Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump: a randomized controlled trial.

Background: Perioperative corticosteroid use may reduce acute kidney injury. We sought to test whether methylprednisolone reduces the risk of acute kidney injury after cardiac surgery.

Methods: We conducted a prespecified substudy of a randomized controlled trial involving patients undergoing cardiac surgery with cardiopulmonary bypass (2007-2014); patients were recruited from 79 centres in 18 countries.

Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial.

Background: Cardiopulmonary bypass initiates a systemic inflammatory response syndrome that is associated with postoperative morbidity and mortality. Steroids suppress inflammatory responses and might improve outcomes in patients at high risk of morbidity and mortality undergoing cardiopulmonary bypass. We aimed to assess the effects of steroids in patients at high risk of morbidity and mortality undergoing cardiopulmonary bypass.

Analysis of ascending and transverse aortic arch repair in octogenarians.

Background: Increasing numbers of older patients are requiring complex thoracic aortic surgery. This retrospective study analyzed early and late outcomes after ascending and transverse arch surgery using hypothermic circulatory arrest (HCA).

Methods: Between January 1991 and December 2006, 779 patients requiring HCA were treated.

Intimo-intimal intussusception of the aorta.

A 50-year-old man presented with acute onset of chest pain. Subsequent transesophageal echocardiography and computed tomography scan showed absence of a flap in the ascending aorta and a clear dissection flap involving the arch and descending aorta. Magnetic resonance imaging showed a tear and a small flap in the right coronary sinus.

Management of a large bronchopleural fistula using a tracheobronchial stent.

Bronchopleural fistula, one of the most serious complications following pneumonectomy, has a complicated treatment protocol and carries a high mortality rate. We present a case report of a 75-year-old female with squamous cell carcinoma of the lower lobe with positive peribronchial hilar nodes who underwent a right pneumonectomy. She represented with a large bronchopleural fistula one month postoperatively, eventually treated by a novel tracheobronchial stenting procedure.

Large retrosternal goitre: a diagnostic and management dilemma.

A substernal goitre is of clinical significance because its growth between the sternum anteriorly and vertebral bodies posteriorly leads to impingement on the surrounding structures and compressive symptoms. The incidence of substernal goitre is documented to vary between .02 and .

Coronary artery bypass surgery in undiagnosed traumatic pericardial rupture--25 years later.

A 55-year-old man was electively admitted for coronary artery bypass surgery. His admission chest X-ray showed an abnormal cardiac silhouette with complete leftward displacement. He had a past history of blunt thoracic trauma due to a motor vehicle accident treated conservatively.

Factors influencing the mean postoperative gradients across stentless porcine valves.

Background: To study the preoperative and intraoperative variables influencing the mean post-operative transvalvular gradient across stentless porcine valves.

Methods: From 1995 to 2002, 84 patients underwent stentless valve insertion. The mean age was 73 years, and 63% were male.

Patency of the radial artery graft: angiographic study in 209 symptomatic patients operated between 1995 and 2002 and review of the current literature.

Objectives: The purpose of this study is to define the long-term patency of the radial artery (RA) graft and review the current literature.

Methods: Two hundred and eighty-six RA symptom-directed graft angiograms were studied in 209 patients. The preoperative patient characteristics and intraoperative variables were collected prospectively from patients who had primary coronary artery bypass grafting between 1995 and 2002.

Clopidogrel and bleeding after coronary artery bypass graft surgery.

Background: There is evidence that clopidogrel (with or without aspirin) confers superior outcomes in patients with coronary artery disease. The purpose of this study is to review the effect of preoperative clopidogrel administration on clinical outcome, bleeding complications and resource utilization after coronary artery bypass graft surgery.

Methods: Patient data were prospectively collected from 919 patients who had isolated coronary surgery during the period 2000 to 2003.

Has the in situ right internal thoracic artery been overlooked? An angiographic study of the radial artery, internal thoracic arteries and saphenous vein graft patencies in symptomatic patients.

Objective: The right internal thoracic artery is being used infrequently despite favorable observational angiographic data. Conversely, the radial artery utilization has increased with only limited data available. The purpose of this paper is to re-evaluate the roles of the right internal thoracic artery and the radial artery grafts.

Factors affecting patency of internal thoracic artery graft: clinical and angiographic study in 1434 symptomatic patients operated between 1982 and 2002.

Objective: The purpose is to define factors influencing long-term patency of the internal thoracic artery (ITA) to optimize the operative strategy.

Methods: 1482 left internal thoracic artery (LITA) and 636 right internal thoracic artery (RITA) symptom-directed angiograms were studied in 1434 patients. Data were prospectively collected from patients who had primary coronary artery bypass surgery during the period 1982-2002.

Factors affecting saphenous vein graft patency: clinical and angiographic study in 1402 symptomatic patients operated on between 1977 and 1999.

Background: The purpose of this study was to find the preoperative and intraoperative factors that affect vein graft patency.

Methods: A total of 3715 graft angiograms in 1607 patients were studied for recurrence of angina. The preoperative patient characteristics and intraoperative variables were prospectively collected from patients who had primary coronary artery bypass grafting during the period from 1977 to 1999.

Survival after myocardial revascularization for ischemic cardiomyopathy: a prospective ten-year follow-up study.

Objective: The aim was to prospectively analyze all-cause mortality, predictors of survival, and late functional results after myocardial revascularization for ischemic cardiomyopathy over a 10-year follow-up.

Methods: We prospectively studied 57 patients with stable coronary artery disease and poor left ventricular ejection function (<35%), enrolled between 1989 and 1994. Stress thallium was analyzed in 37 patients to identify reversible ischemia.