The role of inflammation biomarkers in carotid artery stenosis procedures.

Background: Carotid revascularization procedures, such as carotid endarterectomy (CEA) and carotid artery stenting (CAS), can lead to restenosis. Monitoring restenosis onset through biomarkers is crucial in clinical practice. This study aimed to evaluate inflammation biomarkers in CEA and CAS to determine their predictive value for restenosis risk postprocedure.

Double Valve Failure Due to Perceval Sutureless Aortic Valve Migration.

A 76-year-old woman was admitted to the authors' hospital with pulmonary edema five months after the successful implantation of a Perceval sutureless aortic valve (Sorin Group Srl, Saluggia, Italy). Both echocardiography and computed tomography scanning demonstrated migration of the aortic valve into the left ventricle, causing severe aortic and mitral (secondary) insufficiency. Following heart team discussions, the sutureless valve was replaced with a standard bioprosthesis (Perimount, Magna Ease; Edwards Lifesciences, Irvine, California, USA) with spontaneous restoration of native mitral valve competence.

An Integrated Approach to von Willebrand Disease and Surgical Myocardial Revascularization.

Cardiac surgery in patients with preexisting bleeding disorders can be a challenge. Cardiopulmonary bypass can lead to bleeding disorders, above all in patients with coagulopathy. We report the case of a 42-year-old woman, with type I von Willebrand disease, who underwent off-pump coronary artery bypass grafting.

Continuous coronary sinus perfusion reverses ongoing myocardial damage in acute ischemia.

Acute cardiogenic shock or cardiac arrest (CS/CA) before cardiopulmonary bypass (CPB) installation are life-threatening events in acute coronary syndromes. We evaluated whether continuous retrograde warm-blood perfusion(CRWBP) before aortic cross-clamping (ACC),with immediate CPB installation may improve hospital results in these dreadful events. Hospital outcome of 18 coronary artery bypass grafting (CABG) (Group A) with CS/CA before CPB, with immediate CPB installation and CRWBP,has been compared with 24 CABG (Group B) with CS/CA undergoing only immediate CPB installation.

In vivo functional flowmetric behavior of the radial artery graft: is the composite Y-graft configuration advantageous over conventional aorta-coronary bypass?

Introduction: Intraoperative flowmetric results of different configurations (Y-graft or aorta-coronary) of radial artery grafts have been poorly investigated.

Methods: We report the results of an observational study designed to analyze transit-time flow measurements at baseline and during 1:1 intra-aortic balloon pumping in 114 consecutive patients receiving the radial artery as a aorta-coronary bypass (group A, 72 patients) or as a Y-graft with the left internal thoracic artery (group B, 42 patients). Graft flow reserve, recruited by 1:1 intra-aortic balloon pumping) greater than 1 indicated recruitment of surplus graft flow.

Neurohormonal and echocardiographic results after CorCap and mitral annuloplasty for dilated cardiomyopathy.

Background: Restrictive mitral annuloplasty (RMA) can be an effective treatment for functional mitral regurgitation in congestive heart failure (CHF). Passive cardiac restraint is another surgical approach, but the midterm results are not well characterized.

Methods: Thirty patients with functional mitral regurgitation were prospectively randomized to RMA alone or cardiac restraint with the CorCap Cardiac Support Device (Acorn Cardiovascular Inc, St.

Successful surgical treatment of chronic ischemic mitral regurgitation achieves left ventricular reverse remodeling but does not affect right ventricular function.

Objective: To evaluate left-sided and right-sided heart echocardiographic results after restrictive mitral annuloplasty in chronic ischemic mitral regurgitation.

Methods: Left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular ejection fraction, left ventricular indexed mass, coaptation depth, transmitral mean gradient, systolic pulmonary arterial pressure, tricuspid annular plane systolic excursion, right ventricular ejection fraction, and tricuspid insufficiency grading were evaluated preoperatively, postoperatively, at 6 months, and at the end of the follow-up period in 64 patients undergoing restrictive mitral annuloplasty and coronary artery bypass grafting. Recurrence of chronic ischemic mitral regurgitation was defined as 2+/4+ grade or greater mitral regurgitation at any time postoperatively.

Intraoperative bypass graft flow in intra-aortic balloon pump-supported patients: differences in arterial and venous sequential conduits.

Background: The intra-aortic balloon pump is used worldwide as an anti-ischemic strategy. However, little is known about the modifications of the graft flowmetry during use of intra-aortic balloon pump.

Methods: An observational study aimed at analyzing transit-time flow measurements during 1:1 intra-aortic balloon pump use and during its cessation in 138 consecutive patients using intra-aortic balloon pump before coronary artery bypass grafting (n = 442 graft segments) was reported.

Radial artery achieves better flowmetric results than saphenous vein in the elderly.

