Prophylactic treatment with alkaline phosphatase in cardiac surgery induces endogenous alkaline phosphatase release.

Introduction: Laboratory and clinical data have implicated endotoxin as an important factor in the inflammatory response to cardiopulmonary bypass. We assessed the effects of the administration of bovine intestinal alkaline phosphatase (bIAP), an endotoxin detoxifier, on alkaline phosphatase levels in patients undergoing coronary artery bypass grafting.

Methods: A total of 63 patients undergoing coronary artery bypass grafting were enrolled and prospectively randomized.

Right atrial thrombus migrating to the superior vena cava during surgery.

Free-floating right heart thrombi are extremely mobile structures that carry a very high mortality rate. We describe a case of pulmonary embolism with a free-floating right heart thrombus that migrated to the superior vena cava during the institution of cardiopulmonary bypass.

Endotoxin release in cardiac surgery with cardiopulmonary bypass: pathophysiology and possible therapeutic strategies. An update.

Cardiac surgery with cardiopulmonary bypass provokes a systemic inflammatory response syndrome caused by the surgical trauma itself, blood contact with the non-physiological surfaces of the extracorporeal circuit, endotoxemia, and ischemia. The role of endotoxin in the inflammatory response syndrome has been well investigated. In this report, we reviewed recent advances in the understanding of the pathophysiology of the endotoxin release during cardiopulmonary bypass and the possible therapeutic strategies aimed to reduce the endotoxin release or to counteract the inflammatory effects of endotoxin.

Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population.

Background: Preoperative left ventricular dysfunction is an established risk factor for early and late mortality after revascularization. This retrospective analysis demonstrates the effects of preoperative ejection fraction on the short-term and long-term survival of patients after coronary artery bypass grafting.

Methods: Early and late mortality were determined retrospectively in 10 626 consecutive patients who underwent isolated coronary bypass between January 1998 and December 2007.

Preoperative atrial fibrillation and elevated C-reactive protein levels as predictors of mediastinitis after coronary artery bypass grafting.

Background: Mediastinitis is a serious complication after coronary artery bypass grafting (CABG). We studied the risk factors for the development of postoperative mediastinitis in a large group of patients who underwent isolated CABG at Catharina Hospital, Eindhoven, The Netherlands.

Methods: Data of all patients undergoing an isolated CABG between January 1998 and December 2008 were analyzed.

Effect of body mass index on early and late mortality after coronary artery bypass grafting.

Background: The effect of obesity on the long-term outcome after coronary artery bypass graft surgery (CABG) remains controversial. We analyzed data of patients undergoing CABG in a single center, to determine the predictive value of body mass index in combination with comorbidities on early and late mortality.

Methods: Early and late mortality of consecutive patients undergoing isolated CABG from January 1998 until December 2007 were determined.

Is the use of Steri-StripTM S for wound closure after coronary artery bypass grafting better than intracuticular suture?

Several methods have been used in wound closure after coronary artery bypass grafting (CABG). In this study, the safety and efficacy of one of these methods, Steri-Strip S is compared with the traditional intracuticular suture method. Eighty-one patients undergoing CABG were prospectively randomized into two groups according to the method of skin closure: Steri-Strip S group and traditional suture group.

Diabetes and survival after coronary artery bypass grafting: comparison with an age- and sex-matched population.

Objective: Long-term outcome after coronary artery bypass grafting is worse in diabetic than in non-diabetic patients. No data are currently available regarding survival rates of diabetic and non-diabetic patients after coronary revascularisation compared with cohorts from the general population in the Netherlands, which were matched for age and sex (normal Dutch survival).

Methods: We retrospectively analysed the data from 10626 patients who underwent coronary artery bypass grafting between January 1998 and December 2007.

Use of the Seldinger type movement over a J-shaped stylet for left ventricular vent insertion.

Access through the right superior pulmonary vein is a commonly used route for left ventricular vent insertion. Complex reshaping of the stylet and vent into a certain position or external guidance do not guarantee successful placement. In this article we describe a modified technique where the stylet sets up the position to allow consistent atraumatic advancement of the catheter across the mitral valve.

Transfusion of red blood cells: the impact on short-term and long-term survival after coronary artery bypass grafting, a ten-year follow-up.

Transfusion of red blood cells (RBC) and other blood products in patients undergoing coronary artery bypass grafting (CABG) is associated with increased mortality and morbidity. We retrospectively analyzed data of patients who underwent an isolated coronary bypass graft operation between January 1998 and December 2007. Mean follow-up was 1696+/-1026 days, with exclusion of 122 patients lost to follow-up and 80 patients who received 10 units of RBC.

Risk factors for deterioration of renal function after coronary artery bypass grafting.

Objective: Various definitions of impairment of renal function after coronary artery bypass grafting (CABG) are used in the literature. Depending on the definition, several risk factors are identified. We analysed our data to determine the risk factors for postoperative deterioration of the creatinine clearance of 10% or more.

Preoperative C-reactive protein levels to predict early and late mortalities after coronary artery bypass surgery: eight years of follow-up.

Objective: There is limited evidence that increased preoperative levels of C-reactive protein are associated with increased mortality after coronary artery bypass grafting. We retrospectively investigated in 5669 patients the predictive value of preoperative C-reactive protein levels for early and late mortalities after coronary artery bypass grafting.

Methods: Patients undergoing isolated coronary artery bypass grafting between January 2000 and December 2007 (n = 8500) were studied.

