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.

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).

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.

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.

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).

Infectious endocarditis of a Chiari network.

We present the case of a 62-year-old man with infectious endocarditis in a Chiari network. Chiari networks are present in 1.5% to 3% of the population.

Human leukocyte antigen-DR and ABO mismatch are associated with accelerated homograft valve failure in children: implications for therapeutic interventions.

Objective: This study examines the incidence and factors associated with the failure of homograft valves and identifies those factors that are modifiable.

Methods: From 1990 to 2001, 96 homograft valves were implanted in the right ventricular outflow tract of 83 children (mean age 5.1 +/- 5.

The intraaortic balloon pump in cardiac surgery.

The intraaortic balloon pump (IABP) has been used in cardiac operations since the late 1960s. Over the years, with refinements in technology, its use has expanded; the IABP is now the most commonly used mechanical assist device in cardiac operative procedures. This review provides an evaluation of evidence for the efficacy of IABP use in different clinical scenarios, using the American College of Cardiology/American Heart Association classification of evidence where appropriate.

Is it safe to train residents to perform cardiac surgery?

Background: The impact of surgical training on patient outcomes in cardiac surgery is unknown.

Methods: All cases performed by residents from 1998 to 2001 were compared to staff surgeon cases using prospectively collected data. Operative mortality and a composite morbidity of: reoperation for bleeding perioperative myocardial infarction, infection, stroke, or ventilation more than 24 hours were compared using multivariate analysis.

The Ross procedure for endocarditis in a 4-month-old infant.

Streptococcal endocarditis in an infant is rare. We report a case of acute aortic valve endocarditis with abscess and aorta-to-right atrial fistula formation. This 4-month-old infant with a structurally normal heart had been previously well.

Preoperative cardiovascular risk factor control in elective coronary artery bypass graft patients: a failure of present management.

Background: After coronary artery bypass graft (CABG) patients are at high risk for disease progression and future cardiac events. Risk factor control can reduce subsequent clinical events and mortality. The appropriateness of cardiovascular risk factor management in CABG patients is largely unknown.