Heparin therapy during extracorporeal circulation: deriving an optimal activated clotting time during cardiopulmonary bypass for isolated coronary artery bypass grafting.

Bull's seminal work on heparin therapy during cardiopulmonary bypass (CPB) was carried out over 30 years ago and has not been updated in the modern era. No correlation with postoperative blood loss was performed. The optimal activated clotting time (ACT) with regard to blood loss has not been established for patients undergoing CPB.

Patient directed bypass: cooling for aortic surgery--a preliminary concept.

No consensus exists as to the temperature to cool to on bypass for surgery involving the aortic arch. Excluding normothermic surgery, which is rarely performed for arch work, circulatory arrest, anterograde, and retrograde cerebral perfusion either in isolation or in combination remain the techniques of "cerebral protection." To date, no account of individual patient body or cerebral function variation is involved.

Patient directed perfusion pressure on bypass, an analogy from electrical engineering--a new concept.

Organ ischemia, particularly mesenteric and renal, can occur despite a seemingly adequate perfusion flow and pressure during a period of cardiopulmonary bypass. The blood pressure to run bypass at remains a contentious issue. We present the concept that perfusion pressure during cardiopulmonary bypass should be patient specific, depending on an individual's resting pre-procedural blood pressure.

Preoperative hyponatremia and cardiopulmonary bypass: yet another factor for cerebral dysfunction?

Hyponatremia is common in patients prior to cardiopulmonary bypass (CPB), usually secondary to diuretic therapy. Rapid correction of chronic hyponatremia, which potentially occurs on commencing CPB, may in susceptible patients result in central pontine myelomatosis. There are three parts to this study.

Cardiac comorbidity is not a risk factor for mortality and morbidity following surgery for primary non-small cell lung cancer.

Objective: We examined the effect of cardiac comorbidity on mortality and postoperative complications following surgery for primary non-small cell lung cancer.

Methods: Between October 2001 to December 2005, 1067 consecutive patients underwent lung resection for primary cancer within a single centre; patient data was collected prospectively. Two hundred and seventy-one patients had a history of cardiac comorbidity, which included 196 angina, 118 myocardial infarction, 36 revascularisation, 10 congestive cardiac failure and 19 rhythm disorders (numbers not mutually exclusive).

[Chest X-ray and computed tomography in the evaluation of pulmonary emphysema].

Emphysema is a condition of the lung, characterized by the abnormal increase in the size of the airspace distal to the terminal bronchioles. Currently, emphysema is the fourth leading cause of death in the USA, affecting 14 million people. The present article describes the principal tools in the imaging diagnosis of emphysema, from the early days until the present.

Do beating heart techniques applied to combined valve and graft operations reduce myocardial damage?

We examined the outcomes of combined beating heart CABG and valve surgery (hybrid) and compared these to conventional CABG and valve surgery (conventional). Between April 1997 and March 2006, 388 patients received combined CABG and valve surgery. Patient characteristics and cardiac enzyme release were collected prospectively.

Left internal mammary artery use in patients with poor left ventricular ejection fraction: a propensity-matched analysis of mid-term survival.

We aimed to determine whether the use of left internal mammary artery (LIMA) to the left anterior descending (LAD) artery during coronary artery bypass grafting (CABG) confers an improved survival benefit to patients with an impaired preoperative left ventricular ejection fraction (LVEF). Between April 1997 and March 2004, 7198 consecutive patients underwent first time CABG to the LAD. There were 627 patients who had an LVEF <30% and of these, 548 patients (87.

Mid-term survival after cardiac surgery in elderly patients: analysis of predictors for increased mortality.

This study examines and quantifies the potential risk factors for increased mid-term mortality in elderly patients (> or = 75 years old) undergoing cardiac surgery. We undertook a retrospective analysis of 840 consecutive elderly patients who underwent cardiac surgery (CABG and/or Valve) between April 1997 and March 2002. Deaths occurring as a function of time were described using the product limit methodology of Kaplan and Meier.

Preoperative beta-blocker therapy in coronary artery bypass surgery: a propensity score analysis of outcomes.

Preoperative beta-blockade in patients undergoing coronary artery bypass grafting (CABG) has recently been shown to be beneficial in improving the early outcomes after surgery. We aimed to quantify the effect of preoperative beta-blockade on outcomes in our own patient population. We performed a retrospective analysis on CABG patients identified from our prospectively collected cardiac surgery database.

Logistic risk model for prolonged ventilation after adult cardiac surgery.

Background: The aim of this study was to develop a multivariate risk prediction model for prolonged ventilation after adult cardiac surgery.

Methods: This is a retrospective analysis of prospectively collected data on 12,662 consecutive patients undergoing adult cardiac surgery between April 1997 and March 2005. Data were randomly split into a development dataset (n = 6,000) and a validation dataset (n = 6,662).

Ambulatory cardiac rhythm monitoring.

Cardiac arrhythmias may cause palpitations, dyspnoea, angina pectoris, dizziness or even syncope and sudden death. This article will review the indications for investigation, the novel devices that are available for investigating patients with suspected cardiac dysrhythmias and the new technology available for analysis and reporting.

A multi-centre additive and logistic risk model for in-hospital mortality following aortic valve replacement.

Objective: To develop a multivariate prediction model for in-hospital mortality following aortic valve replacement.

