Effect of preoperative antibiotic prophylaxis on surgical site infections complicating cardiac surgery.

Objective: To evaluate the effect of an optimized policy for antibiotic prophylaxis on surgical site infection (SSI) rates in cardiac surgery.

Design: Prospective cohort study.

Setting: Tertiary medical center in Israel.

Cerebral microemboli during hip fracture fixation: a prospective study.

Background: Recent studies have shown that cerebral fat microembolism takes place during surgery for hip or knee replacement. In this study, we examined the occurrence of cerebral microembolism, solid or gas, during a standard procedure of hip fracture fixation.

Methods: This was a prospective study of patients who underwent urgent surgery with a dynamic hip screw for hip fracture fixation.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa following aortic valve replacement - diagnosis and dynamic evaluation with multidetector CT and transesophageal echocardiography.

Sixteen-slice multidetector CT findings of a pulsatile pseudoaneurysm of the mitral-aortic intervalvular fibrosa, in a woman following aortic valve replacement, are presented. Multidetector CT depicted the pseudoaneurysm and enabled dynamic evaluation of its lumen through the cardiac cycle, documenting expansion during systole and almost complete collapse during diastole. This case illustrates the capabilities of multidetector cardiac CT in the evaluation of aortic valve pathology.

Surgical site infection rates following cardiac surgery: the impact of a 6-year infection control program.

Background: To evaluate the impact of an infection control program on surgical site infections (SSIs) complicating cardiac operations.

Methods: Prospective cohort study of patients undergoing cardiac operations. Interventions included prospective surveillance, povidone-iodine scrub showers, depilation before surgery, administration of preoperative antibiotic prophylaxis in the operating room, and postdischarge follow-up.

Free fatty acids repress the GLUT4 gene expression in cardiac muscle via novel response elements.

Hyperlipidemia (HL) impairs cardiac glucose homeostasis, but the molecular mechanisms involved are yet unclear. We examined HL-regulated GLUT4 and peroxisome proliferator-activated receptor (PPAR) gamma gene expression in human cardiac muscle. Compared with control patients, GLUT4 protein levels were 30% lower in human cardiac muscle biopsies from patients with HL and/or type 2 diabetes mellitus, whereas GLUT4 mRNA levels were unchanged.

Intermittent coronary sinus occlusion complicating coronary sinus cannulation during coronary artery bypass operation.

Coronary sinus (CS) thrombosis is a rare event, usually complicating invasive procedures that cause trauma to the CS. Based on anecdotal case reports, this pathology is frequently associated with serious complications and is commonly fatal. We describe a case of intermittent CS thrombosis resulting from CS cannulation during coronary artery bypass grafting operation.

Can regurgitant flow damage the left atrial endothelium in patients with prosthetic mechanical heart valves?

Background And Aim Of The Study: Previous in-vitro studies of mechanical heart valves (MHVs) in the closed position demonstrated the formation of regurgitant flows, with bubbles and jets forming vortices during each systole. The study aim was to determine whether the regurgitant flow observed in patients with MHVs can damage the left atrial endothelium, due to shear stresses exerted on the endothelial layers. This objective has been accomplished by appropriate in-vitro simulation experiments.

Impact of body mass index on the outcome of patients with multivessel disease randomized to either coronary artery bypass grafting or stenting in the ARTS trial: The obesity paradox II?

The effect of body mass index (BMI) on outcomes after coronary artery revascularization remains controversial. We studied 1,203 patients who had multivessel coronary artery disease and underwent stenting (n = 599) or coronary artery bypass grafting (CABG; n = 604) in the Arterial Revascularization Therapies Study. Patients were assigned to 1 of 3 groups according to BMI: <25, 25 to 30, and >30 kg/m(2).

Mitral mechanical heart valves: in vitro studies of their closure, vortex and microbubble formation with possible medical implications.

Objective: The goal of the present work was to create the closest possible in vitro fluid dynamic environment in which prosthetic mitral valves in the patients' hearts function, in order to demonstrate whether microbubbles are generated, and if yes, under what conditions and at which stage of the cardiac cycle. Microbubbles were observed in the blood of patients with mitral mechanical heart valves (MHV) by means of echocardiography. The phenomenon, often referred to as high-intensity transient signals (HITS), appears as bright, intense, high-velocity and persistent echoes detected by Doppler echocardiography at the instant of valve closure.

Comparison of bypass surgery and stenting for the treatment of multivessel disease: results from the ARTS trial in Israel.

Background: The Arterial Revascularization Therapies Study was a multicenter, randomized trial designed to compare percutaneous coronary intervention with stenting versus coronary artery bypass graft surgery in 1,205 patients with multivessel coronary artery disease. The most appropriate type of treatment for these patients is still a matter of considerable debate.

Objectives: To evaluate the clinical characteristics of patients enrolled in the ARTS trial in Israel in comparison to those worldwide, and to assess the 1 year outcome in these patients.

Minimal dissection and continuous retrograde cardioplegia for aortic valve replacement in patients with a patent left internal mammary artery bypass graft.

Background And Aim Of The Study: Aortic valve replacement (AVR) in patients with previous coronary artery bypass grafting (CABG) and a patent pedicled internal mammary artery (IMA) is often complicated by a need to dissect and clamp the IMA to achieve optimal myocardial protection. Eliminating this need may simplify and facilitate surgery; hence, a new surgical technique for use in these patients is described.

Methods: Five patients with previous CABG and functioning IMA who required AVR between January 1998 and October 2002 were studied.

Bubble formation on St. Jude Medical mechanical heart valves: an in-vitro study.

Background And Aim Of The Study: Bubble formation in blood, which has been observed during valve closure in patients with mechanical heart valves (MHVs), raises concern because of cognitive changes and potential activation of blood elements associated with thromboembolic phenomena. Bubble formation in the vicinity of MHVs has been described previously; the present in-vitro study was undertaken to quantitate bubbles leaving the heart and entering the systemic circulation, and to gain a closer perspective of this phenomenon and its potential clinical implications.

Methods: Experiments were performed in a left heart pulsed flow simulator with 29 mm mitral and 23 mm aortic St.

Successful invasive management and surgical repair of subacute ventricular rupture complicating myocardial infarction.

We describe a patient following acute myocardial infarction with a protracted clinical course presenting transient episodes of hypotension, who eventually developed cardiac tamponade. Echocardiography demonstrated pericardial effusion and emergency pericardiocentesis revealed blood. The patient's condition was stabilized and she underwent emergency thoracotomy with successful repair of left ventricular rupture.