Operative strategies to reduce cerebral embolic events during on- and off-pump coronary artery bypass surgery: A stratified, prospective randomized trial.

Objective: To determine the impact of different aortic clamping strategies on the incidence of cerebral embolic events during coronary artery bypass grafting (CABG).

Methods: Between 2012 and 2015, 142 patients with low-grade aortic disease (epiaortic ultrasound grade I/II) undergoing primary isolated CABG were studied. Those undergoing off-pump CABG were randomized to a partial clamp (n = 36) or clampless facilitating device (CFD; n = 36) strategy.

Avoiding aortic clamping during coronary artery bypass grafting reduces postoperative stroke.

Objective: The purpose of this study was to determine whether the incidence of postoperative stroke could be reduced by eliminating aortic clamping during coronary artery bypass grafting.

Methods: From 2002 to 2013, 12,079 patients underwent primary, isolated coronary artery bypass grafting at a single US academic institution. Aortic manipulation was completely avoided by using in situ internal thoracic arteries for inflow in 1552 patients (12.

A review of cardiac transplantation.

Perioperative anesthetic management for cardiac transplantation is reviewed. Recent developments in adult cardiac transplantation are noted. This review includes demographics and historical results, recipient and donor selection and evaluation, mechanical circulatory support and heart transplantation techniques, and patient management immediately postimplantation.

An argument for routine ultrasound screening of the thoracic aorta in the cardiac surgery population.

Stroke and neurological injury are among the most devastating and disabling complications associated with cardiac surgery. Transesophageal echocardiography and epiaortic ultrasound allow for sensitive, point-of-care diagnosis of thoracic aortic disease, which is especially common in patients with heart disease. Unlike other operative procedures, the manipulation of the ascending aorta is routine in cardiac surgery and often unavoidable.

Training in perioperative echocardiography.

Purpose Of Review: Echocardiography has been used perioperatively as an important diagnostic tool since the 1980s. Introduction of this new technique has been beneficial to our practice, but has also introduced questions and issues related to methods of teaching, requirements for demonstration of competence and testing and certification processes as evidence of satisfactory completion of necessary learning parameters. This article will review the issues presented to date, how they have been addressed, and what options could be arriving in the future.

The use of the SonoSite ultrasound device for intraoperative evaluation of the aorta.

Objective: Neurologic complications remain a significant cause of morbidity and mortality in cardiac surgery. Risk factors for neurologic injuries include the presence of atheromatous disease in the aorta. Epiaortic ultrasound has been shown to be superior in detecting the extent and location of atheromatous disease.

An unusual cause of left ventricular outflow tract obstruction after mitral valve repair.

Left ventricular outflow tract (LVOT) obstruction caused by systolic anterior motion is a cause of failed mitral valve repair. Intraoperative transesophageal echocardiography has been very helpful in diagnosing problems with mitral valve repairs intraoperatively, allowing immediate correction. We report an unusual cause of LVOT obstruction attributed to prolapse of the annuloplasty ring into the LVOT.