Predictive value of intraoperative transit-time flow measurement for short-term graft patency in coronary surgery.

Objective: The aim of this retrospective study was to evaluate the possibility to predict postoperative graft patency in coronary surgery by means of intraoperative transit-time flow measurement.

Methods: Of 3567 patients submitted to isolated myocardial revascularization from June 1997 through June 2003, 157 (4.4%) underwent both intraoperative transit-time flow measurement and angiography at follow-up.

Impact of no-to-moderate mitral regurgitation on late results after isolated coronary artery bypass grafting in patients with ischemic cardiomyopathy.

Background: This study analyzes retrospectively a cohort of patients with ischemic cardiomyopathy (ejection fraction < or = 0.30) who underwent isolated coronary artery bypass grafting to evaluate the impact of no-to-moderate mitral regurgitation (MR) on long-term results.

Methods: From January 1988 to December 2002, 6,108 patients had isolated coronary artery bypass grafting.

Single versus bilateral internal mammary artery for isolated first myocardial revascularization in multivessel disease: long-term clinical results in medically treated diabetic patients.

Background: We evaluated our experience to investigate if the use of bilateral internal mammary artery (BIMA) grafting, with or without complementary saphenous vein grafts (SVG), increases the quality of the results of coronary bypass grafting in medically treated diabetic patients who undergo first myocardial revascularization, when compared with the use of a single left internal mammary artery (LIMA) and SVG.

Methods: From October 1991 to December 2001, 558 diabetic patients with multivessel coronary disease had first isolated myocardial revascularization using LIMA and SVG (group LIMA) in 217 cases and BIMA +/- SVG (group BIMA) in 341. Propensity score analysis identified 400 patients, 200 for each group, with similar preoperative characteristics.

Bilateral internal thoracic artery grafting with and without cardiopulmonary bypass: six-year clinical outcome.

Objectives: We sought to evaluate whether early and late results in patients who underwent off-pump or on-pump myocardial revascularization with bilateral internal thoracic artery grafting were similar.

Methods: From November 1994 through December 2001, 1835 patients underwent isolated myocardial revascularization with bilateral internal thoracic artery grafting. By applying propensity score pairwise matching, 1194 patients were selected and operated on either off pump (n = 597) or on pump (n = 597).

First time myocardial revascularization in patients younger than 70 years. Single versus double internal mammary artery.

Background: We evaluated the early and late outcomes of bilateral internal mammary artery (BIMA) grafting, with or without saphenous vein grafts (SVGs), compared to single internal mammary artery and SVGs in patients < 70 years undergoing first myocardial revascularization.

Methods: From September 1986 to December 1999, 1389 patients underwent first myocardial revascularization using the left internal mammary artery (LIMA) to the left anterior descending artery and SVGs (n = 480) or BIMA (one internal mammary artery on the left anterior descending artery) with or without SVGs (n = 909). Propensity score analysis was used to select 952 (476 of each group) patients with the same preoperative and operative characteristics.

Reoperative coronary artery bypass grafting: analysis of early and late outcomes.

Background: The purpose of this study was to evaluate early and late results of reoperative coronary artery bypass grafting compared with those of first coronary artery bypass grafting.

Methods: From November 21, 1994, to December 31, 2001, 4,381 patients underwent isolated coronary revascularization: among these patients, 274 (6.3%) underwent a redo.

Late results of first myocardial revascularization in multiple vessel disease: single versus bilateral internal mammary artery with or without saphenous vein grafts.

Objective(s): We evaluated our experience to investigate if the use of bilateral internal mammary artery (BIMA) grafting, with or without complementary saphenous vein grafts (SVGs), if compared to the use of single IMA and SVG(s), increases the quality of the results of coronary bypass grafting in patients younger than 75 years who undergo first myocardial revascularization.

Methods: From September 1986 to December 1999, 1602 patients younger than 75 years underwent first myocardial revascularization using left internal mammary (LIMA) to left anterior descending (LAD) and SVG(s) (n=576) or BIMA (one IMA on the LAD) with or without SVG(s) (n=1026). Propensity score analysis was used to select 1140 patients with the same preoperative and operative characteristics.

Immediate flow reserve of Y thoracic artery grafts: an intraoperative flowmetric study.

Objectives: Use of both internal thoracic arteries in a Y graft configuration can raise concerns about the possibility of the single left internal thoracic artery being able to meet the flow requirements of two or three distal territories. We evaluated intraoperatively the flow reserve of a Y thoracic artery graft distally anastomosed to the anterior and lateral territories.

Methods: In 21 patients who had Y thoracic artery grafts, the flow was measured in the main stem of the left internal thoracic artery, in the left internal thoracic artery branch, and in the right internal thoracic artery.

Left ventricular aneurysmectomy: endoventricular circular patch plasty or septoexclusion.

Background: Septoexclusion is a technique described by Guilmet in the mid 1980s. Its indications and midterm results are evaluated and compared to those obtained with the Dor operation.

Methods: From January 1998 to April 2001, 79 patients had an exclusion of scars following myocardial infarction in left anterior descending artery (LAD) territory.

Effect of diabetes on early and late survival after isolated first coronary bypass surgery in multivessel disease.

Objective: Diabetes has not yet been investigated as a risk factor for early and late cardiac-related death.

Methods: Patients operated on from January 1988 to December 1999 were considered; 767 were diabetic (group D) and 2593 were nondiabetic (group ND). Patients with preoperative hemodynamic deterioration were excluded.

Day 0 intensive care unit discharge - risk or benefit for the patient who undergoes myocardial revascularization?

Objective: Day 0 intensive care unit (ICU) discharge allows to use one ICU bed for two patients. Results of this policy were analysed.

Methods: From January 1998 to June 2001, 1194 patients who had myocardial revascularization in the morning were discharged on the same day (Group 0, n=647), or one (Group 1, n=521) or many days (Group 2, n=26) after surgery.

Aortic valve exposure through a combined right atrial-ascending aortic approach in redo cases.

The expanded use of tissue valves in the aortic position lead to an increased number of reoperations in cases o valve failure. The approach to an aortic prosthesis can be difficult because of heavy adhesions, especially if biological glue was used in the first procedure and the interval between the first and second operation is short.

Revascularization of the lateral wall: long-term angiographic and clinical results of radial artery versus right internal thoracic artery grafting.

Objective: We sought to evaluate whether the radial artery provides the same results as the right internal thoracic artery in lateral wall revascularization in the long term.

Methods: From January 1992 to September 1996, 288 patients had myocardial revascularization with the left internal thoracic artery anastomosed to the left anterior descending coronary artery. The lateral wall was grafted with the radial artery in 139 patients (group A) and with the right internal thoracic artery in 149 patients (group B).