Management of Coronary Artery Disease in Patients With Descending Thoracic Aortic Aneurysms.

Background: The combination of descending aortic aneurysm (DAA) with concomitant coronary artery disease (CAD) is associated with increased morbidity and mortality. We review the surgical management for patients with this combined disease.

Methods: From January 2000 to January 2014, we performed 268 elective surgeries on the descending or thoracoabdominal aorta.

Superior haemodynamic stability during off-pump coronary surgery with thoracic epidural anaesthesia: results from a prospective randomized controlled trial.

Objectives: Off-pump coronary artery bypass (OPCAB) surgery is a technically more demanding strategy of myocardial revascularization compared with the standard on-pump technique. Thoracic epidural anaesthesia, by reducing sympathetic stress, may ameliorate the haemodynamic changes occurring during OPCAB surgery. The aim of this randomized controlled trial was to evaluate the impact of thoracic epidural anaesthesia on intraoperative haemodynamics in patients undergoing OPCAB surgery.

Minimal access aortic valve replacement using minimal extracorporeal circuit.

A minimal extracorporeal circuit has been shown to decrease the transfusion rate, cardiac and neurological damage in coronary surgery. We describe in detail a technique for minimal-access aortic valve replacement using a minimal extra-corporeal circuit, and provide surgical and perfusion tips to maintain antegrade perfusion and a clear surgical field.

Reverse subclavian flap and aorto-pulmonary window technique for repair of interrupted aortic arch and truncus arteriosus.

We report a surgical strategy for repairing an interrupted aortic arch (IAA) with truncus arteriosus (TA) by using a reverse subclavian flap and an aorto-pulmonary (A-P) window technique for preserving the pulmonary artery architecture. A 10-day-old neonate with type B IAA and type I TA with echocardiographic evidence of a significant distance between the ascending and descending aorta underwent surgical repair at the Bristol Royal Hospital for Children. The superior part of the arch was reconstructed using a reverse subclavian flap and the undersurface with a pulmonary homograft patch.

Gauze-based negative pressure wound therapy to infected deep sternotomy wound complicated by cardiac tamponade: a case report.

Negative pressure wound therapy is the standard of care for infections after median sternotomy. Foam-based systems are commonly used even in scenarios when the myocardium is exposed. Gauze-based systems have recently gained popularity.

The effect of diabetes mellitus on patients undergoing coronary surgery: a risk-adjusted analysis.

Background: Surgical case-mix is seriously worsening, and the results of surgical revascularization on high-risk cohorts should be continuously evaluated. This study investigates the influence of diabetes mellitus on the short and midterm outcome in the modern era of coronary surgery.

Methods And Results: Patients who underwent first-time coronary artery bypass grafting from April 1996 to October 2003 were classified into diabetic and nondiabetic groups.

Splanchnic organ injury during coronary surgery with or without cardiopulmonary bypass: a randomized, controlled trial.

Background: We investigated the efficacy of coronary surgery with or without cardiopulmonary bypass in protecting the function of the small intestine, liver, and pancreas.

Methods: Patients were randomized to off-pump coronary artery bypass grafting (OPCAB) or coronary artery bypass grafting with cardiopulmonary bypass (CABG-CPB). Small intestine function was assessed by differential four sugars (O = methyl-D-glucose, D-xylose, L-rhamnose, and lactulose) permeability and absorption tests.

Fibrosing mediastinitis as a cause of superior vena cava syndrome.

Fibrosing mediastinitis is a rare, chronic inflammatory process that can cause superior vena cava syndrome, and can mimic malignancy. We present two cases of this disease where surgical resection was not possible and review the treatment options.