Effects of off-pump coronary artery bypass grafting on patient outcome.

Background: Cardiopulmonary bypass (CPB) is associated with postoperative myocardial stunning, hypothermia, formation of microemboli, and systemic inflammatory response syndrome, all of which may prolong recovery from coronary artery bypass grafting (CABG) surgery. This study sought to compare outcomes in patients undergoing CABG off pump versus on pump.

Methods: Outcomes, including mortality and several morbidities, were reviewed in 1,623 on-pump patients and 683 off-pump patients.

Evaluation of the practice of routine culturing of native valves during valve replacement surgery.

Background: We routinely cultured native heart valves removed during valve replacement surgery even when infected carditis (IE) was not suspected. Several probable contaminated cultures prompted us to evaluate this practice.

Methods: The medical records of all patients who had positive valve cultures from 1995 to 1997 were reviewed for admission diagnoses, operative surgery, pathology and microbiology report, postoperative infections, and antibiotic use.

Radial artery use in bypass grafting does not change digital blood flow or hand function.

Background: Patient selection criteria have not been clearly established for use of the radial artery as a bypass conduit. To help establish such criteria, we measured changes in digital blood flow and hand function after radial artery removal.

Methods: Ninety-eight patients of the first 122 consecutive patients considered for radial artery harvest met predetermined criteria by vascular noninvasive studies to undergo removal of the radial artery.

Coronary artery bypass without cardiopulmonary bypass.

The purpose of this article is twofold: to describe our technique for performing coronary artery bypass grafting without cardiopulmonary bypass (off pump) and to demonstrate that this operation is safe, in terms of mortality and certain indices of morbidity. Very little has been published in regard to off-bypass operations. From 1985 through 1990, 220 patients underwent operation off bypass; 220 on-pump controls were retrospectively matched for number of grafts, left ventricular function, and date of operation.

Automatic implantable cardioverter-defibrillator: is early implantation cost-effective?

The evaluation of survivors of sudden cardiac death with serial electrophysiologic studies involves a lengthy and expensive hospitalization, especially when an automatic implantable cardioverter-defibrillator is ultimately necessary. The cost efficacy of this conventional approach was therefore compared with direct implantation of a cardioverter-defibrillator after the first electrophysiologic study. Thirty-two survivors of sudden death who had inducible ventricular tachycardia during their initial electrophysiologic study underwent serial drug trials.