Bilateral versus single internal mammary artery in diabetic patients: systematic review and meta-analysis.

Objectives: Data on bilateral internal mammary artery (BIMA) versus single internal mammary artery (SIMA) on diabetics were analyzed; This is the only meta-analysis, the last 7 years.

Methods: Medline through PubMed/EMBASE/CINHAL and the Cochrane Central Register of Controlled Trials; 179 articles were studied; 19 studies deemed suitable and were included in the analysis.

Results: The mortality was 2.

Up-to-Date, Skeletonized or Pedicle Bilateral Internal Mammary Artery; Does It Matter?

Purpose: In this article, we reported on the up-to-date literature regarding skeletonized bilateral internal mammary artery (BIMA) flow and the effect on sternal perfusion. We also reviewed the pros and cons of the skeletonization technique versus the conventional pedicle technique for harvesting the BIMA.

Methods: We performed an up-to-date review using the PubMed database, with a specific focus on the contemporary published literature.

Non-surgical bleeding in cardiac surgery.

Bleeding is an occurrence stemming from complex interactions encountered in cardiac surgery and is often attributed to the perioperative administration of anti-thrombotic products if inadequate surgical haemostasis is excluded. Very occasionally, bleeding does not fit the norm and the aetiology is not a lack of surgical prolene or an iatrogenic-induced coagulopathy. Patients who present for cardiac surgery should be questioned carefully for a history of bleeding; however, patients at risk are not always identified.

Post-cardiotomy open chest management. A single-unit experience.

Objective: Post-cardiotomy open chest management is used either for salvage or as a planned therapeutic option in patients with low cardiac output, hemorrhage, or intractable arrhythmias. We reviewed our experience with these patients.

Methods: Over a 3-year period, 2534 adult cardiac patients were operated on and 35 (1.

Concomitant off-pump coronary artery bypass grafting and total thyroidectomy for a large retrosternal goitre: a case report and review of the literature.

A 76-year-old male presented with angina and a large retrosternal goitre causing marked dyspnoea. Coronary angiography revealed triple vessel disease and moderately impaired left ventricular function. CT imaging demonstrated a substantial multinodular goitre extending into the posterior mediastinum to the level of the carina, with associated compression of the trachea and oesophagus.

A novel approach: how an intracoronary shunt proved to be lifesaving.

Outcomes and complications following internal massage in cardiac surgery are unknown due to the lack of cumulative effort to capture those events and subsequently developing a registry. Therefore, under the circumstances there are no algorithms defined in the literature. This case report outlines the importance of sound decision-making under pressure in order to achieve a favourable outcome.

Current randomized control trials, observational studies and meta analysis in off-pump coronary surgery.

The off-pump literature is divided into three eras: the "early phase" with results favouring off-pump surgery supported with randomized control trials (RCTs) mainly from Bristol, UK; an "intermediate phase" dominated by the results of the ROOBY trial and finally a more "contemporary phase" whereby the off/on-pump argument is unsettled. Although the literature has failed to project an overall superiority of off-pump versus on-pump surgery, nevertheless, small randomized control trials and large meta-analysis studies are concluding that the incidence of a stroke is less than 1 % when an aortic off-pump techniques (especially the non-touch technique) are advocated in patients with diseased ascending aorta. Furthermore, off-pump combined with hybrid procedures may lead to a reduction of adverse outcome in the aged high-risk population with concomitant poor left ventricular function and co-morbidities.

The impact of off-pump surgery in end-organ function: practical end-points.

Most surgeons perform coronary bypass surgery with the aid of cardiopulmonary bypass, which inflicts a massive systemic inflammatory response to the body leading to adverse clinical outcome. In an attempt to make CABG less invasive, interest have been diverted to the off pump technique.The current review attempts to bring an insight onto the last ten years knowledge on the off-pump impact in end organ function, with an aim to draw some clear conclusions in order to allow practitioners to reflect on the subject.

Off-pump coronary surgery: current justifications.

