Early administration of clopidogrel is safe after off-pump coronary artery bypass surgery.

Background: Patients who undergo off-pump coronary artery bypass graft surgery (OPCAB) may be hypercoagulable with an increased risk of graft thrombosis due to the lack of platelet dysfunction that accompanies "on-pump" surgery. Clopidogrel may be indicated in these patients to prevent recurrent ischemic events. The purpose of this observational study was to determine the safety of early clopidogrel administration after OPCAB.

Incidence of deep sternal wound infections after tracheostomy in cardiac surgery patients.

Background: Tracheostomy after median sternotomy is associated with an increased risk of deep sternal wound infection (DSWI). However, associated comorbidities in these patients make the exact risk of tracheostomy difficult to discern. Therefore, we performed a retrospective review to determine the risk of DSWI in our cardiac surgery patients who underwent postoperative tracheostomy.

Intraoperative radiofrequency ablation for the treatment of atrial fibrillation during concomitant cardiac surgery.

Background: Radiofrequency ablation has been recently introduced as an alternative to the surgical maze procedure to eliminate atrial fibrillation (AF). The purpose of this study was to examine the effectiveness of unipolar radiofrequency ablation in patients with AF undergoing open heart surgery.

Methods: A retrospective review was performed on 54 patients undergoing radiofrequency ablation with concomitant cardiac operations from March 2002 through July 2003.

Emergency coronary artery bypass grafting can be performed safely without cardiopulmonary bypass in selected patients.

Background: Patients requiring emergency surgical revascularization are often not considered for off-pump coronary artery bypass grafting (OPCAB).

Methods: From 1996 to 2003, 614 patients underwent emergency coronary artery bypass grafting (Society of Thoracic Surgeons definition) at an academic institution. Forty-four (7%) of these procedures were performed without cardiopulmonary bypass, while 570 were conventional coronary artery bypass procedures with cardiopulmonary bypass (CABG/CPB).

Outcomes and long-term survival for patients undergoing mitral valve repair versus replacement: effect of age and concomitant coronary artery bypass grafting.

Background: A paucity of literature is available on the effects of age and coronary artery bypass grafting (CABG) on the outcomes of patients undergoing mitral valve (MV) repair versus replacement.

Methods And Results: A matched study was performed using prospectively collected data from the Emory cardiovascular database from 1984 to 1997 comparing 625 MV repair patients with 625 MV replacement patients. Mean age was significantly higher in the replacement group (56+/-14 versus 55+/-14 years).

The Carbomedics Top Hat supraannular aortic valve: a multicenter study.

Background: Introduced in 1993, the Carbomedics Top Hat (Sulzer, Carbomedics, Austin, TX) valve is a bileaflet mechanical aortic prosthesis designed to be placed in a supraannular position. Five institutions pooled their clinical experiences to evaluate early outcome in patients with this prosthesis.

Methods: From 1994 to 2000, 639 patients underwent aortic valve replacement with Top Hat (Sulzer Carbomedics) valves at 5 institutions.

Perfusion-assisted direct coronary artery bypass provides early reperfusion of ischemic myocardium and facilitates complete revascularization.

Background: Perfusion-assisted direct coronary artery bypass (PADCAB) was developed to initiate early reperfusion of grafted coronary artery segments during off-pump operations to resolve episodes of myocardial ischemia and avoid its sequelae. This case series outlines intraoperative findings and clinical outcomes of our first year clinical experience with PADCAB.

Methods: From November 1999 to November 2000, 169 PADCAB and 358 off-pump coronary artery bypass procedures were performed at the Emory University Hospitals.

Twenty-year survival after coronary artery surgery: an institutional perspective from Emory University.

Background: Coronary artery bypass graft (CABG) surgery has been performed frequently for symptomatic coronary atherosclerotic heart disease for more than 30 years. However, uncertainty exists regarding the relationship between long-term survival after CABG and readily available clinical correlates of mortality.

Methods And Results: We studied outcome at 20 years by age, sex, and other variables in 3939 patients who had CABG surgery from 1973 to 1979 in the Emory University System of Healthcare.

Outcomes of repeat revascularization in diabetic patients with prior coronary surgery.

Objectives: This study evaluated both short- and long-term outcomes of diabetic patients who underwent repeat coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) after initial CABG.

Background: Although diabetic patients who have multivessel coronary disease and require initial revascularization may benefit from CABG as compared with PCI, the uncertainty concerning the choice of revascularization may be greater for diabetic patients who have had previous CABG.

Methods: Data were obtained over 15 years for diabetic patients undergoing PCI procedures or repeat CABG after previous coronary surgery.

Valve replacement in patients on chronic renal dialysis: implications for valve prosthesis selection.

Background: Reports are sparse describing heart valve replacement in patients with end-stage renal disease. This review assesses a 15-year experience and outcomes after valve replacement in patients on chronic preoperative renal dialysis.

Methods: A computerized database, hospital records, and telephone contact provided outcome data for patients on chronic dialysis undergoing valve replacement between March 22, 1985, and October 13, 2000, in two hospitals.