High flow and high dose neosynephrine are effective to maintain perfusion pressure for the patient with preoperative angiotensin converting enzyme inhibitor during cardiopulmonary bypass.

Angiotensin converting enzyme inhibitors (ACEIs) are widely used in the treatment of hypertension, myocardial infarction, and congestive heart failure. They have a known adverse effect of unresponsiveness to vasoconstrictors resulting in hypotension for the patients undergoing cardiac surgery. We report a case of a 43-year-old female patient with preoperative lisinopril (2.

Underutilization of implantable cardioverter defibrillators post coronary artery bypass grafting in patients with systolic dysfunction.

Background: Evaluation of the need for prophylactic internal cardiac defibrillators among patients with ischemic cardiomyopathies should be deferred until at least 3 months after revascularization procedures to allow adequate time for recovery of ventricular function.

Methods: Among patients with left ventricular systolic dysfunction (LVSD) who undergo coronary artery bypass grafting (CABG), the proportion of patients who are risk stratified postoperatively with reassessment of left ventricular ejection fraction (LVEF) is unknown.

Results: One hundred and six patients with LVSD (LVEF < 40%) who underwent CABG during 2004-2006 and survived 3 months post CABG were evaluated.

Late outcomes after radial artery versus saphenous vein grafting during reoperative coronary artery bypass surgery.

Objective: We investigated whether use of radial artery versus saphenous vein grafts during coronary artery bypass grafting reoperations is associated with a significant long-term survival benefit.

Methods: We reviewed a series of 347 consecutive coronary artery bypass grafting reoperations (1996-2007; 270 [78%] male patients; age, 65.3 +/- 9.

The effect of diabetic medications on creatine kinase-myocardial band levels in patients undergoing coronary artery bypass surgery.

Ischemic preconditioning has been shown to attenuate the rise in creatine kinase-myocardial band levels that occur with coronary artery bypass surgery (CABG). Recently, concerns have been raised that some sulfonylureas particularly glibenclamide may block ischemic preconditioning. The purpose of this study was to determine the effect of various diabetic medicines on creatine kinase-myocardial band levels after CABG.

The effect on long-term survival of erythrocyte transfusion given for cardiac valve operations.

Background: Studies in patients undergoing coronary artery bypass grafting (CABG) have shown an increased long-term mortality rates associated with perioperative blood transfusions. However, some studies in other patient populations have shown no effect on death or even a lowered mortality rate in patients receiving blood transfusions, which suggests that the effects of blood transfusion may be disease-dependent.

Methods: Data of all patients who underwent valve operations with or without associated CABG between October 2, 1991, and November 14, 2007, were obtained from the department's database and analyzed using logistic regression for 30-day and Cox models for long-term mortality to determine the effects of transfusion on death.

Sequential radial artery grafts for multivessel coronary artery bypass graft surgery: 10-year survival and angiography results.

Background: Increasing the number of arterial grafts for coronary artery bypass grafting (CABG) has been linked to improved late survival. Currently, it is not known if these long-term benefits are also true when sequential radial artery (RA) grafts are the primary means to maximizing arterial revascularization.

Methods: We compared late survival of 532 consecutive patients receiving sequential RA grafts (sequential RA group: 438 men; 462 with three-vessel disease) with that of a 4,131 contemporaneous internal thoracic artery (ITA) with saphenous vein (SV) multivessel CABG cohort (conventional group).

Late results of conventional versus all-arterial revascularization based on internal thoracic and radial artery grafting.

Background: Use of one or more arterial grafts to revascularize two-vessel and three-vessel coronary artery disease has been shown to improve coronary artery bypass graft surgery (CABG) survival. Yet, the presumed long-term survival benefits of all-arterial CABG have not been quantified.

Methods: We compared propensity-adjusted 12-year survival in two contemporaneous multivessel primary CABG cohorts with all patients receiving 2 or more grafts: (1) all-arterial cohort (n = 612; 297 three-vessel disease [49%]); and (2) single internal thoracic artery (ITA) plus saphenous vein (SV) cohort (n = 4,131; 3,187 three-vessel disease [77%]).

The prevalence of elevated hemoglobin A1c in patients undergoing coronary artery bypass surgery.

Background: Diabetes mellitus has become a major health issue in the United States and contributes to morbidity and mortality from coronary artery disease. Despite lifestyle changes and medications that have been shown to decrease complications and death, many persons have poor glycemic control. The purpose of this study is to determine the prevalence of elevated Hemoglobin A1c levels, a marker of glycemic control in patients presenting for coronary artery bypass surgery, and to determine if risk factors for diabetes mellitus could identify those patients with an elevated hemoglobin A1c.

Influence of intraoperative fluid volume on cardiopulmonary bypass hematocrit and blood transfusions in coronary artery bypass surgery.

A hematocrit (Hct) of less than 25% during cardiopulmonary bypass (CPB) and transfusion of homologous packed red blood cells (PRBC) are each associated with an increased probability of adverse events in cardiac surgery. Although the CPB circuit is a major contributor to hemodilution intravenous (IV) fluid volume may also significantly influence the level of hemodilution. The objective of this study was to explore the influence of asanguinous IV fluid volume on CPB Hct and intraoperative PRBC transfusion.

Endometrial adenocarcinoma metastatic to the right ventricle: a case report and review of the literature.

