Matrix Signaling Subsequent to a Myocardial Infarction: A Proteomic Profile of Tissue Factor Microparticles.

This study investigated the release and proteomic profile of tissue factor microparticles (TFMPs) prospectively (up to 6 months) following a myocardial infarction (MI) in a chronic porcine model to establish their utility in tracking cellular level activities that predict physiologic outcomes. Our animal groups (n = 6 to 8 each) consisted of control, noninfarcted (negative control); infarcted only (positive control); and infarcted animals treated with cardiac resynchronization therapy (CRT) and a β-blocker (BB) (metoprolol succinate). The authors found different protein profiles in TFMPs between the control, infarcted only group, and the CRT + BB treated group with predictive impact on the outward phenotype of pathological remodeling after an MI within and between groups.

Persufflation (gaseous oxygen perfusion) as a method of heart preservation.

Persufflation (PSF; gaseous oxygen perfusion) is an organ preservation technique with a potential for use in donor heart preservation. Improved heart preservation with PSF may improve outcomes by maintaining cardiac tissue quality in the setting of longer cold ischemia times and possibly increasing the number of donor hearts available for allotransplant. Published data suggests that PSF is able to extend the cold storage times for porcine hearts up to 14 hours without compromising viability and function, and has been shown to resuscitate porcine hearts following donation after cardiac death.

Effects of centrifugal and roller pumps on survival of autologous red cells in cardiopulmonary bypass surgery.

Background: Either a roller pump or a centrifugal pump can be used in the extracorporeal circuit during surgery with cardiopulmonary bypass. In this study, we assessed the effect of these two pumps on the 24-h post-transfusion survival values of autologous red blood cells (RBC).

Study Design And Methods: Fourteen male patients subjected to extracorporeal bypass procedures were studied.

A femoral artery cannula that allows distal blood flow.

Objective: A femoral artery cannula is used for certain types of circulatory support but can cause ischemia, especially during prolonged perfusion. This study tests the function of a femoral cannula designed to allow proximal and distal blood flow.

Methods: Five pigs were used in the study.

Facilitated vascular anastomosis in coronary bypass surgery.

The goal of truly minimally invasive surgical revascularization with 1-day hospital stays is shared by surgeons, patients, and payors alike. However, accomplishing this will involve doing surgery through more limited-access incisions and working within closed spaces. Suture management in this setting is cumbersome, slow, and unreliable.

Limited-access surgical coronary artery revascularization.

The continued evolution of surgical revascularization has resulted in much less invasive alternatives for patients undergoing coronary artery bypass grafting. In particular, techniques and technologies have been developed to allow for the grafting of coronary arteries through limited access incisions without the circulatory support of cardiopulmonary bypass. The conduits are generally arterial rather than the venous alternatives used originally, and the harvesting of these conduits is performed through limited access incisions described in another article in this review.

Chronic effects of arterial balloon dilatation on internal mammary artery endothelial function.

Background: Manipulation for harvesting of the internal mammary artery (IMA) for coronary artery bypass grafting has been shown to acutely impair endothelium-dependent, but not endothelium-independent contractions and relaxations. Recently the use of a novel arterial balloon catheter to dilate the IMA has shown an increased IMA flow while preserving endothelial cell integrity and function acutely. This study examines the chronic effects on endothelial function of IMA segments subjected to arterial balloon catheter dilatation in comparison to either no manipulation (control), luminal dilatation with papaverine, or temporary occlusion with soft or hard jaw in a porcine model.

Endoscopic radial artery harvest: a new approach.

Background: Although early attempts to use the radial artery (RA) as a conduit for cardiac revascularization met with disappointing results, recent data have shown the RA to achieve very good short-term patency as well as promising mid-term patency results. The recent increase in the frequency of coronary reoperations, with their limited options for vascular conduits, has also stimulated an interest in the RA graft. The success of minimally invasive vein harvesting techniques encouraged us to develop a minimally invasive technique for harvesting the RA from the forearm, which is reviewed in this article.

Arterial balloon catheter: a new atraumatic device for dilating arterial grafts.

Background: Harvesting of the internal mammary artery (IMA) for use in myocardial revascularization may result in spasm, which can impair early graft flow. Hydrostatic and mechanical dilatation can exert an intraluminal shear force, causing denudation of the IMA endothelium. A new long balloon dilatation technique (LB) has been developed to mechanically increase IMA diameter and flow without exerting any shear force on the endothelium.

