Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients.

Background: This retrospective study compared clinical outcomes and resource utilization in patients having off-pump coronary artery bypass grafting (OPCAB) versus conventional coronary artery bypass grafting (CABG). Angiographic patency was documented in the OPCAB group.

Methods: From April 1997 through November 1999, OPCAB was performed in 200 consecutive patients, and the results were compared with those in a contemporaneous matched control group of 1,000 patients undergoing CABG.

Myocardial protection for off-pump coronary artery bypass surgery.

Myocardial protection during off-pump coronary artery bypass surgery (OPCAB) is a multifactorial problem. Careful, individualized choice of graft sequence and maintenance of stable systemic hemodynamics are of central importance. Recently refined techniques for atraumatic rotation of the heart and visualization of coronary anastomoses allow precise and controlled grafting of all coronary territories without cardiopulmonary bypass in the large majority of cases.

Risk factors for ARDS in the United States: analysis of the 1993 National Mortality Followback Study.

Objective: To identify specific comorbid factors that are present in US decedents with ARDS.

Design: We searched the 1993 National Mortality Followback Study for all decedents who had a code for ARDS mentioned on their death certificate. We also searched for comorbid conditions both on the death certificates (sepsis, medical or surgical misadventures, cirrhosis) and in the study database (current or former smoking, use of alcohol at least 3 d/wk, race, gender, and age).

Clinical outcomes and angiographic patency in 125 consecutive off-pump coronary bypass patients.

Background: This study compared clinical outcomes, length of stay, and hospital costs in patients having off-pump coronary bypass (OPCAB) versus conventional bypass surgery (CABG).

Methods: From November 1996 through April 9, 1999, OPCAB was performed for 125 consecutive patients and compared with a contemporaneous, matched control group of 625 CABG patients. Patients were matched according to age, gender, incidence of renal failure, diabetes, pulmonary disease, stroke (CVA), hypertension, peripheral vascular disease, and previous myocardial infarction.

In vivo hemodynamic, histologic, and antimineralization characteristics of the Mosaic bioprosthesis.

Background: Performance of bioprosthetic valves is limited by tissue degeneration due to calcification with reduced performance and longevity. The Mosaic bioprosthetic valve (Medtronic Heart Valves, Inc, Minneapolis, MN) combines zero pressure fixation, antimineralization properties of alpha-amino oleic acid (AOA), and a proven stent design. We tested the hypothesis that AOA treatment of Mosaic valves improves hemodynamics, antimineralization properties, and survival in a chronic ovine model.

Coronary sinus compression as a sign of cardiac tamponade.

Coronary perforation and resultant cardiac tamponade are well-known but rare complications of percutaneous coronary interventions. We present a case that demonstrates coronary sinus compression caused by increasing pericardial pressure as a new sign of impending cardiac tamponade. This previously unreported angiographic sign preceded hemodynamic, symptomatic, and echocardiographic evidence of tamponade.

Bradyarrhythmias, temporary and permanent pacing.

Bradycardia is common in critical care units. It may be transient, asymptomatic and of little consequence, or life-threatening. Bradycardia may result from abnormalities of the sinus node, atrioventricular node, or the His-Purkinje system.

Gender and preceptors' feedback to students.

To determine whether evaluation comments differed based on preceptors' and students' genders, preceptors' evaluations of medical students were analyzed. Preceptors tended to comment on the same themes in the same proportions, regardless of gender. However, women preceptors commented about "Personality/Maturity" and "Personality/Character" more frequently for men students than they did for women students.

Comparative study of AMP579 and adenosine in inhibition of neutrophil-mediated vascular and myocardial injury during 24 h of reperfusion.

Objective: The purpose of this study was to compare protective effects of AMP579 and adenosine (Ado) at reperfusion (R) on inhibition of polymorphonuclear neutrophil (PMN) activation, PMN-mediated injury to coronary artery endothelium, and final infarct size.

Methods: In anesthetized dogs, 1 h of left anterior descending coronary artery occlusion was followed by 24 h R and drugs were administered at R. Control (n=8, saline control), AMPI (n=7, AMP579, 50 microg/kg i.

The use of intrastent peripheral stent in large coronary arteries: report of three cases.

We report three cases of coronary angioplasty using the IntraTherapeutics Intrastent biliary stent. We describe a technique utilizing routine coronary angioplasty equipment including 8 Fr guiding catheters and 0.014" guidewires.

Nonanticoagulant heparin inhibits NF-kappaB activation and attenuates myocardial reperfusion injury.