Background: Endometrial adenocarcinoma of any histologic type rarely metastasizes to the heart. Only three such metastases to the myocardium and three to the pericardium have been reported antemortem in the literature. The rarity of this metastasis is likely explained by the relative avascularity of the endocardium and velocity of blood.

Does radial use as a second arterial conduit for coronary artery bypass grafting improve long-term outcomes in diabetics?

Objectives: The evidence supporting the survival benefit of multiple arterial grafts in the general coronary bypass surgery (CABG) population is compelling. Alternatively, results of studies comparing 2 versus 1 internal thoracic artery (ITA) grafts in diabetics have reported conflicting survival data. The use of radial versus ITA as the second arterial conduit has not been studied.

Postoperative analgesia with ketorolac is associated with decreased mortality after isolated coronary artery bypass graft surgery in patients already receiving aspirin: a propensity-matched study.

Objective: This study was designed to determine the effect of ketorolac on mortality after cardiac surgery.

Design: A retrospective multivariable analysis with propensity matching and propensity scoring.

Setting: A tertiary care university-affiliated medical center.

Survival and graft patency after coronary artery bypass grafting with coronary endarterectomy: role of arterial versus vein conduits.

Background: Coronary artery bypass grafting with concomitant coronary endarterectomy (CABG/CE) is used in patients with severe coronary atherosclerosis to revascularize otherwise ungraftable targets. This study investigates the efficacy of arterial versus vein grafting for CABG/CE surgery.

Methods: We reviewed our experience in 288 CABG/CE patients (63 +/- 10 years, 207 men).

Obesity and risk of new-onset atrial fibrillation after cardiac surgery.

Background: New-onset postoperative atrial fibrillation (AF) is a common complication of cardiac surgery that has substantial effects on outcomes. In the general (nonsurgical) adult population, AF has been linked to increasing obesity, which correlates with left atrial enlargement. It is not known whether postoperative AF is similarly linked to obesity.

Operative and late coronary artery bypass grafting outcomes in matched African-American versus Caucasian patients: evidence of a late survival-Medicaid association.

Objectives: This study sought to determine whether African-American versus Caucasian race is a determinant of early or late coronary artery bypass surgery (CABG) outcomes.

Background: African Americans are referred to CABG less frequently than Caucasians and Medicaid coverage is disproportionately common among those who are referred. How these factors affect the relative early and late CABG outcomes in these groups is incompletely elucidated.

Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome.

Objective: Acute renal injury and failure (ARF) after cardiopulmonary bypass (CPB) has been linked to low on-pump hematocrit (hematocrit). We aimed to 1) elucidate if and how this relation is modulated by the duration of CPB (TCPB) and on-pump packed red blood cell transfusions and 2) to quantify the impact of post-CPB renal injury on operational outcome and resource utilization.

Design: Retrospective review.

The association of elevated creatine kinase-myocardial band on mortality after coronary artery bypass grafting surgery is time and magnitude limited.

Objective: The joint European Society of Cardiology and American College of Cardiology consensus statement on myocardial necrosis after revascularization stated that any amount of myocardial necrosis as detected by cardiac enzymes should be labeled a myocardial infarct. However, it also stated that more data collection is necessary to better interpret the elevation of cardiac enzymes after coronary artery bypass grafting. We sought to determine if a single postoperative value of creatine kinase-myocardial band could be used as a risk factor to help predict mortality after coronary artery bypass surgery.

Effects of obesity and small body size on operative and long-term outcomes of coronary artery bypass surgery: a propensity-matched analysis.

Background: The effects of body habitus on coronary artery bypass graft surgery (CABG) operative and long-term outcomes are not well defined. We aimed to elucidate the independent effects of small body size and obesity on CABG outcomes.

Methods: Primary isolated CABG patients were grouped based on body surface area (BSA, m2) and body mass index (BMI, kg/m2) as follows: 611 very small (BSA < or = 1.

Is hospital procedure volume a reliable marker of quality for coronary artery bypass surgery? A comparison of risk and propensity adjusted operative and midterm outcomes.

Background: Worse operative mortality has been reported for hospitals with low versus high coronary artery bypass grafting surgery volumes. Despite a lack of comparisons beyond the early postoperative period and evidence of surgeon-volume confounding, some have suggested that regionalization of coronary artery bypass grafting in favor of high volume institutions is warranted.

Methods: We retrospectively compared operative mortality and 3-year survival in coronary artery bypass grafting patients (2001 to 2003) at a low-volume hospital (n = 504; 160 per year [median]) versus a high-volume hospital (n = 1,410; 487 per year) served by the same high-volume surgeon team.

Early efficacy of CABG care delivery in a low procedure-volume community hospital: operative and midterm results.

Background: The Leapfrog Group recommended that coronary artery bypass grafting (CABG) surgery should be done at high volume hospitals (>450 per year) without corresponding surgeon-volume criteria. The latter confounds procedure-volume effects substantially, and it is suggested that high surgeon-volume (>125 per year) rather than hospital-volume may be a more appropriate indicator of CABG quality.

Methods: We assessed 3-year isolated CABG morbidity and mortality outcomes at a low-volume hospital (LVH: 504 cases) and compared them to the corresponding Society of Thoracic Surgeons (STS) national data over the same period (2001-2003).