Impact of an Enhanced Recovery after Surgery Protocol on Postoperative Outcomes in Cardiac Surgery.

Enhanced recovery after surgery (ERAS) protocols are perioperative care pathways designed to achieve early recovery after procedures. ERAS protocols have shown shortened recovery time, and lower opioid utilization and postoperative complication rates. Evidence to support the use of ERAS protocols is robust, however, minimal data exists in cardiac surgery patients.

Transxiphoid Revascularization of the Anterior Descending Coronary Artery with the Left Mammary Artery.

Revascularization of the coronary arteries, via open sternotomy and on cardiopulmonary bypass, remains the most common cardiac surgical procedure in the United States. Patients, and cardiologists, seek an alternative to dividing the sternum while reaping the advantages of left internal mammary artery (LIMA) revascularization of the diseased left anterior descending (LAD) coronary artery. We describe a strictly transxiphoid mammary artery liberation with anastomosis to the anterior descending (TRAX CABG) without sternal division.

Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve.

Objective: Reoperative sternotomy to address mitral valve pathology carries substantial risk, especially with patent bypass grafts or an aortic valve prosthesis. We previously reported our early experience with minimally invasive right thoracotomy and peripheral cannulation as an alternative strategy, and we recently reviewed our cumulative 15-year hospital outcomes with this approach.

Methods: Between June 1996 and April 2010, we performed right minithoracotomy for reoperations involving the mitral valve on 167 patients, 85 (51%) of these since 2006.

Combined minimally invasive mitral valve repair and direct coronary artery bypass: a new alternative to sternotomy.

A case is presented in which significant single-vessel coronary artery disease and severe mitral valve regurgitation were successfully managed using combined minimally invasive direct coronary artery bypass and mitral valve repair. Although the management of coronary artery disease with simultaneous mitral valve disease has traditionally been approached using a median sternotomy, this combined minimally invasive approach led to a successful outcome and may serve as an alternative methodology for patients who are appropriate candidates.