The Perception of Evidence for Venous Thromboembolism Prophylaxis Current Practices after Cardiac Surgery: A Canadian Cross-Sectional Survey.

Background. Venous thromboembolism (VTE) is the third leading cause of cardiovascular death in patients undergoing surgery. However, VTE prophylaxis practices in cardiac surgery are based on noncardiac surgical literature.

A pilot randomized controlled trial comparing CABG surgery performed with total arterial grafts or without.

Objective: To date only a few randomized controlled studies have compared grafting strategies in patients with multi-vessel coronary disease. This study represents a pilot RCT designed to test the feasibility of a trial comparing conventional CABG performed with a LIMA-LAD plus saphenous vein grafts (LIMA+SVG) and CABG performed with total arterial grafting (TAG).

Methods: Consenting patients undergoing non-redo isolated CABG surgery at a single institution were randomized to TAG or LIMA+SVG groups.

Mitral valve and short-term ventricular assist devices; potential mechanical complications.

Mechanical complications of ventricular assist devices (VADs) are rare but serious. The authors describe two cases of different mechanical complications of VADs that can affect the mitral valve. Attention should be paid to the position of the inflow/outflow cannula after off-loading of the ventricle, especially in acute heart failure and normal atrial dimensions.

Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study.

Background: Persistent postoperative pain continues to be an underrecognized complication. We examined the prevalence of and risk factors for this type of pain after cardiac surgery.

Methods: We enrolled patients scheduled for coronary artery bypass grafting or valve replacement, or both, from Feb.

Development of a predictive model for major adverse cardiac events in a coronary artery bypass and valve population.

Background: Quality improvement initiatives in cardiac surgery largely rely on risk prediction models. Most often, these models include isolated populations and describe isolated end-points. However, with the changing clinical profile of the cardiac surgical patients, mixed populations models are required to accurately represent the majority of the surgical population.

Are intraoperative precursor events associated with postoperative major adverse events?

Objectives: Precursor events are undesirable events that can lead to a subsequent adverse event and have been associated with postoperative mortality. The purpose of the present study was to determine whether precursor events are associated with a composite endpoint of major adverse cardiac events (MACE) (death, acute renal failure, stroke, infection) in a low- to medium-risk coronary artery bypass grafting, valve, and valve plus coronary artery bypass grafting population. These events might be targets for strategies aimed at quality improvement.

Canadian Cardiovascular Society focused position statement update on assessment of the cardiac patient for fitness to drive: fitness following left ventricular assist device implantation.

There have been significant advances in mechanical circulatory support during the past several years. Older pulsatile models of left ventricular assist devices (LVADs) (also known as VADs) have shown improved outcomes compared with medical therapy but have had limited durability and significant morbidity associated with their use. For this reason, Canadian Cardiovascular Society 2003 guidelines recommended permanent cessation of driving in these patients (for both private and commercial vehicle operation).

Delirium: a cause for concern beyond the immediate postoperative period.

Background: Delirium is a common neurologic complication after cardiac surgery, and may be associated with increased morbidity and mortality. Research has focused on potential causes of delirium, with little attention to its sequelae.

Methods: Perioperative data were collected prospectively on all isolated cases of coronary artery bypass grafting (CABG) performed from 1995 to 2006 at a single center.

Should all patients be treated with an angiotensin-converting enzyme inhibitor after coronary artery bypass graft surgery? The impact of angiotensin-converting enzyme inhibitors, statins, and β-blockers after coronary artery bypass graft surgery.

Background: We sought to evaluate the association between angiotensin-converting enzyme (ACE) inhibitors and outcomes after coronary artery bypass graft surgery (CABG).

Methods: Postoperative outpatient utilization of ACE inhibitors, statins, and β-blockers was assessed in a cohort of 3,718 patients after CABG 65 years and older. The primary outcome was freedom from a composite of all-cause mortality or hospital readmission for cardiac events or procedures.

Delirium as a predictor of sepsis in post-coronary artery bypass grafting patients: a retrospective cohort study.

Introduction: Delirium is the most common neurological complication following cardiac surgery. Much research has focused on potential causes of delirium; however, the sequelae of delirium have not been well investigated. The objective of this study was to investigate the relationship between delirium and sepsis post coronary artery bypass grafting (CABG) and to determine if delirium is a predictor of sepsis.

The impact of sequential grafting on clinical outcomes following coronary artery bypass grafting.

Objectives: Sequential anastomoses in coronary artery bypass grafting (CABG) offer theoretical advantages including increased graft flow and more complete revascularisation. However, published studies concerning the safety and efficacy of this technique are not definitive. The objective of this study was to assess the effect of sequential anastomoses on outcomes following CABG.

