Radical nephrectomy with resection of vena cava thrombus using extracorporeal circulation and deep hypothermic circulatory arrest.

Introduction: Patients with renal cell carcinoma (RCC) with level 3 or 4 caval thrombus have a poor prognosis, with reported five-year survival rates of 30-40%. The aim of this study was to assess the perioperative morbidity and long-term oncological outcomes for radical nephrectomy with resection of vena cava thrombus using a combined surgical approach, including extracorporeal circulation and deep hypothermic circulatory arrest.

Methods: A retrospective review was performed of the institutional case log to identify all radical nephrectomies with caval thrombus performed from January 2006 to May 2020.

Planting the 'SEAD': early comprehensive exposure to surgery for medical students.

Introduction: The popularity of surgical specialties is declining amongst Canadian medical students. Limited early exposure of students to surgery and minor involvement of surgeons in preclerkship education are barriers to creating interest in the field. Although many informal observerships and interest groups exist, there are no structured programs in Canada that offer preclerkship medical students a comprehensive exposure to surgery.

Cut-off values for transit time flowmetry: are the revision criteria appropriate?

Background: Graft Imaging to Improve Patency (GRIIP), a single-center, randomized blinded clinical trial, reported that intraoperative graft assessment with graft revision according to a priori criteria of transit time flowmetry (TTF) and intraoperative fluorescent angiography did not improve graft patency at one year after coronary artery bypass grafting (CABG) when compared with standard intraoperative management. The objective of this study is to investigate whether other TTF values are more predictive of the saphenous vein graft (SVG) failure and/or clinical outcomes.

Methods: This is a case control retrospective study of 65 SVGs from 44 patients from GRIIP.

Are stentless valves hemodynamically superior to stented valves? Long-term follow-up of a randomized trial comparing Carpentier-Edwards pericardial valve with the Toronto Stentless Porcine Valve.

Objective: The benefit of stentless valves remains in question. In 1999, a randomized trial comparing stentless and stented valves was unable to demonstrate any hemodynamic or clinical benefits at 1 year after implantation. This study reviews long-term outcomes of patients randomized in the aforementioned trial.

The Graft Imaging to Improve Patency (GRIIP) clinical trial results.

Objective: This trial aimed to determine whether intraoperative graft assessment with criteria for graft revision would decrease the proportion of patients with 1 or more graft occlusions or stenoses or major adverse cardiac events 1 year after coronary artery bypass grafting.

Methods: A single-center, randomized, single-blinded, controlled clinical trial was designed. Patients were randomized to either of 2 groups: intraoperative graft patency assessment using indocyanine-green fluorescent angiography and transit-time flowmetry, with graft revision according to a priori criteria (imaging group), or standard intraoperative management (control group).

Troponin after cardiac surgery: a predictor or a phenomenon?

Background: Increased cardiac troponin is observed after virtually every cardiac operation, indicating perioperative myocardial injury. The clinical significance of this elevation is controversial. This study aimed to correlate postoperative troponin levels with major adverse cardiac events (MACE).

A randomized comparison of intraoperative indocyanine green angiography and transit-time flow measurement to detect technical errors in coronary bypass grafts.

Background: Early coronary bypass graft failures may be preventable if identified intraoperatively. The purpose of this investigation was to compare the diagnostic accuracy of two intraoperative graft assessment techniques, transit-time ultrasound flow measurement and indocyanine green fluorescent-dye graft angiography.

Methods: Patents undergoing isolated coronary artery bypass grafting with no contraindications for postoperative angiography were enrolled in the study.

Improving the quality of coronary bypass surgery with intraoperative angiography: validation of a new technique.

Objectives: We report a comprehensive assessment and validation of a new intraoperative angiography technique.

Background: Technical problems at the site of the distal anastomosis compromise an underappreciated proportion of coronary bypass grafts. The absence of a systematic, validated technique to verify graft patency in the operating room represents a significant breach in quality assurance.

Determinants of incomplete left ventricular mass regression following aortic valve replacement for aortic stenosis.

Objective: Incomplete regression of left ventricular hypertrophy (Abn-LVMI) following AVR for aortic stenosis (AS) may decrease long-term survival. In this prospective study, we identified the predictors of Abn-LVMI.

