Nonoperative management of traumatic aortic injury.

Background: The standard management for patients with blunt aortic injury is surgery; however, a small number of patients have been medically managed. The outcome of these nonoperatively managed patients is unknown.

Methods: Seven patients diagnosed as blunt aortic injury were managed without aortic surgery between January 1993 and April 2002, and their outcomes were retrospectively investigated.

Internal thoracic artery to left anterior descending anastomosis performed on the beating heart by endoscopic robot assistance using a new distal connector.

Background: Automated distal connecting devices have been recently introduced to facilitate coronary anastomosis. This could have a large impact on the capacity of robotic systems to perform completely endoscopic off-pump bypass, where the quality of anastomosis and the prolonged operative time for the performance of the anastomosis have until now been cause for concern. Our group tried to determine the feasibility and efficacy of the JoMed distal graft connector using the ZEUS robotic system.

Intraoperative glucose control in diabetic and nondiabetic patients during cardiac surgery.

Objective: The purpose of this study was to evaluate intraoperative glucose control.

Design: Prospective unblinded study.

Setting: Tertiary care center.

Clinical diagnosis of actinic keratosis identifies an elderly population at high risk of developing skin cancer.

Background: Development of actinic keratoses (AK) involves some of the same processes as nonmelanoma skin cancer and may serve as a marker for overall increased risk of skin cancer.

Objective: The objective of this study was to examine the risk of developing skin cancer in an elderly population with and without AK.

Methods: This was a retrospective observational study.

Left subclavian artery to descending aorta bypass for coarctation physiology after descending aortic repair.

Stenosis of the aorta observed after descending aorta replacement for traumatic aortic injury was managed by a placement of a bypass between the left subclavian artery and the distal descending aorta with success.

Blunt injury of the innominate artery: a case report and review of literature.

Innominate artery injury after blunt trauma is uncommon and mostly observed at its origin from the aorta. We report here an unusual case of distal innominate artery injury associated with acute right subclavian occlusion. MEDLINE search of blunt traumatic injury to the innominate artery revealed a total of 132 case reports by the end of 2003, including this case report, and all these published studies were reviewed.

Redo-aortic valve replacement after previous bilateral internal thoracic artery bypass grafting.

Background: Aortic valve replacement (AVR) after coronary artery bypass using bilateral internal thoracic arteries (ITAs) is a challenge. Management of these patent grafts and myocardial protection are important issues. Moreover the risk and outcome of these complex operations have not been clearly defined.

Robotically assisted endoscopic transmyocardial laser revascularization.

Background: The surgical approach to transmyocardial laser revascularization (TMR) via thoracotomy has been approved for the treatment of angina in inoperable patients, but it has had limited use as a stand-alone procedure.

Objectives: To assess the feasibility and efficacy of robotically assisted endoscopic TMR using the Zeus robotic surgical system (Computer Motion, USA) and an excimer TMR system (Spectranetics, USA) in a porcine model.

Methods: Five pigs weighing 20 kg to 40 kg were used.

Blunt injury of proximal innominate artery.

Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery injury, successfully treated with aorto-innominate bypass.

Preservation of the anterior fat pad paradoxically decreases the incidence of postoperative atrial fibrillation in humans.

Objectives: The goal of this study was to determine if parasympathetic nerves in the anterior fat pad (FP) can be stimulated at the time of coronary artery bypass surgery (CABG), and if dissection of this FP decreases the incidence of postoperative atrial fibrillation (AF).

Background: The human anterior epicardial FP contains parasympathetic ganglia and is often dissected during CABG. Changes in parasympathetic tone influence the incidence of AF.

Migration of an inferior vena cava filter to the right ventricle and literature review.

Migration of an inferior vena cava (IVC) filter to the heart after placement is an extremely rare complication. The case of a 42-year-old man who presented with ventricular arrhythmia and tricuspid valve regurgitation, and underwent open heart surgery to extract an IVC filter from the right ventricle 12 days after infrarenal IVC filter placement, is reported.

No smoking gun: findings from a national survey of office-based cosmetic surgery adverse event reporting.

Background: Because of recent press reports of adverse outcomes, office-based cosmetic surgery has come under intense scrutiny and associated legislative regulatory action.

Objective: To assess the safety of office-based cosmetic surgery through a national survey of state agencies that collect information on adverse patient outcomes.

Methods: Medical boards or other responsible authorities were contacted in 48 states to obtain records on adverse outcomes from cosmetic surgery procedures performed in an office-based setting.

Transesophageal echocardiography-guided closed aortic plication for intraoperative aortic dissection.

A 71-year-old female who developed intraoperative aortic dissection after coronary artery bypass grafting underwent a successful closed aortic plication with obliteration of the intimal tear under image guided transesophageal echocardiography.

Biventricular pacing for congestive heart failure: early experience in surgical epicardial versus coronary sinus lead placement.

Objective: Biventricular pacing (BVP) has recently been introduced for the treatment of refractory congestive heart failure. Coronary sinus lead placement for left ventricular pacing is technically difficult, has a risk of lead dislodgement, and has long procedure times. Surgical epicardial lead placement has the potential advantage of the visual selection of an optimal pacing site, does not need exposure to ionic radiation, and allows lead multiplicity, but it does require a thoracotomy and general anesthesia.

Delayed operative intervention in the management of traumatic descending thoracic aortic rupture.

Background: Outcomes may be improved by purposefully delaying surgical intervention of the traumatically ruptured descending thoracic aorta.

Methods: Fifty-seven patient records identified through the Trauma Registry of a level 1 trauma center between January 1993 and April 2002 were retrospectively analyzed between groups who underwent "clamp-and-sew" versus partial left heart bypass repair techniques and between emergent versus delayed repair.

Results: Thirty-two (56%) of 57 patients were male.