Long-term results of heart operations performed by surgeons-in-training.

Background: We investigated the association between trainees performing supervised operations and late outcomes of patients undergoing cardiac surgery.

Methods And Results: Data were prospectively collected on patients who underwent coronary artery bypass graft surgery, aortic valve replacement, or a combination of these between 1998 and 2005 at the Maritime Heart Center, Halifax, Canada. In-hospital mortality and a composite outcome of in-hospital mortality, stroke, bleeding, intra-aortic balloon pump insertion, renal failure, and sternal infection was compared between teaching (n=1054) and nonteaching cases (n=5877).

Serotonin syndrome following cardiac surgery.

Selective serotonin reuptake inhibitors (SSRIs) are widely used to treat depression. We report a case of serotonin syndrome following cardiac surgery. This syndrome is rare in the cardiac literature.

Mitral insufficiency and morbidity and mortality in left ventricular dysfunction.

Background: Mitral insufficiency is known to occur in a substantial proportion of patients with heart failure. Its relationship with morbidity and mortality is poorly described.

Methods: The mortality and hospitalization for heart failure were retrospectively examined in patients who underwent baseline echocardiography in the Studies Of Left Ventricular Dysfunction (SOLVD) treatment and prevention trials.

Pulmonary artery to distal bypass for surgery on the descending thoracic aorta.

A variety of extracorporeal techniques have been described in surgery of the descending thoracic and thoracoabdominal aorta. We describe an operative approach involving the cannulation of the pulmonary artery for venous drainage in 12 patients undergoing descending thoracic aortic surgery. In-hospital mortality was 17%; there were no in-hospital deaths for elective cases.

The impact of diffuseness of coronary artery disease on the outcomes of patients undergoing primary and reoperative coronary artery bypass grafting.

Objective: Diffuse coronary artery disease jeopardizes myocardium, increasing surgical mortality in primary coronary artery bypass grafting (CABG). We sought to determine the impact of diffuseness on pre- and post-discharge outcomes for both primary and reoperative CABG (REOP).

Methods: Using a validated system for measuring diffuseness of coronary disease, preoperative angiograms were scored for primary CABG (n=792) and REOP cases (n=268) performed 1997-2004.

Total arterial revascularization is safe: multicenter ten-year analysis of 71,470 coronary procedures.

Background: The purpose of this study was to assess the use of arterial revascularization and to compare the in-hospital mortality with other CABG grafting strategies.

Methods: A total of 71,470 CABG patients (1992-2001) in 27 centers in the United Kingdom were studied. The proportion of patients with arterial revascularization was compared.

The preoperative intraaortic balloon pump in coronary bypass surgery: a lack of evidence of effectiveness.

Background: There is limited evidence demonstrating the effectiveness of preoperative intraaortic balloon pump (IABP) use in isolated coronary artery bypass graft (CABG) surgery. A single-center randomized trial demonstrated its benefit. We undertook a multicenter observational study to verify this finding.

The association between prior percutaneous coronary intervention and short-term outcomes after coronary artery bypass grafting.

Background: Increasingly, patients are being referred for coronary artery bypass grafting (CABG) for management of symptoms after prior percutaneous coronary intervention (PCI). In this study, we assessed the impact of prior PCI on inhospital mortality after CABG.

Methods: Perioperative data were collected on patients who underwent first-time CABG at 2 surgical centers.

Outcomes in octogenarians undergoing coronary artery bypass grafting.

Background: Although octogenarians are being referred for coronary artery bypass grafting (CABG) with increasing frequency, contemporary outcomes have not been well described. We examined data from 4 Canadian centres to determine outcomes of CABG in this age group.

Methods: Data for the years 1996 to 2001 were examined in a comparison of octogenarians with patients less than 80 years of age.

Training residents in mitral valve surgery.

Background: The safety of training residents in complex procedures has not been elucidated. In particular, the impact of resident-performed mitral valve surgery on patient outcomes is unknown.

Methods: All mitral valve procedures performed by residents between 1998 and 2003 were compared with those performed by staff surgeons.

A multicenter comparison of intraaortic balloon pump utilization in isolated coronary artery bypass graft surgery.

Background: Single-center studies suggest substantial variation in intraaortic balloon pump (IABP) utilization. Our purpose is to examine IABP utilization over time and across medical centers.

Methods: This was a prospective cohort of 29,961 consecutive patients undergoing isolated coronary artery bypass graft surgery, between 1995 and 2000, at 10 centers (eight in northern New England and two in Canada).