Impact of preoperative chronic lung disease on survival after surgical aortic valve replacement.

Background: An increasing number of patients requiring surgical aortic valve replacement (SAVR) present with chronic pulmonary obstructive disease (COPD). The purpose of this study was to compare patients who had a range of COPD from normal to severe and were undergoing SAVR.

Methods: Retrospective review of 2,379 patients undergoing SAVR ± coronary artery bypass grafting (CABG) from January 2002 to April 2012 at a US academic institution was performed.

The impact of specific preoperative organ dysfunction in patients undergoing aortic valve replacement.

Background: Optimizing treatment strategies to risk profile patients undergoing aortic valve replacement remains a priority. The role that specific and combinations of preoperative organ dysfunction (OD) plays in informing these decisions remains uncertain. This study sought to determine the relative effect that OD in particular systems has on short- and long-term outcomes.

Sternotomy versus nonsternotomy LIMA-LAD grafting for single-vessel disease.

Background: Single-vessel disease of the left anterior descending (LAD) coronary artery may be surgically revascularized by left internal mammary artery (LIMA) grafting either through a sternotomy or a nonsternotomy approach. Nonsternotomy approaches are used in the hope of achieving a less invasive operation. It is unknown whether nonsternotomy approaches impact in-hospital or midterm outcomes.

Risk factors for conversion to cardiopulmonary bypass during off-pump coronary artery bypass surgery.

Background: Off-pump coronary artery bypass graft (OPCAB) may be associated with improved hospital outcomes compared with on-pump coronary artery bypass graft. However, intraoperative conversion to on-pump coronary artery bypass graft has been associated with adverse outcomes. The purpose of this study was to identify preoperative risk factors for intraoperative conversion in nonemergent patients undergoing isolated OPCAB.

A randomized trial of a skin sealant to reduce the risk of incision contamination in cardiac surgery.

Background: Immobilizing skin microbes is a rational approach to reducing contamination of surgical sites by endogenous microorganisms.

Methods: This randomized, controlled, parallel-group, multicenter, open-label clinical trial (ClinicalTrials.gov NCT00467857) enrolled 300 adults scheduled for elective coronary artery bypass graft surgery.

Impact of preoperative renal dysfunction on long-term survival for patients undergoing aortic valve replacement.

Background: The impact of the degrees of renal dysfunction (RD) after aortic valve replacement (AVR) has not been well described. The purpose of this study was to compare patients undergoing AVR with a range of renal function from normal to dialysis-dependence.

Methods: A retrospective review of 2,408 patients undergoing AVR with or without coronary artery bypass graft surgery (CABG) from January 1996 to March 2009 was performed.

Long-term survival for patients with preoperative renal failure undergoing bioprosthetic or mechanical valve replacement.

Background: The objective of this study was to assess short-term and long-term outcomes after valve replacement with biologic or mechanical prostheses in patients with preoperative end-stage renal disease on chronic dialysis.

Methods: A retrospective review of patients with end-stage renal disease undergoing valve replacement from January 1996 through March 2008 at Emory Healthcare Hospitals was performed. Outcomes were compared using χ(2) tests and 2-sample t tests.

The effect of diabetes mellitus on in-hospital and long-term outcomes after heart valve operations.

Background: Diabetes mellitus (DM) is associated with adverse in-hospital and long-term outcomes in patients undergoing coronary artery bypass grafting. This study evaluated outcomes in patients with DM undergoing isolated heart valve operations.

Methods: From January 1, 1996, to March 31, 2008, 2964 consecutive patients underwent primary, isolated heart valve operations at Emory University Hospitals.

Racial disparity persists after on-pump and off-pump coronary artery bypass grafting.

Background: Race has been shown to be an independent risk factor for operative mortality after coronary artery bypass grafting (CABG). This study sought to determine the extent to which race is a risk factor for adverse events, long-term mortality, and whether off-pump surgery (OPCAB) modifies that risk.

Methods And Results: The Society of Thoracic Surgeons Adult Cardiac Database at Emory Healthcare affiliated hospitals was queried for all primary isolated CABG records from 1997 to 2007.

Aortic valve replacement for aortic stenosis in patients with left ventricular dysfunction.

Background: The purpose of this study was to assess the impact of left ventricular dysfunction and other risk factors on short- and mid-term outcomes after aortic valve replacement for aortic stenosis.

Methods: From January 1, 2002, to December 31, 2007, 773 consecutive patients underwent primary aortic valve replacement for aortic stenosis at a single institution; concomitant coronary artery bypass graft surgery (CABG) was performed in 45.4% (351 of 773).

Long-term outcomes after isolated aortic valve replacement in octogenarians: a modern perspective.

Background: With the recent advent of percutaneous valve therapy, an increased need for the evaluation of outcomes after open aortic valve replacement (AVR) in elderly patients is warranted. This study compares the short- and long-term survival outcomes of octogenarians after AVR with younger age groups in the modern surgical era.

Methods: A retrospective review was performed on patients who underwent isolated, primary AVR from 1996 to 2006 at the Emory Healthcare Hospitals.

Elevated preoperative hemoglobin A1c level is associated with reduced long-term survival after coronary artery bypass surgery.

Background: The predictive role of hemoglobin A1c (HbA1c) on long-term outcomes after coronary artery bypass surgery has not been evaluated.

Methods: Preoperative HbA1c levels were obtained in 3,201 patients undergoing primary, elective coronary artery bypass surgery at Emory Healthcare Hospitals from January 2002 to December 2006 and entered prospectively into a computerized database. Long-term survival status was determined by cross-referencing patient records with the Social Security Death Index.

Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival.

Background: This study compared in-hospital major adverse cardiac events (MACE) and long-term survival after off-pump (OPCAB) vs on-pump (CPB) coronary artery bypass grafting (CABG).

