resistant organisms such as methicillin-resistant Staphylococcus aureus in ventricular assist device recipients are often difficult to treat and present a high mortality rate. Daptomycin is a new cyclic lipopeptide antibiotic, useful in gram-positive organisms resistant to standard treatment.

Mid-term patency after magnetic coupling for distal bypass anastomosis in coronary surgery.

Background: The magnetic vascular positioner (MVP), a device for distal bypass anastomosis in coronary surgery, was developed to allow a simple and rapid procedure and to improve graft patency. We analyze our mid-term results with this device.

Methods: Eighteen distal anastomoses were performed by using the MVP, and 18 with a hand-sewn technique were completed in 11 patients.

Miniaturized cardiopulmonary bypass in coronary artery bypass surgery: marginal impact on inflammation and coagulation but loss of safety margins.

Purpose: Inflammation and coagulation disturbances are common consequences of cardiopulmonary bypass (CPB). Recently, miniaturized closed CPB circuits without cardiotomy suction and venous reservoir have been proposed to reduce complication rates. We compared outcomes with conventional (CCPB) and miniaturized cardiopulmonary bypass (MCPB) after coronary artery bypass operations (CABG) with respect to inflammation and coagulation.

Hemodynamic and vascular effects of ventricular sourcing by stent-based ventricle to coronary artery bypass in patients with multivessel disease undergoing coronary artery bypass surgery.

Background: The hemodynamic and vascular effects of ventricular sourcing by a stent-based (VSTENT, Percardia) left ventricle-to-coronary artery bypass were studied in a patient subgroup of the European multicenter ADVANTAGE study (ADjunctive treatment with the VCAB/VSTENT myocardial implANT system in coronary Artery bypass Graft patiEnts).

Methods And Results: Twelve patients who underwent VSTENT implantation in addition to coronary artery bypass surgery were studied up to 12 months after the procedure. The VSTENT was implanted distal to a hemodynamically relevant coronary artery stenosis.

Early clinical results with a magnetic connector for distal coronary artery anastomoses.

Purpose: The main goals in the development of an anastomotic device are to reduce the invasiveness of the procedure and to improve graft patency. We analyze our preliminary clinical experience with the Ventrica magnetic vascular positioner (MVP) series 6000 system.

Description: Eighteen distal anastomoses were performed in 11 patients using the MVP.

First clinical experience with the HEARTSTRING, a device for proximal anastomoses in coronary surgery.

Purpose: The HEARTSTRING is a device designed to enable the creation of a clampless hand-sewn proximal anastomosis.

Description: Seventy-six patients who underwent myocardial revascularization had 113 proximal anastomoses created by the HEARTSTRING. Fifty-five procedures were performed on cardiopulmonary bypass and 21, off pump.

Bipolar irrigated radiofrequency ablation of the posterior-inferior left atrium and coronary sinus is feasible and safe.

Background: Success of surgical therapy for atrial fibrillation (AF) mainly depends on creating a complete set of transmural atrial lesions. The established Cox procedures may be simplified by dropping lesions, but not without the risk of impaired results. We aimed to create a complete set of lesions using bipolar irrigated radiofrequency including ablation of the posterior-inferior left atrium (LA) and coronary sinus.

Percutaneous approach to a stent-based ventricle to coronary vein bypass (venous VPASS): comparison to catheter-based selective pressure-regulated retro-infusion of the coronary vein.

Aims: Percutaneous stent-based ventricle-to-coronary vein bypass (venous VPASS) is a new approach to chronic venous arterialization as a treatment modality in an otherwise no option patient with coronary artery disease. In this study, the efficacy of venous VPASS was compared with catheter-based selective pressure-regulated retro-infusion of arterial blood during acute ischaemia.

Methods And Results: In seven pigs, venous VPASS was established using a percutaneous ultrasound-guided puncture from the anterior cardiac vein to the left ventricle, with subsequent implantation of an ePTFE-covered stent graft.

First clinical experience with the VSTENT: a device for direct left ventricle-to-coronary artery bypass.

Background: Stent-based left ventricle-to-coronary artery stent (VSTENT) is a newly developed, alternative surgical revascularization procedure (VCAB). We present here our initial experience using this technique.

Methods: Twelve patients (10 male and 2 female, mean age 61 +/- 13 years) underwent a VCAB concomitant to coronary artery bypass surgery.