Due to the limited life expectancy and the supposed higher morbidity with complete arterial grafting, extensive arterial graft in the elderly is still questioned. It was the aim of this study to evaluate transit time flow and clinical, biochemical and echocardiographic results of elderly patients undergoing coronary artery bypass grafting (CABG) with either saphenous vein (SV) or radial artery (RA) employed as the second conduit of choice. The present study evaluates clinical and flowmetric results of a prospective series of elderly patients (>or=70 years old) undergoing RA CABG (75 patients, Group A) or SV CABG (163 patients, Group B) during isolated myocardial revascularization, performed either off-pump (OPCABG) and on-pump during the last 5 years at a single academic institution (between January 2003 and December 2007).

Radial artery graft flowmetry is better than saphenous vein on postero-lateral wall.

Background: Although general agreement exists on internal mammary graft as the first conduit, the second choice is still questioned. Despite radial artery (RA) grafting has been suggested, saphenous veins (SV) continue to be extensively used.

Methods: A prospective series of isolated RA-CABG (150 patients) or SV-CABG (180 patients), performed either off-pump (OP-CABG) and on-pump (CPB-CABG), in diabetics and non-diabetics, in elderly and young patients, during the last 5-years at a single institution were evaluated.

Intra-aortic balloon pump-induced pulsatile flow reduces coagulative and fibrinolytic response to cardiopulmonary bypass.

The aim of this study is to evaluate if a simple intra-aortic balloon pump (IABP)-induced pulsatile perfusion reduces activation of coagulative system during cardiopulmonary bypass (CPB). Ninety-six patients undergoing preoperative IABP were randomized to nonpulsatile CPB with IABP discontinued during cardioplegic arrest (Group A) or IABP-induced pulsatile CPB (Group B). White blood cells (WBC), hematocrit (Ht), platelets (PLTs), International Normalized Ratio (INR), fibrinogen, activated partial thromboplastin time (aPTT), antithrombin III (AT-III) activity, and D-dimer were measured at the end of surgery (ES) and postoperatively.

Troponin I and lactate from coronary sinus predict cardiac complications after myocardial revascularization.

Background: Postoperative troponin I and lactate elevation are related to cardiac complications after myocardial revascularization. We sought to evaluate earlier predictive value for acute myocardial infarction (AMI) and myocardial damage of troponin I and lactate after myocardial revascularization.

Methods: In all, 183 consecutive isolated myocardial revascularizations were prospectively enrolled in the study.

Surgical treatment of coronary-to-pulmonary fistula: how and when?

Coronary arteriovenous fistulas (CAVF) are rare malformations. Opinions vary on which operation should be offered to these patients, particularly those asymptomatic. We report four patients operated on for CAVF referred to our institution over the course of a year.

Intraaortic balloon pumping during cardioplegic arrest preserves lung function in patients with chronic obstructive pulmonary disease.

Background: Linear flow during cardiopulmonary bypass is considered a potential mechanism of lung damage in patients with chronic obstructive pulmonary disease (COPD). We evaluated differences in lung function of patients with COPD undergoing preoperative intraaortic balloon pumping (IABP), between linear flow during cardiopulmonary bypass (IABP-off) and maintenance of pulsatile flow (IABP-on at automatic 80 bpm) during cardioplegic arrest.

Methods: Fifty patients with COPD undergoing preoperative IABP were randomized between January 2004 and July 2005 to receive nonpulsatile cardiopulmonary bypass with IABP discontinued during cardioplegic arrest (25 patients; group A), or IABP-induced pulsatile cardiopulmonary bypass (25 patients; group B).

Can harvesting techniques modify postoperative results of the radial artery conduit?

Background: Inappropriate harvesting of arterial conduits can lead to severe postoperative complications. We analyzed clinical and functional results of patients undergoing radial artery (RA) harvesting by means of three techniques.

Methods: From January 2001 to January 2004 188 patients undergoing coronary artery bypass graft with RA were divided into three groups: harmonic scalpel was employed in 61 (RA1), electrocautery in 63 (RA2), Potts-scissors and clips in 64 (RA3) patients.

Should we discontinue intraaortic balloon during cardioplegic arrest? Splanchnic function results of a prospective randomized trial.

Background: Preoperative use of intraaortic balloon pumping (IABP) has increased in high-risk patients. Linear flow during cardiopulmonary bypass (CPB) can induce subclinical damage, whereas automatic IABP mode may maintain pulsatile flow. We sought to evaluate differences between suspending IABP and switching it to an automatic 80 bpm mode during cardioplegic arrest.

Determinants and prognosis of myocardial damage after coronary artery bypass grafting.

Background: Myocardial infarction remains a devastating complication after coronary revascularization. Although electrocardiography (ECG) and echocardiography suggest transmural infarction, myocardial damage and the quality of myocardial protection are not recognized unless troponin I (TnI) is assessed. Determinants and prognosis of TnI elevation after coronary artery bypass grafting (CABG) were evaluated.