Selective use of off-pump coronary bypass surgery reduces mortality and neurologic morbidity associated with high-risk coronary bypass surgery: a 400-case comparative experience.

The frequency of use of off-pump coronary artery bypass (CAB) surgery to surgically treat coronary artery disease has varied greatly from center to center and from surgeon to surgeon because of preference, training, and experience. We report an experience with 400 consecutive isolated CAB procedures selectively managed with on-pump or off-pump surgery, according to the perceived potential for aortic embolization or stroke as determined by clinical and imaging determinations. The off-pump CAB group (46 patients) was 7.

Improving outcomes in coronary surgery: the impact of echo-directed aortic cannulation and perioperative hemodynamic management in 500 patients.

Background: Stroke and death continue to occur perioperatively associated with on-pump and off-pump coronary artery bypass grafting surgery (CABG) procedures. We report on a prospectively implemented multifaceted strategy to improve short-term outcomes associated with on-pump CABG.

Methods: Five hundred consecutive patients from a single teaching institution undergoing standardized on-pump nonreoperative CABG between June 1996 and July 2003 were entered into the New York State Cardiac Surgery database, a verified comprehensive clinical registry.

Opportunities--and challenges--in the surgical subspecialties.

The visionary physicians who brought physician assistants (PAs) into the surgical suite saw that these professionals were well suited to collaborate with surgeons, who were facing the dual challenges of rapidly developing surgical technology and the need to manage costs. Two significant factors that will shape the future for surgical PAs are the downsizing of the surgical physician workforce and recent mandates limiting the hours that surgical residents are permitted to work.