Bilateral versus single internal thoracic artery grafting in hemodialysis patients.

Background: The use of the bilateral internal thoracic arteries (BITAs) during myocardial revascularization reportedly provides a survival benefit over using a single internal thoracic artery (SITA). However, the advantages in chronic hemodialysis patients, who generally have multiple comorbidities, is unclear.

Methods: Outcomes of chronic hemodialysis patients who underwent isolated coronary artery bypass grafting (CABG) using a SITA with additional saphenous vein grafts (SVGs) (n = 33) or BITAs (n = 30) for left-side revascularization were retrospectively reviewed.

The long-term patency of a gastroepiploic artery bypass graft deployed in a semiskeletonized fashion: predictors of patency.

Objectives: Whether or not using the gastroepiploic artery (GEA) is associated with improved outcomes of coronary artery bypass grafting (CABG) remains unclear. Previous research has shown that the short-term function of the GEA was strongly associated with the degree of native vessel stenosis. We assessed the association between long-term GEA patency and the degree of stenosis of the coronary artery.

Ascending Aortic Aneurysm in a Child With Fibulin-4 Deficiency.

EFEMP2 (alias FBLN4) encodes extracellular matrix protein fibulin-4, and its mutation is associated with autosomal recessive cutis laxa type 1B and leads to severe aortopathy with aneurysm formation and vascular tortuosity. A 4-month-old child presented with a large ascending aortic aneurysm, and genetic testing revealed an EFEMP2 mutation. We achieved successful repair of the ascending aortic aneurysm at 33 months of age and report the macroscopic and microscopic findings.

Valve selection for the aortic position in dialysis patients.

Background: Prosthetic valve selection in dialysis patients remains controversial because of the limited data available. This study aimed to clarify late clinical outcomes and discuss strategies for optimal valve selection in dialysis patients.

Methods: We retrospectively analyzed the data obtained from 406 consecutive patients who underwent aortic valve replacement between 1995 and 2010.

Superior mesenteric artery plasty for type A acute aortic dissection with visceral ischemia.

Treatment of visceral ischemia complicated with acute type A aortic dissection is controversial. We had two cases of acute type A aortic dissection complicated by superior mesenteric artery (SMA) ischemia and successfully treated them with direct SMA perfusion during central aortic repair followed by SMA plasty. The presented procedures can be an option to treat visceral ischemia with a standard operative theater and equipment.

Mitral annular calcification in patients undergoing aortic valve replacement for aortic valve stenosis.

Limited data exis t on clinical relevance of aortic valve stenosis (AVS) and mitral annular calcification (MAC), although with similar pathophysiologic basis. We sought to reveal the prevalence of MAC and its clinical features in the patients undergoing aortic valve replacement (AVR) for AVS. We reviewed 106 consecutive patients who underwent isolated AVR from 2004 to 2010.

Recent risk factors for open surgical mortality in patients with ruptured abdominal aortic aneurysm.

Aim: We examined recent relevant prognostic factors for the outcome of open surgical treatment of ruptured abdominal aortic aneurysm.

Methods: Between 2006 and 2012, 35 patients received emergency open surgical treatment for ruptured abdominal aortic aneurysm at our institute. We reviewed ambulance activity logs and clinical records of 34 infrarenal ruptured abdominal aortic aneurysm patients retrospectively.

Impact of secondary hyperparathyroidism on ventricular mass regression after aortic valve replacement for aortic stenosis in hemodialysis-dependent patients.

In hemodialysis (HD)-dependent patients, secondary hyperparathyroidism induces cardiac hypertrophy. This study investigated whether parathyroid hormone (PTH) levels affect the degree of left ventricular (LV) mass regression in HD patients after aortic valve replacement (AVR) for aortic stenosis (AS). We retrospectively obtained preoperative and 2-year postoperative echocardiography and intact PTH measurements in 88 HD patients who underwent AVR, with bioprostheses (n = 35, 40%) and mechanical valves (n = 53, 60%) of effective orifice area >0.

Bad aorta.

As its outcomes improve, cardiac surgery has been performed on more and more cases which were previously considered to be difficult to deal with. However, there are still a number of problems to be solved regarding surgery on patients with severe sclerotic lesions in the ascending aorta, which we collectively call "bad aorta". Concerning a preoperative assessment of the ascending aorta, our report revealed no relationship between the severity of calcification detected with a preoperative non-enhanced CT and the aortic lesion found during the surgery.

Effects of the side of arteriovenous fistula on outcomes after coronary artery bypass surgery in hemodialysis-dependent patients.

Objective: The aim of the study was to determine whether using the in situ internal thoracic artery (ITA) graft ipsilateral to the arteriovenous fistula adversely affects the outcomes after isolated coronary artery bypass grafting (CABG) in the dialysis-dependent patients to answer the concerns of a possible steal and consequent myocardial ischemia.

Methods: We categorized 155 dialysis patients undergoing isolated CABG between January 1993 and December 2011 into 108 patients (70%, ipsilateral group) whose left anterior descending artery (LAD) was revascularized with the ITA ipsilateral to the arteriovenous fistula and 47 patients (contralateral group) whose LAD was grafted with the ITA opposite to the fistula, to compare their early and late outcomes.

Results: While 94% of the ipsilateral group had left fistula, 55% of the contralateral group had left fistulas.

Clinical validation of coronary artery flow through an intracoronary shunt during off-pump coronary artery bypass grafting.

Objectives: Intracoronary shunts have been developed for a bloodless field and preserved forward flow preventing ischemia during off-pump coronary artery bypass (OPCAB) surgery. However, reports directly measuring the forward flow through the shunt in clinical settings are lacking.

