Is It Safe to Let Trainees Operate on High Risk Cardiac Surgery Cases?

Increasing complexity in cardiac operations has raised the discussion on trainee autonomy and the number of cases required to achieve competency. This study compares outcomes among cases done by trainees vs consultants for high risk patients. 696 (trainee=158 vs consultant=438) major high risk cardiac operations (Euroscore >10) were reviewed at a single center.

Aortic Stenosis Prognostication in Patients With Type 2 Diabetes: Protocol for Testing and Validation of a Biomarker-Derived Scoring System.

Background: Type 2 diabetes mellitus (T2DM) has been established as an important independent risk factor for aortic stenosis. T2DM patients present with a higher degree of valve calcification and left ventricular dysfunction compared to patients without diabetes. This may be due to an increase in incidence and severity of myocardial fibrosis.

A record-breaking lung metastasis from renal cell carcinoma 37 years after nephrectomy.

Development of distant metastases from renal cell carcinoma (RCC) is a frequent occurrence and, in nearly 95% of the cases, secondary lesions present within 5 years following nephrectomy. We performed a left pneumonectomy for a peri-hilar lung mass in an 81-year-old man with history of kidney cancer, resected 37 years earlier. Histopathological examination revealed a solitary lung metastasis from RCC, relapsed after an extraordinary 37-year time interval.

Hearts from mice fed a non-obesogenic high-fat diet exhibit changes in their oxidative state, calcium and mitochondria in parallel with increased susceptibility to reperfusion injury.

Rationale: High-fat diet with obesity-associated co-morbidities triggers cardiac remodeling and renders the heart more vulnerable to ischemia/reperfusion injury. However, the effect of high-fat diet without obesity and associated co-morbidities is presently unknown.

Objectives: To characterize a non-obese mouse model of high-fat diet, assess the vulnerability of hearts to reperfusion injury and to investigate cardiac cellular remodeling in relation to the mechanism(s) underlying reperfusion injury.

Combined clopidogrel and aspirin treatment up to surgery increases the risk of postoperative myocardial infarction, blood loss and reoperation for bleeding in patients undergoing coronary artery bypass grafting.

Objectives: Recent guidelines suggest that patients undergoing coronary artery bypass grafting (CABG) should discontinue clopidogrel and aspirin (ASA) 5 and 2-10 days, respectively, before surgery to reduce postoperative bleeding and its complications. The aim of our study was to evaluate the relationship between the timing of discontinuing clopidogrel + ASA and early clinical outcomes in patients undergoing CABG.

Methods: Four thousand three hundred and thirty consecutive patients underwent isolated CABG from April 2004 to February 2009.

Training residents in off-pump coronary artery bypass surgery: a 14-year experience.

Objective: Off-pump coronary artery bypass grafting (OPCAB) is an established procedure in many cardiothoracic centers. For it to be widely applicable, however, teaching methods must be developed for surgical trainees. Early clinical outcomes and long-term survival of patients who underwent OPCAB at our institution by trainees supervised and unsupervised were compared with those of patients whose procedures were performed by senior surgeons.

On-pump and off-pump coronary artery bypass grafting in patients with left main stem disease: a propensity score analysis.

Objective: This study compared safety and efficacy between off-pump coronary artery bypass grafting (OPCAB), a relatively new technique, and conventional on-pump coronary artery bypass grafting (CCAB) in patients with left main stem disease.

Methods: In a retrospective, observational, cohort study of prospectively collected data on 2375 consecutive patients with left main stem disease undergoing isolated CABG (1297 OPCAB, 1078 CCAB) between April 1996 and December 2009 at the Bristol Heart Institute, 548 patients undergoing OPCAB were matched with 548 patients undergoing CCAB by propensity score.

Results: After propensity matching, groups were comparable in preoperative characteristics.

Mild renal dysfunction in patients undergoing cardiac surgery as a new risk factor for EuroSCORE.

Background: It has recently been suggested that mild renal dysfunction is associated with increased mortality in cardiac surgery; however, this risk factor is not accounted for in the European System for Cardiac Operative Risk Evaluation (EuroSCORE). The aim of the present study was to assess the effect of mild renal dysfunction as a predictor of operative mortality and develop and validate a modified logistic EuroSCORE model.

Methods: This was a retrospective, observational, cohort study of prospectively collected data on 16 086 consecutive patients undergoing cardiac surgery at the Bristol Heart Institute between April 1996 and February 2009.

A clinical score to predict the need for intraaortic balloon pump in patients undergoing coronary artery bypass grafting.

Background: There is no accepted consensus on the definition of high-risk patients who may benefit from the use of intraaortic balloon pump (IABP) in coronary artery bypass grafting (CABG). The aim of this study was to develop a risk model to identify high-risk patients and predict the need for IABP insertion during CABG.

Methods: From April 1996 to December 2006, 8,872 consecutive patients underwent isolated CABG; of these 182 patients (2.

Floating intra-aortic thrombus presenting as distal arterial embolism.

Floating thrombi in the aorta are a rare finding in the absence of any coagulation abnormality. They often represent a surgical emergency. Our case refers to a 45-year-old woman who presented with acute ischemia of the upper extremity.