Preoperative renal function as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population.

Objective: Preoperative renal dysfunction is an established risk factor for early and late mortality after revascularization. We studied how renal function affects long-term survival of patients after coronary artery bypass grafting.

Methods: Early and late mortality were determined retrospectively among consecutive patients having isolated coronary bypass at a single Dutch institution between January 1998 and December 2007.

Postoperative blood loss in patients undergoing coronary artery bypass surgery after preoperative treatment with clopidogrel. A prospective randomised controlled study.

Objective: The optimal timing for discontinuation of clopidogrel before surgery remains under debate. The purpose of this study is to determine the effect of preoperative clopidogrel administration on postoperative blood loss and the total requirements of homologous blood products after coronary artery bypass grafting (CABG). We also evaluated the perioperative complications.

Preoperative hemoglobin level as a predictor of survival after coronary artery bypass grafting: a comparison with the matched general population.

Background: The predictive value of the preoperative hemoglobin value after coronary artery bypass grafting (CABG) has not been well established. We studied how the preoperative hemoglobin level affects the survival of patients after CABG. Late mortality was compared with that of a general population.

Anti-inflammatory effects of alkaline phosphatase in coronary artery bypass surgery with cardiopulmonary bypass.

Laboratory and clinical data have implicated endotoxin as an important factor in the inflammatory response to cardiopulmonary bypass. Alkaline phosphatase prevents endotoxin-induced systemic inflammation in animals and humans. We assessed the effects of the administration of bovine intestinal alkaline phosphatase on surgical complications in patients undergoing coronary artery bypass grafting.

Long-term results of coronary artery bypass grafting in patients with left ventricular dysfunction.

Background: In this prospective study, we investigated the determinants of long-term outcome, symptoms, and left ventricular function after coronary artery bypass grafting in patients with a moderate to severely decreased left ventricular ejection fraction.

Methods: Between 1997 and 1998, 75 consecutive patients with moderate to severe left ventricular dysfunction underwent coronary artery bypass grafting procedures. The operative mortality rate was 4.

Resection of a lipomatous hypertrophic interatrial septum involving the right ventricle.

Lipomatous hypertrophy of the interatrial septum is a rare cardiac lesion that is usually limited to the interatrial septum. We report a case of an extensive lipomatous hypertrophy, which protruded into the right and the left atrium as well as the superior and the inferior vena cava and the right ventricle. A 71-year-old woman was referred to us because of a cardiac mass on a transthoracic echocardiogram, performed on a routine check-up because of a known membranous ventricular septum defect.

Cardiac tamponade: an unusual, lifethreatening complication after transhiatal resection of the esophagus.

Transhiatal resection for carcinoma of the distal esophagus is associated with relative high morbidity and mortality. We present a rare case of cardiac tamponade after transhiatal esophagectomy for which emergency sternotomy was performed. Probably the retraction of the heart during exploration of the mediastinum caused a laceration of an epicardial vein.

Does stenosis severity of native vessels influence bypass graft patency? A prospective fractional flow reserve-guided study.

Background: After coronary bypass surgery, occlusion or narrowing of bypass grafts may occur over time. The present study prospectively evaluated the angiographic patency of bypass grafts after 1 year in relation to the preoperative angiographic and functionally severity of the coronary lesion assessed by fractional flow reserve measurement to test the hypothesis that grafting of less critical stenosis may be a risk factor for early dysfunction of the graft.

Methods: The study comprised 164 patients eligible for coronary artery bypass surgery who were not suitable for percutaneous intervention and with at least one intermediate lesion.

Surgical treatment of bilateral aneurysmal coronary to pulmonary artery fistulas associated with severe atherosclerosis.

A 39-year-old diabetic patient with an old inferior wall infarction presented with disabling angina pectoris, despite medical treatment. Coronary angiography showed severe triple-vessel coronary artery disease, and bilateral coronary to pulmonary fistulas originating from the right coronary artery and the left anterior descending coronary artery. Both coronary artery saphenous vein bypass grafting and ligation of the fistulas was performed.

Platelet-rich plasma preparation using three devices: implications for platelet activation and platelet growth factor release.

Background: In this study, three commercial systems for the preparation of platelet-rich plasma (PRP) were compared and platelet growth factors release was measured.

Methods: Ten healthy volunteers donated whole blood that was fractionated by a blood cell separator, and a table-top centrifuge to prepare PRP. Furthermore, an autologous growth factor filter was used to concentrate PRP fractionated by the blood cell separator.

Platelet-rich plasma and platelet gel: a review.

Strategies to reduce blood loss and transfusion of allogeneic blood products during surgical procedures are important in modern times. The most important and well-known autologous techniques are preoperative autologous predonation, hemodilution, perioperative red cell salvage, postoperative wound blood autotransfusion, and pharmacologic modulation of the hemostatic process. At present, new developments in the preparation of preoperative autologous blood component therapy by whole blood platelet-rich plasma (PRP) and platelet-poor plasma (PPP) sequestration have evolved.

Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial.

Objectives: The long-term (five-year) comparative results of treatment of multivessel coronary artery disease with stenting or coronary artery bypass grafting (CABG) is at present unknown.

Background: The Arterial Revascularization Therapies Study (ARTS) was designed to compare CABG and stenting in patients with multivessel disease.

Methods: A total of 1,205 patients with the potential for equivalent revascularization were randomly assigned to CABG (n = 605) or stent implantation (n = 600).