Methods: Using a 7.

Predictors for early and late outcomes after coronary artery bypass grafting in hemodialysis patients.

Background: Markedly higher hospital and long-term mortality after coronary artery bypass grafting (CABG) have been reported in hemodialysis (HD)-dependent patients. We tried to identify the predictors for short-term and long-term outcomes after CABG, which have not been well studied.

Methods: Between 1993 and 2010, 152 patients undergoing HD (117 men; HD duration of 8.

Can we predict the site of entry tear by computed tomography in patients with acute type a aortic dissection?

Background: In patients with acute type A aortic dissection (AAD), localization of the primary entry tear to be excluded is of major importance for intervention.

Hypothesis: There are reliable indirect computed tomography (CT) findings to predict the entry site.

Methods: In 83 patients with type A AAD whose primary entry tears were identified surgically between 2003 and 2009, we retrospectively examined the diagnostic CT scans regarding pericardial effusion, the largest short-axial diameter of the aorta, widths of true and false lumens, and false lumen thrombosis at 6 levels of thoracic aorta from the aortic root to the descending aorta.

Early and late outcomes of coronary artery bypass surgery versus percutaneous coronary intervention with drug-eluting stents for dialysis patients.

Background: Advances in percutaneous coronary intervention (PCI) using drug-eluting stents (DES) have impacted clinical practice. However, the efficacy of DES for dialysis patients still remains controversial. This study compares the early and long-term clinical outcomes of coronary artery bypass grafting (CABG) and PCI with DES in dialysis patients.

Long-term size follow-up of knitted Dacron grafts (Gelseal™) used in the ascending aorta.

There is limited information about the size change of a knitted Dacron graft (Gelseal™) used in the thoracic aorta. We evaluated the diameters of the Gelseal™ grafts at a long-term follow-up for 3.7 ± 1.

Early and late outcomes of aortic valve replacement in dialysis patients.

Background: Few data are available on the outcomes of aortic valve replacement (AVR) in dialysis patients. Valve selection has been controversial, and systemic calcification in these patients has been an important concern. This study reports our experiences and evaluates whether dialysis patients can be treated in a way that is similar to nondialysis patients.

Simplified management of hemodialysis-dependent patients undergoing cardiac surgery.

Background: The mortality and morbidity rates are high after cardiac surgery in hemodialysis (HD)-dependent patients. To improve their outcomes, optimal perioperative managements should be discussed.

Methods: A retrospective analysis of 245 HD patients who underwent cardiac surgery between 1994 and 2007 was conducted.

Transit-time flow characteristics of in situ right gastroepiploic arterial grafts in coronary artery bypass grafting.

Objective: We investigated flow characteristics of right gastroepiploic arterial grafts, widely used to extend in situ arterial conduits in coronary artery bypass grafting.

Methods: Intraoperative transit-time measurements and postoperative angiographic findings were obtained for 111 patients undergoing coronary artery bypass grafting with gastroepiploic artery and bilateral internal thoracic arteries: mean, maximum, and minimum flows; pulsatility index; insufficiency rate; and differentiated index of early diastolic flow.

Results: Favored target for gastroepiploic artery was posterior descending artery (106 patients, 95%).

Safer aortic crossclamping during short-term moderate hypothermic circulatory arrest for cardiac surgery in patients with a bad ascending aorta.

Objective: Cardiac surgery in patients with severely atherosclerotic or porcelain ascending aorta is technically challenging, with markedly increased risk of atheroembolism. We describe a technique of meticulous crossclamping of a difficult aorta during short-term moderate hypothermic circulatory arrest.

Methods: From 1997 to 2007, we found 40 patients (mean age, 70 +/- 8 years), including 14 patients undergoing hemodialysis, whose preoperative computed tomographic and intraoperative epiaortic ultrasonographic scans revealed eggshell calcification (n = 15) or protruding atheromas (n = 25) of the ascending aorta.

Near-infrared spectroscopy for noninvasive evaluation of chest wall ischemia immediately after left internal thoracic artery harvesting.

Objective: The conclusions remain controversial about whether the sternal blood flow is preserved or diminished after internal thoracic artery (ITA) harvesting for coronary artery bypass grafting (CABG), especially in diabetic patients. We investigated the blood supply of the chest wall noninvasively using near-infrared spectroscopy (NIRS) immediately after CABG.

Methods: The study group comprised 30 patients who underwent CABG using a skeletonized left ITA through median sternotomy.

Results of isolated valve replacement in hemodialysis patients.

Frequent bleeding complications and poor long-term results have been reported after valve replacement in hemodialysis patients. We use mainly bileaflet mechanical valves with low-dose warfarin therapy (target international normalized ratio, 1.8-2.

Learning curve of coronary surgery by a cardiac surgeon in Japan with the use of cumulative sum analysis.

Objective: Case-volume has been believed to be of paramount importance in becoming a good cardiac surgeon. However, for a training cardiac surgeon there is no evidence regarding the specific number of necessary cases to attain the medico-legally acceptable level. We attempted to observe the learning curve in performing coronary surgery with the use of the cumulative sum (CUSUM) method to provide some evidence.

Echocardiographic evaluation of internal mammary artery graft patency.

The feasibility of using transthoracic echocardiography to assess internal mammary artery graft patency and function was examined. Coronary angiography and transthoracic echocardiography was performed in 60 consecutive patients undergoing coronary artery bypass from April 2000 to March 2002. Flow velocity, velocity-time integral, and the ratio of the diastolic fraction of the velocity-time integral to total velocity-time integral were measured by doppler transthoracic echocardiography.