Methods: Between 1990 and 2000, 529 patients undergoing AVR for AS had clinical and hemodynamic data collected prospectively.

Long-term results of aortic valve replacement with the St. Jude Toronto stentless porcine valve.

Background: Long-term survival and freedom from valve-related events of the St. Jude Toronto stentless porcine valve (SPV) are unknown. The aim of this study was to investigate late clinical outcomes after aortic valve replacement with the Toronto SPV.

Why is off-pump coronary surgery uncommon in Canada? Results of a population-based survey of Canadian heart surgeons.

Background: Off-pump coronary artery bypass (OPCAB) is proposed to improve clinical outcomes and decrease resource use. However, off-pump surgery is not widely used in Canada. The purpose of this study was to determine the current use of OPCAB in Canada and determine why surgeons have not adopted this technique.

Late outcomes in patients with uncorrected mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting.

Objectives: Patients undergoing coronary artery bypass grafting often have untreated mild to moderate mitral regurgitation. The long-term outcome of these patients follows an uncertain course. The purpose of this study was to examine the late outcomes in patients with mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting.

Radial artery use is safe in patients with moderate to severe left ventricular dysfunction.

Background: Using radial artery grafts in patients with moderate to severe left ventricular dysfunction (LVD; ejection fraction < 35%) has been discouraged for the fear that postoperative vasopressor support may cause graft spasm and lead to ischemic complications. We, therefore, examined the safety of radial grafts in aortocoronary bypass (ACB) patients with LVD.

Methods: Data were collected from 5,455 patients who underwent isolated ACB between January 1995 and September 2001.

The influence of cardiopulmonary bypass flow characteristics on the clinical outcome of 1820 coronary bypass patients.

Objective: To determine whether pulsatile perfusion is clinically beneficial for adult cardiac operations.

Methods: Data concerning consecutive patients undergoing isolated coronary bypass surgery (n=1820) from January 1, 1997 to July 31, 1999 were reviewed.

Results: Nine hundred fifteen patients received pulsatile perfusion (PP) while perfusion in the remaining 905 patients was nonpulsatile (NP).

The short-term and long-term effects of warm or tepid cardioplegia.

Background: Clinical studies of myocardial protection rarely identify differences in hard clinical outcomes after surgery, either early or late, because most trials lack sufficient statistical power to deal with low-frequency events.

Methods: Prospectively collected data concerning all isolated coronary bypass operations from November 1989 to February 2000 were analyzed to determine the effects of cold blood cardioplegia and warm or tepid blood cardioplegia on early and late outcomes after surgery. Warm blood cardioplegia was used in 4532 patients, whereas cold blood cardioplegia was used in 1532.

Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevant.

Background: Although small valve size and patient-prosthesis mismatch are both considered to decrease long-term survival, little direct evidence exists to support this hypothesis.

Methods: To assess the prevalence of patient-prosthesis mismatch and the influence of small valve size on survival, we prospectively studied 1,129 consecutive patients undergoing aortic valve replacement between 1990 and 2000. Mean and peak gradients and indexed effective orifice area were measured by transthoracic echocardiography postoperatively (3 months to 10 years).

The insulin cardioplegia trial: myocardial protection for urgent coronary artery bypass grafting.

Background: Small, nonrandomized clinical trials have demonstrated a beneficial effect of solutions containing insulin and glucose on the recovery of myocardial metabolism and ventricular function after cardioplegic arrest and reperfusion. However, no large, blinded, randomized study has yet determined the effects of insulin-enhanced cardioplegia on clinical outcomes after coronary artery bypass grafting.

Methods: The Insulin Cardioplegia Trial was designed to evaluate the clinical impact of insulin-enhanced cardioplegia on patients at high risk undergoing isolated coronary artery bypass grafting for unstable angina.

Are stentless valves hemodynamically superior to stented valves? A prospective randomized trial.

Background: Although stentless aortic bioprostheses are believed to offer improved outcomes, hemodynamic benefits remain unsubstantiated.

Methods: Fifty-three patients were randomized to receive the stented C-E pericardial valve (CE) and 46 patients the Toronto Stentless Porcine valve (SPV). Annuli were sized for the optimal insertion of both valve types, such that surgeons were required to commit to specific valve sizes before randomization.