Methods: Retrospective analysis of prospectively collected data on 4550 consecutive patients undergoing aortic valve replacement between 1 April 1997 and 31 March 2004 at four hospitals. A multivariate logistic regression analysis was undertaken, using the forward stepwise technique, to identify independent risk factors for in-hospital mortality.

Edge-to-edge technique for mitral valve repair: medium-term results with echocardiographic follow-up.

Background: The follow-up data for the Alfieri edge-to-edge technique of mitral valve repair is still a matter of interest. We describe the medium-term results of a single surgeon's practice with clinical and echocardiographic follow-up.

Methods: Between October 1998 and July 2003, 41 patients underwent the Alfieri repair.

Does off-pump surgery offer benefit in high respiratory risk patients? A respiratory risk stratified analysis in a propensity-matched cohort.

Objective: The role of off-pump surgery in high respiratory risk patients remains unclear. In this study, we aim to evaluate the effect of off-pump surgery on high respiratory risk patients.

Methods: To achieve comparative groups, a five digit propensity score matching with 18 pre-operative variables was performed on 4406 consecutive CABG patients operated between January 2000 and September 2003.

Does prophylactic sotalol and magnesium decrease the incidence of atrial fibrillation following coronary artery bypass surgery: a propensity-matched analysis.

Background: Atrial fibrillation can occur in up to 40% of patients undergoing coronary surgery.

Methods: We retrospectively analysed 103 consecutive coronary surgery patients under the care of one surgeon between April 2003 and September 2003. These patients received 40 mg of sotalol orally twice daily from the first post-operative day for 6 weeks and 2 g of magnesium intravenously immediately post surgery and on the first post-operative day.

Intestinal ischaemia following cardiac surgery: a multivariate risk model.

Objective: Intestinal ischaemia following cardiac surgery is a serious complication, which carries a high mortality rate. Several studies have examined pre-operative and intra-operative risk factors. We aimed to develop a multivariate risk model to identify those patients at highest risk of intestinal ischaemia.

Acute renal failure in patients with ischemic heart disease: causes and novel approaches in breaking the cycle of self-perpetuating insults abrogated by surgery.

At present, there seems to be diametrically opposing views on the causes of acute renal insufficiency in patients with ischemic heart disease (IHD) elective for cardiac revascularization. In this review, we examined recent advances in the understanding of the pathophysiology of acute renal failure in patients with IHD and surgery-induced acute phase reaction. Emphasis is given to the cellular and molecular mechanisms that contribute to the initiation and progression of inflammation.

Preoperative white blood cell count is independently associated with higher perioperative cardiac enzyme release and increased 1-year mortality after coronary artery bypass grafting.

Background: Elevated preprocedural systemic markers of inflammation, including white blood cell count, have been associated with adverse clinical outcomes after percutaneous coronary intervention. The relationship between preoperative white blood cell count and clinical outcomes after coronary artery bypass grafting is less clear despite increasing evidence that neutrophils participate in reperfusion injury. We sought to determine the relationship between preoperative white blood cell count and in hospital major morbidity and 1-year survival after coronary artery bypass grafting.

Effect of the left internal mammary artery to the left anterior descending artery on mortality and morbidity after combined coronary and valve operations.

Background: The effect of using the left internal mammary artery in combined coronary and valve operations have not been fully investigated. We aimed to quantify the impact of the left internal mammary artery to the left anterior descending artery on early and mid-term outcomes in these patients.

Methods: Data was collected prospectively on 630 consecutive patients who underwent revascularization of the left anterior descending artery with concomitant valve operations between April 1997 and March 2003.

Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery.

Objective: The purpose of this study was to examine the effect of peri-operative red blood cell (RBC) transfusion on 30-day and 1-year mortality following coronary artery bypass grafting (CABG).

Methods: We retrospectively analysed 3024 consecutive patients who underwent isolated CABG between January 1999 and December 2001. Patient records were linked to the National Strategic Tracing Service, which records all mortality in the UK.

Total arterial revascularisation: effect of avoiding cardiopulmonary bypass on in-hospital mortality and morbidity in a propensity-matched cohort.

Objective: The combination of total arterial revascularisation and avoidance of cardiopulmonary bypass may provide additional benefits to patients receiving complete arterial grafting with cardiopulmonary bypass. We performed a propensity-matched cohort study of complete arterial off-pump and on-pump coronary surgery and examined differences in in-hospital mortality and morbidity.

Methods: Three hundred and sixty patients who underwent off-pump coronary surgery with complete arterial grafting between April 1997 and September 2002 were matched to 360 patients who received coronary surgery with cardiopulmonary bypass and complete arterial grafting.

On-pump versus off-pump coronary artery bypass grafting in diabetic patients: a propensity score analysis.

Background: Diabetic patients are recognized as being at high risk for adverse outcomes after coronary artery bypass grafting. We evaluated our outcomes in diabetic patients to compare the effect of off-pump with on-pump coronary revascularization.

Methods: Between April 1997 and September 2002, 951 consecutive diabetic patients underwent isolated coronary artery bypass grafting.

Limitations of additive EuroSCORE for measuring risk stratified mortality in combined coronary and valve surgery.

Objective: To study the use of the additive and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) to predict mortality following adult combined coronary artery bypass grafting (CABG) and valve surgery.

Methods: Data were collected prospectively, from all four centres providing adult cardiac surgery in the north west of England, on 1769 consecutive patients undergoing combined CABG and valve surgery between April 1997 and March 2002. Observed in-hospital mortality was compared to predicted mortality as determined by both additive and logistic EuroSCORE.