An aortic cinch to quell suture line bleeding.

Bleeding from an aortic suture line or cannula site may be difficult to control, especially in the patient with a fragile or dilated aorta. This method of wrapping a vascular graft around the aorta to relieve tension on the suture line and control bleeding is simple and effective, and it facilitates obtaining the proper tension of the wrapped graft.

Severe, transient aortic insufficiency after bovine pericardial aortic valve replacement: a cautionary note.

Three patients demonstrated severe, central aortic insufficiency noted immediately upon removal of the aortic cross clamp after aortic valve replacement with a bovine pericardial Edwards Magna valve. After maintaining left ventricular decompression, the aortic insufficiency resolved in less than 1 hour. Knowledge of this phenomenon will prevent unnecessary prosthetic valve explantation and re-replacement.

Intermediate-term outcomes of surgical atrial fibrillation correction with the CryoMaze procedure.

Background: Few studies have reported long-term outcomes of surgical atrial fibrillation (AF) correction. We perform the Cox-Maze III lesion set with argon-powered cryoenergy (CryoMaze procedure) on all patients with AF presenting for cardiac operations. This study reports long-term clinical results and heart rhythm status.

Learning in a new cardiac surgical center: an analysis of precursor events.

Background: Few studies of learning in the health care sector have analyzed measures of process, as opposed to outcomes. We assessed the learning curve for a new cardiac surgical center using precursor events (incidents or circumstances required for the occurrence of adverse outcomes).

Methods: Intraoperative precursor events were recorded prospectively during major adult cardiac operations, categorized by blinded adjudicators, and counted for each case (overall and according to these categories).

Impact of cardiac intraoperative precursor events on adverse outcomes.

Background: Although extensive study has been directed at the influence of patient factors and comorbidities on cardiac surgical outcomes, less attention has been focused on process. We sought to examine the relationship between intraoperative precursor events (those events that precede and are requisite for the occurrence of an adverse event) and adverse outcomes themselves.

Methods: Anonymous, prospectively collected intraoperative data was merged with database outcomes for 450 patients undergoing major adult cardiac operations.

Single venous return for mitral valve operations.

Objective: : Most cardiac surgeons routinely perform bicaval venous cannulation for mitral valve operations. We describe the technique and advantage of a single-venous cannulation strategy.

Methods/results: : Single venous cannulation with a 29-French small-bore cannula (facilitated by vacuum-assisted venous drainage) yields reliable decompression of the right heart and affords outstanding exposure of the mitral valve.

Prospective assessment of intraoperative precursor events during cardiac surgery.

Objective: Increasing attention has been afforded to the ubiquity of medical error and associated adverse events in medicine. There remains little data on the frequency and nature of precursor events in cardiac surgery, and we sought to characterize this.

Methods: Detailed, anonymous information regarding intraoperative precursor events (which may result in adverse events) was collected prospectively from six key members of the operating team during 464 major adult cardiac surgical cases at three hospitals and were analyzed with univariable statistical methods.

Methods for reduction of sternal wound infection.

Deep sternal wound infections continue to be an uncommon but potentially devastating complication of cardiac surgical procedures. Numerous risk factors have been identified but only a few can be characterized as modifiable. These risk factors and their modifications are reviewed in the following article.

Multiparameter fiber optic sensor for the assessment of intramyocardial perfusion.

Objectives: The objective of this study was to characterize a multiparameter fiber optic sensor for detection of changes in intramyocardial perfusion and to demonstrate a method of determining critical values for pH, PCO2, and PO2 to indicate onset of anaerobic metabolism.

Methods: Six swine underwent a 20-minute occlusion of the left anterior descending coronary artery (LAD). Myocardial pH, PCO2, and PO2 were measured continuously in the LAD and left circumflex coronary artery (CFX) territories.

Noninvasive, near infrared spectroscopic-measured muscle pH and PO2 indicate tissue perfusion for cardiac surgical patients undergoing cardiopulmonary bypass.

Objective: To determine whether near infrared spectroscopic measurement of tissue pH and Po2 has sufficient accuracy to assess variation in tissue perfusion resulting from changes in blood pressure and metabolic demand during cardiopulmonary bypass.

Design: Prospective clinical study.

Setting: Academic medical center.

Experimental coronary artery occlusion: relevance to off-pump cardiac surgery.

Mechanical coronary artery occlusion is required for minimally invasive direct coronary artery bypass and off-pump coronary artery bypass surgery. It is important that the method of occlusion be minimally traumatic. Chronic effects of these methods have never been studied.

What constitutes optimal surgical revascularization? Answers from the Bypass Angioplasty Revascularization Investigation (BARI).

Objectives: The study was done to derive the optimum definition of complete revascularization in coronary artery bypass surgery.

Background: "Complete revascularization" has been considered the goal of coronary artery bypass operations, but various definitions of completeness exist.

Methods: We evaluated the Bypass Angioplasty Revascularization Investigation (BARI) surgical results in the seven years after operation.

Origin of the left anterior descending coronary artery from the pulmonary artery: An unusual cause of angina in a middle-aged woman.

A 48-year-old woman was admitted to our institution with angina pectoris and a systolic murmur. At cardiac catheterization, she was found to have an anomalous origin of the left anterior descending coronary artery from the pulmonary trunk. There was also an associated atrial septal defect and a bicuspid aortic valve.