Do all cardiac surgery patients benefit from antifibrinolytic therapy?

Background: In trauma patients, the recognition of fibrinolysis phenotypes has led to a re-evaluation of the risks and benefits of antifibrinolytic therapy (AF). Many cardiac patients also receive AF, but the distribution of fibrinolytic phenotypes in that population is unknown. The purpose of this hypothesis-generating study was to fill that gap.

DCD and DBD lung transplantation optimized by ex vivo perfusion: What to do when the pump fails.

Background: Ex vivo perfusion is a safe and feasible method of assessing and using high-risk donor organs.

Aim: We describe a case of successfully ex vivo treated and transplanted human lung allografts.

Methods: Donor human lungs were assessed using ex vivo, our trouble shooting protocol allowed safe recovery.

Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly: Long-Term Survival Benefit.

Background: Extensive evidence documents a survival benefit for bilateral internal mammary artery (BIMA) grafting compared with single internal mammary artery (SIMA) grafting for patients with advanced coronary artery disease. However, controversy continues to exist regarding the incremental benefit of broadly applied BIMA grafting in elderly patients.

Methods: Retrospective analysis was conducted of 4,503 consecutive isolated coronary artery bypass grafting operations (SIMA, n = 2,340 and BIMA, n = 2,163) performed from 1972 to 1994.

Bilateral internal mammary artery grafting reverses the negative influence of gender on outcomes of coronary artery bypass grafting surgery.

Objectives: Coronary artery bypass grafting (CABG) has historically demonstrated higher hospital mortality in women compared with men. The influence of gender on long-term outcomes has not been clearly defined.

Methods: A retrospective analysis of 4584 consecutive CABG patients was conducted: 3647 men (1761 single internal mammary artery, [SIMA]; 1886 bilateral IMA, [BIMA]) and 937 women (608 SIMA and 329 BIMA).

Bilateral internal mammary artery grafting enhances survival in diabetic patients: a 30-year follow-up of propensity score-matched cohorts.

Background: The prevalence of diabetes mellitus is increasing at an unprecedented rate, affecting nearly 8% of the population. Previous studies have demonstrated a potential benefit for surgical over interventional revascularization in this group of patients. Similarly, studies have shown the superiority of bilateral internal mammary artery (BIMA) grafting over single internal mammary artery (SIMA) grafting in select populations.

Bilateral internal thoracic artery grafting improves long-term survival in patients with reduced ejection fraction: a propensity-matched study with 30-year follow-up.

Objective: Bilateral internal thoracic artery (BITA) grafting has been shown to improve long-term survival after coronary artery bypass grafting. However, there has been reluctance to use this technique in higher-risk patients. Patients with reduced ejection fraction (EF) have been shown to present a higher operative risk and reduced long-term survival.

Location of the second internal mammary artery graft does not influence outcome of coronary artery bypass grafting.

Background: Although the use of two internal mammary arteries (IMA) in coronary artery bypass graft surgery has been associated with improved patient survival and clinical status, the optimal use of the second IMA graft remains controversial. We, therefore, explored clinical outcomes in a large cohort of patients undergoing bilateral IMA grafting.

Methods: Between February 1972 and May 1994, 2,215 consecutive patients underwent bilateral IMA grafting.

Thirty-year follow-up defines survival benefit for second internal mammary artery in propensity-matched groups.

Background: The value of the left internal mammary artery (LIMA) graft is well established. However, the incremental value of a second IMA graft is controversial. Despite reports of improved survival with bilateral IMA (BIMA) grafting, the Society of Thoracic Surgeons reports its use in 4% of coronary artery bypass graft operations.

Coronary bypass surgery in women: a long-term comparative study of quality of life after bilateral internal mammary artery grafting in men and women.

Background: Coronary bypass surgery carries a higher operative mortality and less favorable long-term clinical benefits for women than men. The impact of arterial revascularization on long-term results, including quality of life (QOL) in women, compared with men, has not been clearly defined.

Methods: A retrospective analysis was performed comparing 261 consecutive women patients from a single surgical practice receiving bilateral internal mammary artery (IMA) and supplemental vein grafts between January 1972 and October 1994 with a computer-matched cohort of 261 men undergoing bilateral IMA surgery during the same time period.

