Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay.

Background: We aimed to identify risk factors for reexploration for bleeding after surgical revascularization in our practice. We also looked at the impact of resternotomy and the effect of time delay on mortality and other in-hospital outcomes.

Methods: In all, 2,898 consecutive patients undergoing coronary artery bypass grafting between April 1999 and March 2002 were retrospectively analyzed from our cardiac surgery registry.

Left internal mammary artery to the left anterior descending artery: effect on morbidity and mortality and reasons for nonusage.

Background: The left internal mammary artery to the left anterior descending artery is recognized as the gold standard for revascularization. Several studies have shown the benefits of the left internal mammary artery. However, a substantial portion of patients undergoing coronary artery bypass grafting does not receive this conduit.

Effect of training on outcomes following coronary artery bypass graft surgery.

Objective: We examined our coronary artery bypass surgery (CABG) experience to assess the effect of training on mortality and morbidity outcomes.

Methods: Between April 1997 and September 2002, 5678 consecutive patients underwent isolated CABG. Five hundred and fifty-five (9.

Monitoring blood transfusion in patients undergoing coronary artery bypass grafting: an audit methodology.

Background And Objectives: The purpose of this work was to describe the methodology used to build a transfusion database that allows continuous audit of transfusion practices in coronary artery bypass surgery.

Materials And Methods: The transfusion database requires electronic data available from two sources: the hospital's patient administration system; and the local blood transfusion service.

Results: We demonstrated a reduction in the percentage of patients receiving red blood cell transfusion: from 47.

Intratracheal cocaine induced myocardial infarction: an unusual complication of fibreoptic bronchoscopy.

A 73 year old man developed chest pains 5 minutes after fibreoptic bronchoscopy. The procedure had been performed without sedation following an intratracheal injection of 5 ml 2.5% cocaine solution and xylocaine spray to the pharynx for topical anaesthesia.

Effect of avoiding cardiopulmonary bypass in non-elective coronary artery bypass surgery: a propensity score analysis.

Objective: Non-elective coronary artery surgery (emergent/salvage or urgent) carries an increased risk in most risk-stratification models. Off-pump coronary surgery is increasingly used in non-elective cases. We aimed to investigate the effect of avoiding cardiopulmonary bypass on outcomes following non-elective coronary surgery.

Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery.

Objective: To identify risk factors for sternal wound infection following coronary artery bypass surgery (CABG), and to compare early and mid-term survival outcome.

Methods: Data were prospectively collected for 4228 patients who underwent CABG surgery between April 1997 and March 2001. One hundred and nine (2.

Neurological outcomes in coronary surgery: independent effect of avoiding cardiopulmonary bypass.

Background: Recent studies examining neuroprotective effects of off-pump coronary artery bypass grafting (CABG) have shown inconsistent results. We examined our database to quantify the independent effects of avoidance of cardiopulmonary bypass (CPB) and aortic manipulation on neurologic outcomes after CABG.

Methods: A total of 2,327 consecutive cases undergoing isolated CABG between April 1997 and May 2001 were identified at our two institutions.

The effect off-pump coronary artery bypass surgery on in-hospital mortality and morbidity.

Objective: Off-pump coronary artery bypass (OPCAB) surgery is being increasingly reported to show better outcomes compared to conventional on bypass grafting. We examined the effect of OPCAB on in-hospital mortality and morbidity, while adjusting for patient and disease characteristics, in four institutions in the North West of England.

Methods: Between April 1997 and March 2001, 10,941 consecutive patients underwent isolated coronary artery bypass surgery at these four institutions.

'Shunt shuffle'-a simple technique of introducing intracoronary shunts for off-pump coronary artery bypass.

Intracoronary shunting is a useful method for maintaining distal perfusion as well as providing a bloodless field during off-pump coronary revascularization. Intracoronary shunts require insertion of both ends through a limited arteriotomy, which sometimes can be troublesome. We describe the 'shunt shuffle' as a simple technique, which allows rapid, atraumatic and easy insertion of intracoronary shunts.

Should we rely on nasopharyngeal temperature during cardiopulmonary bypass?

