Emergency on-pump beating heart reconstructive coronary artery bypass grafting for entrapped percutaneous coronary intervention equipment.

Background: Equipment entrapment during percutaneous coronary intervention (PCI) may lead to acute ischemia necessitating emergency surgery.

Case Presentation: This is the first case report where emergency surgery had to be performed on beating heart, for removal of retained PCI equipment, due to an incidental finding of severely atheromatous aorta precluding cross-clamp. Ultrasound-guided aortic cannulation and off-pump strategy made the complex reconstruction of left anterior descending artery possible.

Bivalirudin in acute coronary syndromes and percutaneous coronary intervention: should we use it?

Major bleeding remains a major risk factor for percutaneous coronary intervention of acute coronary syndromes and is associated with higher morbidity, mortality, prolonged hospital stay and costs. With the recognition that bleeding is an important factor in patient outcomes, the prevention of bleeding has become as important a goal as the prevention of ischaemia. The direct thrombin inhibitor bivalirudin has been shown to reduce ischaemia and importantly, is associated with less bleeding.

Association of prerandomization anticoagulant switching with bleeding in the setting of percutaneous coronary intervention (A REPLACE-2 analysis).

The REPLACE-2 trial of patients who underwent urgent or elective percutaneous coronary intervention (PCI) demonstrated a significantly lower bleeding risk with bivalirudin plus provisional glycoprotein IIb/IIIa inhibitor compared with unfractionated heparin with planned glycoprotein IIb/IIIa inhibitor. The goal of this analysis was to evaluate whether a hazard existed when unfractionated heparin or low-molecular-weight heparin was administered before study medication in the REPLACE-2 trial. The REPLACE-2 trial randomized 6,010 patients undergoing PCI to receive bivalirudin plus provisional glycoprotein IIb/IIIa inhibitor or unfractionated heparin plus planned glycoprotein IIb/IIIa inhibitor.