Efficacy and safety of early parenteral anticoagulation as a bridge to warfarin after mechanical valve replacement.

Limited evidence exists to guide the use of early parenteral anticoagulation following mechanical heart valve replacement (MVR). The purpose of this study was to compare the 30-day rates of thrombotic and bleeding complications for MVR patients receiving therapeutic versus prophylactic dose bridging regimens. In this retrospective cohort study we reviewed anticoagulation management and outcomes of all patients undergoing MVR at five Canadian hospitals between 2003 and 2010.

Isoprostanes constrict human radial artery by stimulation of thromboxane receptors, Ca2+ release, and RhoA activation.

Objectives: Radial artery vasospasm remains a potential cause of early graft failure after coronary bypass graft surgery, despite pretreatment with alpha-adrenergic or calcium channel blockers. We examined the roles of isoprostanes and prostanoid receptors selective for thromboxane A2 in the vasoconstriction of human radial arteries.

Methods: Human radial arterial segments were pretreated intraoperatively with verapamil/papaverine or nitroglycerine/phenoxybenzamine, or not treated.

Does the number of grafts influence surgeon choice and patient benefit of off-pump over conventional on-pump coronary artery revascularization in multivessel coronary artery disease?

Background: It is not known whether surgeons preferentially assign patients requiring fewer grafts (1 to 3) to off-pump coronary artery bypass graft surgery (OPCABG) and those requiring many grafts (4 to 7) to conventional on-pump coronary artery bypass graft surgery (ONCABG), nor whether risk-adjusted outcomes are similar for OPCABG and ONCABG among patients receiving 1 to 3 and 4 to 7 grafts.

Methods: Emory Hospitals' prospective database was retrospectively reviewed for 11,413 consecutive, isolated, primary coronary revascularization procedures between January 1997 and May 2005. Patients were divided into four groups: OPCABG 1 to 3 grafts (n = 3,187), OPCABG 4 to 7 grafts (n = 1,305), ONCABG 1 to 3 grafts (n = 3,279), and ONCABG 4 to 7 grafts (n = 3,642).

Off-pump coronary artery bypass grafting through sternotomy: for whom?

Purpose Of Review: Off-pump coronary artery bypass grafting hopes to avoid morbidity associated with cardiopulmonary bypass, improving clinical outcomes. Yet its technical difficulty and unfamiliarity raise concern that adoption of off-pump coronary artery bypass might be associated with poorer outcomes. Both surgeon-specific and patient-related factors are believed to play roles in the success of off-pump coronary artery bypass.

Pulse low dose steroids attenuate post-cardiopulmonary bypass SIRS; SIRS I.

Background: Cardiopulmonary bypass (CPB) initiates inflammation that contributes to multiorgan dysfunction (SIRS). Steroids have been demonstrated to attenuate this response; however, resistance to use steroids remains because of potential adverse effects of the high doses used. This study examines a lower dose steroid protocol for safety and attenuation of SIRS.

Determination of troponin I release after CABG surgery.

Background: Troponin I is used to diagnose myocardial infarction (MI). Its use and pattern of elevation is not well defined in coronary artery bypass graft (CABG) surgery. This study assessed the timing of troponin I elevation in patients undergoing urgent CABG.

The effect of oxygenator membranes on blood: a comparison of two oxygenators in open-heart surgery.

Open-heart surgery (OHS) requires cardiopulmonary bypass (CPB) in most patients. Membrane oxygenators are a critical component of the CPB system. Despite advancements in CPB technology, injury to blood components during CPB still occurs and may result in complications after surgery.