Methods: Reviewed were 12,812 consecutive isolated CABG patients from 1997 to 2006. A propensity score (PS), including 40 preoperative risk factors, balanced characteristics between OPCAB and CPB groups.

Influence of on-pump versus off-pump techniques and completeness of revascularization on long-term survival after coronary artery bypass.

Background: Off-pump coronary artery bypass graft surgery (OPCABG) may be associated with reduced morbidity and in-hospital mortality. In this study, we report the influence of surgery type, number of grafts, and the Index of Completeness of Revascularization (ICOR), namely, the number of grafts/number diseased vessel systems, on long-term survival.

Methods: From 1997 to 2006, 12,812 consecutive patients underwent isolated CABG at a single academic center.

Propensity-score analysis of early outcomes after bilateral versus single internal thoracic artery grafting.

Objective: : The use of bilateral internal thoracic arteries (BITAs) during coronary artery bypass grafting (CABG) improves long-term and event-free survival compared with single internal thoracic artery (SITA) grafting. It is controversial whether BITA grafting alters in-hospital adverse events after CABG.

Methods: : Isolated CABG cases using BITA or SITA at a single US academic center between January 1, 1997 and June 30, 2006 were retrospectively reviewed.

Outcomes after off-pump reoperative coronary artery bypass grafting.

Objective: : Application of off-pump techniques to reoperative coronary artery bypass (redo CABG) has been limited by technical difficulty and potential for embolism of atheromatous debris from diseased grafts, resulting in myocardial infarction and rapid hemodynamic deterioration. We compared outcomes after off-pump (OPCAB) and on-pump (ONCAB) in redo CABG.

Methods: : A retrospective chart review was performed for patients who underwent redo CABG at a single academic institution between January 1997 and December 2004.

Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database.

Background: Although patients with end-stage renal disease are known to be at high risk for mortality after coronary artery bypass graft (CABG) surgery, the impact of lesser degrees of renal impairment has not been well studied. The purpose of this study was to compare outcomes in patients undergoing CABG with a range from normal renal function to dependence on dialysis.

Methods And Results: We reviewed 483,914 patients receiving isolated CABG from July 2000 to December 2003, using the Society of Thoracic Surgeons National Adult Cardiac Database.

Early administration of clopidogrel is safe after off-pump coronary artery bypass surgery.

Background: Patients who undergo off-pump coronary artery bypass graft surgery (OPCAB) may be hypercoagulable with an increased risk of graft thrombosis due to the lack of platelet dysfunction that accompanies "on-pump" surgery. Clopidogrel may be indicated in these patients to prevent recurrent ischemic events. The purpose of this observational study was to determine the safety of early clopidogrel administration after OPCAB.

Intraoperative radiofrequency ablation for the treatment of atrial fibrillation during concomitant cardiac surgery.

Background: Radiofrequency ablation has been recently introduced as an alternative to the surgical maze procedure to eliminate atrial fibrillation (AF). The purpose of this study was to examine the effectiveness of unipolar radiofrequency ablation in patients with AF undergoing open heart surgery.

Methods: A retrospective review was performed on 54 patients undergoing radiofrequency ablation with concomitant cardiac operations from March 2002 through July 2003.

Emergency coronary artery bypass grafting can be performed safely without cardiopulmonary bypass in selected patients.

Background: Patients requiring emergency surgical revascularization are often not considered for off-pump coronary artery bypass grafting (OPCAB).

Methods: From 1996 to 2003, 614 patients underwent emergency coronary artery bypass grafting (Society of Thoracic Surgeons definition) at an academic institution. Forty-four (7%) of these procedures were performed without cardiopulmonary bypass, while 570 were conventional coronary artery bypass procedures with cardiopulmonary bypass (CABG/CPB).

The use of the SonoSite ultrasound device for intraoperative evaluation of the aorta.

Objective: Neurologic complications remain a significant cause of morbidity and mortality in cardiac surgery. Risk factors for neurologic injuries include the presence of atheromatous disease in the aorta. Epiaortic ultrasound has been shown to be superior in detecting the extent and location of atheromatous disease.

Pretreatment with phenoxybenzamine attenuates the radial artery's vasoconstrictor response to alpha-adrenergic stimuli.

Background: Although the radial artery bypass conduit has excellent intermediate-term patency, it has a proclivity to vasospasm. We tested the hypothesis that brief pretreatment of a radial artery graft with the irreversible adrenergic antagonist phenoxybenzamine attenuates the vasoconstrictor response to the vasopressors phenylephrine and norepinephrine compared with the currently used papaverine/lidocaine.

Methods: Segments of human radial artery grafts were obtained after a 30-minute intraoperative pretreatment with a solution containing 20 mL of heparinized blood, 0.

Impact of renal disease in cardiovascular surgery: emphasis on the African-American patient.

Cardiovascular disease remains a significant source of morbidity and mortality for patients with kidney disease. Coincident with the development of chronic renal failure, patients typically manifest a systemic vasculopathy often involving the cardiovascular system. The renal failure patient is also plagued by multiple comorbid conditions that may adversely affect cardiovascular outcomes.

Perfusion-assisted direct coronary artery bypass provides early reperfusion of ischemic myocardium and facilitates complete revascularization.

Background: Perfusion-assisted direct coronary artery bypass (PADCAB) was developed to initiate early reperfusion of grafted coronary artery segments during off-pump operations to resolve episodes of myocardial ischemia and avoid its sequelae. This case series outlines intraoperative findings and clinical outcomes of our first year clinical experience with PADCAB.

Methods: From November 1999 to November 2000, 169 PADCAB and 358 off-pump coronary artery bypass procedures were performed at the Emory University Hospitals.