Revascularization of the right coronary artery: grafting or percutaneous coronary intervention?

Background: The choice of myocardial revascularization strategy for the right coronary artery (RCA) in patients with multivessel disease and chronic stable angina remains controversial. Our aim was to determine the better strategy-hybrid, combining bypass of the left coronary network and percutaneous coronary intervention of the RCA, or exclusively surgical-and if the latter, the best conduit.

Methods: We used decision analysis, a modeling technique, to compare two RCA revascularization strategies: surgical grafting and percutaneous coronary intervention.

How to tailor A "pi" graft for complex myocardial revascularization: a variant of the mammary loop technique.

We present a new pattern for tailoring the "pi" graft that uses the advantages of the mammary loop technique. The two internal thoracic mammary arteries are skeletonized. The free right mammary artery is anastomosed end-to-side to the proximal part of the in situ left mammary artery to make a "Y" graft.

The mammary loop: how to do an adjustable "Y" graft with the left internal thoracic artery.

We present a technique that permits the grafting of two vessels with the left internal thoracic artery when a sequential graft cannot be performed. The left internal mammary artery is anastomosed to itself resulting in a loop that will be cut open at the time of the coronary anastomosis.

Beating versus arrested heart coronary revascularization: evaluation by cardiac troponin I release.

Background: This prospective randomized study aimed to compare beating and arrested heart revascularization in patients undergoing first elective coronary artery bypass graft, with cardiac troponin I release used to evaluate myocardial injury.

Methods: Seventy patients were randomly assigned to a beating or arrested heart revascularization group. Cardiac troponin I concentrations were measured in serial venous blood samples drawn preoperatively in both groups: after aortic unclamping at 6, 9, 12, and 24 hours in the arrested heart group and after the last anastomosis at 6, 9, 12, and 24 hours in the beating heart group.

Endovascular treatment of the traumatic rupture of the aortic isthmus.

The traumatic rupture of the aortic isthmus is a dehiscence of all or part of the aortic wall, occurring as a result of a closed thoracic trauma. Standard surgical technique requires left thoracotomy, aortic cross-clamping and use of the cardiopulmonary by-pass to prevent ischemic complications, in special the neurologic and visceral ones. The endovascular treatment of these lesions is a more simple solution and there are recent reports on the stent-grafting of the isthmic rupture of the thoracic aorta.

Management of the second episode of spontaneous pneumothorax: a decision analysis.

Background: Optimal management for patients presenting a second episode of spontaneous pneumothorax remains controversial. The aim of this study was to compare two possible treatment strategies, video-assisted thoracic surgery (VATS) and conservative management, in order to assess which of the two was better adapted for the treatment of the second episode of spontaneous pneumothorax.

Methods: The authors propose a decision analytic model including a cost-effectiveness study to compare two clinical strategies: VATS (reference strategy) and conservative management (alternative strategy).

Open heart surgery: one-year self-assessment of quality of life and functional outcome.

Background: The aim of this prospective study, based on the completion of the short form health survey questionnaire (SF36) before and 1-year after open heart surgery, was threefold: to evaluate the changes in quality of life (QOL) after open heart surgery, to determine the factors influencing QOL, and to assess the relation between preoperative QOL and 1-year cardiac functional status.

Methods: Logistic regression was used to determine factors that influence patients' QOL scores and their 1-year cardiac functional status. Different groups were constituted in terms of 1-year cardiac functional status by means of an arborescent classification.

Endovascular stent grafting for contained rupture of the descending thoracic aorta.

We report three cases of contained rupture of the descending thoracic aorta managed by endovascular stent grafting and discuss the possibility of managing this life-threatening complication in emergency, by endoluminal devices. Further experience is needed to specify the indications for aortic stenting in descendant thoracic aortic ruptures.

Warm and tepid cardioplegia: do they provide equal myocardial protection?

Background: Cardiac troponin I (CTnI) has been shown to be a marker of myocardial injury. The aim of this prospective, randomized study was to compare intermittent antegrade warm cardioplegia with tepid blood cardioplegia in patients undergoing first elective coronary artery bypass graft, using CTnI release as the criterion for evaluating the adequacy of myocardial protection.

Methods: Seventy patients were randomly assigned to one of two cardioplegia groups.

[To be cured of lung cancer].

Pronostic of lung carcinoma is very poor but, every year in Europe and North America, thousands of patients are offered a chance of cure. However only a long period of time without relapse allows to state the reality of cure. Sequelae generated by cancer treatments are potentially increased by the use of treatments combinations.

Comparison of the Nottingham Health Profile and the 36-item health survey questionnaires in cardiac surgery.

Background: Quality of life (QOL) instruments help to integrate the patient's view into clinical practice and into the evaluation of new therapeutic strategies. The aim of the present study was to determine which of two generic QOL instruments, the Nottingham Health Profile (NHP) or the Short Form Health Survey (SF36), was the more suitable for use in cardiac surgery.

Methods: The NHP and the SF36 were compared before and 5 weeks after surgery.

Crystalloid versus cold blood cardioplegia and cardiac troponin I release.

Background: Cardiac troponin I (CTnI) has been shown to be a marker of myocardial injury. The aim of this study was to compare antegrade crystalloid cardioplegia with antegrade cold blood cardioplegia with warm reperfusion using CTnI release as the criteria for evaluating the adequacy of myocardial protection.

Methods And Results: Seventy patients were randomly assigned to receive crystalloid or blood cardioplegia.