A potential morbidity of incomplete re-warming following hypothermic cardiopulmonary bypass (CPB) is cardiac arrest. In contrast, attempts to fully re-warm the patient can lead to cerebral hyperthermia. Similarly, rigid adherence to 37.

Successful primary angioplasty in Hughes syndrome.

Acute myocardial infarction is a well-recognized complication of the Hughes syndrome but its optimal treatment is uncertain. We report a case of a 42-year-old man with a history of previous arterial and venous thrombosis who presented with an acute myocardial infarction that was successfully treated by primary angioplasty and stenting.

Isoflurane and coronary heart disease.

Early studies indicated that isoflurane caused coronary steal and should therefore be avoided in patients with coronary heart disease. Subsequently, more detailed trials have disputed this and have shown that as long as coronary perfusion pressure is maintained, isoflurane does not cause coronary steal or myocardial ischaemia. There is now growing evidence, initially in animal work but more recently in human studies, that isoflurane has myocardial protective properties, limiting infarct size and improving functional recovery from myocardial ischaemia.

Does off-pump total arterial revascularization without aortic manipulation influence neurological outcome? A study of 226 consecutive, unselected cases.

Background: Off-pump coronary artery bypass (OPCAB) is increasingly reported to have better post-operative outcomes than on-pump coronary artery bypass (ONCAB). Most series report OPCAB in selected cases and therefore the results of such studies are affected by selection bias. We report our series of consecutive, unselected OPCAB cases representing an entire coronary revascularization practice and its effect on neurological outcome.

Does lung biopsy help patients with interstitial lung disease?

Objectives: The decision to perform lung biopsy in the evaluation of interstitial lung disease (ILD) is based on the probability that this examination will yield a specific diagnosis, leading to a change in treatment. The purpose of this study was to identify factors that influence the diagnostic yield of lung biopsy for ILD.

Methods: One hundred patients underwent lung biopsy for ILD over a 5-year period.

"Cutting Balloon and the Three Burrs": treatment for ostial left anterior descending artery in-stent restenosis.

A 58-year-old man re-presented with symptoms of angina 3 months after percutaneous transluminal coronary angioplasty (PTCA) and stenting to his proximal left anterior descending artery (LAD). Angiography revealed ostial in-stent restenosis of the LAD, which was treated with rotational atherectomy and a cutting balloon PTCA. Combining two useful technologies for treating in-stent restenosis may prove to yield better results than using either technique alone.

Suprascapular nerve block for ipsilateral shoulder pain after thoracotomy with thoracic epidural analgesia: a double-blind comparison of 0.5% bupivacaine and 0.9% saline.

Unlabelled: Despite receiving thoracic epidural analgesia, severe ipsilateral shoulder pain is common in patients after thoracotomy. We recruited 44 patients into a double-blinded randomized placebo-controlled study to investigate whether suprascapular nerve block would treat postthoracotomy shoulder pain effectively. All patients received a standard anesthetic with a midthoracic epidural.

Left circumflex coronary artery to left atrial fistula in a patient with mitral regurgitation after excision of a left atrial myxoma.

Acquired coronary artery to left atrial fistulas are rare and previously only described in mitral stenosis associated with left atrial thrombus or coronary arteriosclerosis. We present the case of a patient who developed a left circumflex coronary artery to left atrial fistula associated with mitral regurgitation 12 years after excision of a left atrial myxoma. This was successfully ligated at the time of mitral valve replacement.

Cardiac rupture caused by Staphylococcus aureus septicaemia and pericarditis: an incidental finding.

A 35 year old woman with a long history of intravenous drug abuse presented to a local hospital with severe anaemia, fever, raised markers of inflammation, and positive blood cultures for Staphylococcus aureus. She responded to treatment with antibiotics with improvement in her symptoms and markers of inflammation. Four weeks later a "routine" echocardiogram showed a rupture of her left ventricular apex and a large pseudoaneurysm.

Sustaining care delivery--team nursing with intensive care assistants.

The Cardiothoracic Centre Liverpool faced an acute nursing recruitment problem, which is accentuated in the specialist area of intensive care. To ensure that activity through the 20-bedded unit remains broadly in line with contracted levels, a number of initiatives were implemented to help maximise the financial and non-financial resources available.