Left atrial compression by a pericardial hematoma presenting as an obstructing intracavitary mass: a difficult differential diagnosis.

The differential diagnosis of extracavitary, intramural and intracavitary disease may be difficult. An extrinsic compression of the left atrium by a dissecting pericardial hematoma was misdiagnosed as an intracavitary mass, by echocadiography and computer tomography. This case emphasizes the importance of patient history and clinical setting.

Efficacy of single versus bilateral internal mammary artery grafting in women: a long-term study.

Background: Coronary artery bypass grafting carries a higher operative mortality and less favorable long-term benefit in women than in men. Bilateral internal mammary artery grafting (BIMA) has been shown to yield excellent perioperative and long-term results in both women and men. However, controversy continues to exist as to the benefits of a second internal mammary artery graft in women.

Bilateral internal mammary artery grafting in women: a 21-year experience.

Background: Coronary artery bypass grafting traditionally has carried a higher mortality rate in women than in men. It remains the leading cause of death in women despite major advances in diagnosis and treatment over the past 2 decades.

Methods: A retrospective analysis was conducted to identify risk factors that adversely influence hospital mortality, morbidity, and long-term clinical results in women undergoing bilateral internal mammary artery grafting.

Coronary bypass grafting in the elderly. Single versus bilateral internal mammary artery grafts.

A surgical experience between October 1983 and December 1990, with 1467 consecutive patients 65 years of age and over, was used to compare patients receiving single internal mammary artery grafts (n = 736) with those receiving bilateral internal mammary artery grafts (n = 731). The mean age in the single-graft group was 73.2 years and 70.

Bilateral internal mammary artery grafts in patients with left main coronary artery disease.

The use of the internal mammary artery (IMA) in myocardial revascularization has been expanded with bilateral and sequential grafting. However, its application in the presence of left main coronary artery stenosis (LMCAS) has not been well established. From September 1983 through December 1990, 280 patients with LMCAS greater than 50% were revascularized (3.

Bilateral internal mammary artery grafts in reoperative and primary coronary bypass surgery.

Bilateral internal mammary artery grafting is recognized as a preferred method of myocardial revascularization. However, its efficacy in coronary bypass reoperation has not been clearly established. From January 1982 through June 1989, 88 patients underwent coronary bypass reoperation with bilateral internal mammary artery grafts.

Seventeen-year experience with bilateral internal mammary artery grafts.

The internal mammary artery (IMA) is being recognized as the conduit of choice for myocardial revascularization. From January 1972 through June 1988, 1,087 patients received bilateral IMA and supplemental vein grafts. There were 917 men (84.

Twelve-year experience with bilateral internal mammary artery grafts.

A 12 1/2-year experience with 227 patients who underwent coronary revascularization with bilateral internal mammary artery (IMA) and supplemental saphenous vein grafts is presented. There were 725 coronary grafts performed (3.2 per patient).

Endomyocardial fibrosis. Preoperative diagnosis and surgical therapy.

The case of a Nigerian student with biventricular endomyocardial fibrosis is presented. Diagnosis was suggested by cardiac catheterization and histologically confirmed by a percutaneous endomyocardial biopsy. Successful surgical repair including mitral valve replacement, tricuspid valve reconstruction, and left ventricular endomyocardial resection was performed through a biatrial approach.

Surgery of descending aorta. A method of autotransfusion and intercostal artery preservation.

Paraplegia is a tragic complication of surgery of the descending aorta. It is unpredictable and occurs with a similar incidence with or without distal circulatory support. Hypotension, prolonged aortic cross clamp time, and ligation of intercostal arteries have been considered causative factors.

Insulinoma: diagnosis, surgical management and long-term follow-up. Review of 41 cases.

The clinical features, diagnosis and surgical considerations in 41 patients with insulinoma treated at Columbia-Presbyterian Medical Center are presented along with a review of the literature. One hundred percent of patients surviving surgery for benign functional beta cell tumors were cured of hypoglycemia. A detailed long-term follow-up study in the majority of patients after surgical cure documented a statistically significant incidence of neuropsychiatric aberration, adult-onset diabetes mellitus and peptic ulcer disease.