Although the literature has failed to project an overall superiority of off-pump vs. on-pump surgery, nevertheless, small randomized control trials and large meta-analysis studies have concluded that the incidence of a stroke is less than 1 % when anaortic off-pump techniques are advocated in patients with diseased ascending aorta. Furthermore, off-pump techniques or their combination with hybrid procedures may lead to a reduction of adverse outcome in the aged high-risk population with concomitant poor left ventricular function and co-morbidities.

Aspergillus infection in pulmonary cavitating lesions with right atrial myxoma.

Cardiac myxomas are rare primary tumors with varied clinical presentations that may pose a diagnostic challenge. Here, we describe the case of a 21-year-old man with multiple cavitating lung lesions with aspergillosis and underlying right atrial myxoma, who presented with hemoptysis and weight loss. He was successfully treated with right atrial myxoma resection and antifungal agents, with no recurrence or complications after one year of follow-up.

Ascending aorta thrombus: A diagnostic and treatment dilemma.

Due to its position, a mass lesion in the ascending aorta poses a diagnostic and treatment dilemma. We describe the management of a symptomatic mass in the ascending aorta in a 35-year-old man who presented with a cerebrovascular accident.

Complete right ventricular obstruction caused by a giant cardiac myxoid sarcoma.

Myxoid sarcoma is a very rare variant of primary malignant sarcoma of the heart, which presents like a myxoma. We describe the case of 21-year-old man with a giant myxoid sarcoma occupying most of the right ventricle. He underwent emergency surgery to resect the tumor and replace the tricuspid valve which was infiltrated.

Which is the best graft for the right coronary artery?

Bilateral internal mammary arteries directed to the left coronaries are gaining popularity; an increasing level of evidence nowadays supports this surgical strategy. On the other hand, composite right internal mammary artery, radial artery, and gastroepiploic artery targeting high-grade stenotic lesions in the right coronary artery system may confer improved mid- and long-term patency compared to long saphenous veins. This analysis looks into the evidence comparing data of the third best available conduit for grafting the right coronary artery, and by extrapolating this report, compares total arterial revascularization vs.

Double patch repair for a double ventricular rupture.

We describe the case of a 77-year-old woman with recent acute myocardial infarction complicated by ventricular septal defect and formation of a pseudoaneurysm, which were successfully treated surgically with a double patch repair. This case highlights the importance of early recognition of this serious complication, using clinical and echocardiographic examinations, and the various challenges encountered in surgical repair.

Systolic anterior motion of mitral valve with calcified annulus in octogenarians.

Systolic anterior motion of the mitral leaflet causing left ventricular outflow tract obstruction is commonly seen in hypertrophic cardiomyopathy and also in patients with advanced mitral valve disease with excessive anterior leaflet tissue or a reduced aortic-mitral angle. We describe 2 octogenarians who presented with systolic mitral leaflet anterior motion in advanced mitral valve disease with severe mitral annular calcification and associated asymmetrical septal hypertrophy.

Two questions on bilateral internal mammary artery usage.

The use of a single internal mammary graft to the left anterior descending artery has been the gold standard in surgical coronary revascularization since its introduction. However, the take-up rate of use of bilateral internal mammary arteries has been slow despite emerging evidence. This has been partly due to the worry of postoperative complications, in particular, sternal wound complications.

Cardiac surgical patients are not the same. But who knows that: the patient, the cardiologist or the surgeon?

Nowadays, outcome measures get published following risk adjustment; mortality rates are adjusted for risks to give a picture of the performance of a surgeon or a unit. The risk factors associated with in-hospital death are likely to reflect concurrent disease-specific variables. Factors associated with increased resource utilisation (as measured by length of stay) reflect serious co-morbid illness.

Rapid pannus formation after few months of obstructing aortic mechanical prosthesis.

We report a rare case of a prosthetic aortic valve obstruction due to pannus formation only 3 months following aortic and mitral valve replacement. Fragments of asymmetrical pannus formation affected one of the leaflets of the bi-leaflet mechanical valve; the leaflet appeared immobile due to pannus ingrowth into the mechanical skeleton resulting in encroachment of the leaflet, which in turn became immobile. The patient successfully underwent emergency redo-aortic valve replacement.