Noninvasive graft flow and patency assessment following minimally invasive direct coronary artery bypass (MIDCAB) grafting.

Objective: Assessment of graft patency following minimally invasive direct coronary artery bypass (MIDCAB) surgery is essential in order to determine the efficacy of this technique. This study was conducted to evaluate the role of intraoperative and postoperative noninvasive flow and velocity measurements to follow and predict graft performance.

Methods: Between April 1996 and July 1997, 130 patients had 133 grafts placed using MIDCAB techniques.

Minimally invasive atrial septal defect closure using the subxyphoid approach.

Background: Atrial septal defects in adults are associated with paradoxical emboli, atrial tachyarrythmias, and congestive heart failure. Surgical closure is highly efficacious with low operative mortality and morbidity. However, in young women sternotomy scars are unsightly reminders of an otherwise curative procedure.

Integrated myocardial revascularization.

The integration of minimally invasive coronary artery bypass grafting with catheter-based interventions is being practiced with increasing frequency both in the standard and high risk patient populations. The procedures can be staged on different days or done concurrently in either an operative cathlab or an operating room with imaging capabilities. The new clinical issues raised with these new approaches are reviewed for practitioners considering adopting this new treatment strategy.

Initial experience with MIDCAB grafting using the gastroepiploic artery.

Background: Minimally invasive direct coronary artery bypass grafting with the gastroepiploic artery can be used in primary operations and reoperations to revascularize the inferior or anterior surface of the heart.

Methods: Patients who had symptomatic coronary artery disease limited to a single coronary distribution were selected. Coronary targets were grafted with the pedicled gastroepiploic artery through a small midline epigastric incision.

Early experience with minimally invasive direct coronary artery bypass grafting with the internal thoracic artery.

Objective: Minimally invasive direct coronary artery bypass is performed under direct vision without sternotomy or cardiopulmonary bypass. The technique can be used in both primary and reoperative cases by employing the internal thoracic artery to perform arterial revascularization of the anterior surface of the heart.

Methods: Patients were selected who had significant coronary artery disease limited to 1 or 2 coronary distributions on the anterior surface of the heart.

The expanded role of minimally invasive coronary grafting.

The evolution of minimally invasive direct coronary artery bypass (MIDCAB) grafting has extended the role of this approach for limited coronary revascularization. MIDCAB techniques can now be used to address isolated stenoses in the inferior and lateral coronary distributions. MIDCAB techniques are increasingly being used in the reoperative setting, and multiple vessels can be bypassed during a single operation.

Reoperative MIDCAB grafting: 3-year clinical experience.

Objective: Minimally invasive direct coronary artery bypass (MIDCAB) is performed under direct vision without sternotomy or cardiopulmonary bypass. The technique is used in reoperative patients through various incisions to revascularize one or two areas of the heart. The internal mammary artery, gastroepiploic artery, radial artery, or saphenous vein are used as graft conduits.

Cost analysis of current therapies for limited coronary artery revascularization.

Background: Single or double (limited) coronary artery revascularization using percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass (CAB) surgery has recently been enhanced with further innovation in intracoronary stenting and the emergence of minimally invasive direct coronary artery bypass (MIDCAB) grafting. Resource allocation for all modalities is directly dependent on hospitalization costs, length of stay, and clinical results.

Methods And Results: Four groups of 25 consecutive patients over 9 months at a single center received either PTCA, stenting, MIDCAB, or conventional CAB for single-vessel coronary disease, primarily of the left anterior descending circulation.

Lateral MIDCAB grafting via limited posterior thoracotomy.

Objective: Minimally invasive direct coronary artery bypass (MIDCAB) is a technique for coronary artery bypass grafting performed under direct vision without sternotomy or cardiopulmonary bypass. The approach has been used principally for primary single vessel grafting of the anterior or inferior coronary circulation. This initial experience presents a new lateral technique for patients with isolated circumflex coronary disease which can be used for both primary and reoperative revascularization with either saphenous vein or a free radial artery conduit.

One-month histologic response of transmyocardial laser channels with molecular intervention.

Background: Transmyocardial revascularization reduces the symptoms and morbidity of patients with endstage ischemic heart disease. The mechanism is postulated to be the formation of transmural left ventricular channels through which oxygenated blood directly perfuses the myocardium. New techniques for molecular enhancement of angiogenesis and endothelial cell motility may represent strategies to augment this clinical benefit.