Heparin reduces ischemia-reperfusion injury to myocardium. This effect has been attributed to complement inhibition, but heparin also has other activities that might diminish ischemia-reperfusion. To further probe these mechanisms, we compared heparin or an o-desulfated nonanticoagulant heparin with greatly reduced anticomplement activity.

Hypothermic circulatory arrest causes multisystem vascular endothelial dysfunction and apoptosis.

Background: Multiple organ failure after deep hypothermic circulatory arrest (DHCA) may occur secondary to endothelial dysfunction and apoptosis. We sought to determine if DHCA causes endothelial dysfunction and apoptosis in brain, kidney, lungs, and other tissues.

Methods: Anesthetized pigs on cardiopulmonary bypass were: (1) cooled to 18 degrees C, and had their circulation arrested (60 minutes) and reperfused at 37 degrees C for 90 minutes (DHCA, n = 8); or (2) time-matched normothermic controls on bypass (CPB, n = 6).

Transvenous cardioverter defibrillator lead malfunction due to terminal connector damage in pectoral implants.

Lead failure places patients with implantable cardioverter defibrillators (ICD) at risk for sudden cardiac death or results in delivery of inappropriate shocks. This study describes a mechanism of lead malfunction occurring at the junction of the terminal ring with the conductor coil of the rate sensing terminal connector in one specific model of a transvenous ICD lead. We detected the problem in a population of 179 patients with a mean age of 61 +/- 10 years and a mean lead implant duration of 16 +/- 11 months.

The role of neutrophils in myocardial ischemia-reperfusion injury.

Reperfusion of ischemic myocardium is necessary to salvage tissue from eventual death. However, reperfusion after even brief periods of ischemia is associated with pathologic changes that represent either an acceleration of processes initiated during ischemia per se, or new pathophysiological changes that were initiated after reperfusion. This 'reperfusion injury' shares many characteristics with inflammatory responses in the myocardium.

The cardiovascular effects and implications of peroxynitrite.

Nitric oxide is an endogenous autacoid produced primarily by the vascular endothelium. Under basal conditions, nitric oxide undergoes a rapid biradical reaction with superoxide anions to form peroxynitrite. This reaction, and hence the formation of peroxynitrite is augmented in inflammatory-like conditions such as ischemia-reperfusion injury when both substrates are present in high concentrations.

Peroxynitrite, the breakdown product of nitric oxide, is beneficial in blood cardioplegia but injurious in crystalloid cardioplegia.

Background: Peroxynitrite (ONOO(-)) has been implicated as a primary mediator in the deleterious effects of nitric oxide (NO) in crystalloid solutions, possibly due to a lack of detoxification mechanisms, leading to the formation of.OH. In contrast, ONOO(-) may exert cardioprotective effects in blood environments secondary to detoxification and the subsequent formation of NO-donating nitrosothiols.

Adenosine-supplemented blood cardioplegia attenuates postischemic dysfunction after severe regional ischemia.

Background: Various studies have reported that the administration of adenosine (ADO) in cardioplegia reduces myocardial ischemic injury, but this timing may not utilize ADO's potential against myocardial reperfusion injury. This study tested the hypothesis that ADO-supplemented blood cardioplegia (BCP) or ADO administered during reperfusion reduces postischemic dysfunction after severe regional ischemia.

Methods And Results: After 75 minutes of left anterior descending coronary artery occlusion, total cardiopulmonary bypass was initiated; cold (4 degrees C) antegrade BCP (8:1 blood:crystalloid) was delivered every 20 minutes for the first 3 doses, and 27 degrees C BCP was delivered for the terminal infusion.

A(3) adenosine receptor activation attenuates neutrophil function and neutrophil-mediated reperfusion injury.

This study tested the hypothesis that A(3) adenosine receptors inhibit neutrophil (PMN) function and PMN-mediated reperfusion injury. 2-Chloro-N(6)-(3-iodobenzyl)adenosine-5'-N-methyluronamide (Cl-IB-MECA), an A(3) agonist, did not attenuate superoxide production or myeloperoxidase release from stimulated PMNs. However, Cl-IB-MECA reduced platelet-activating factor-stimulated PMN adherence to coronary endothelium at low concentrations: 52 +/- 27, 45 +/- 10, and 87 +/- 23 PMNs/mm(2) at 0.

Risk neutralization in cardiac operations: detection and treatment of associated carotid disease.

Background: A screening and treatment protocol was implemented to extend the benefit of prophylactic carotid endarterectomy to patients who had open heart operations.

Methods: Patients aged 65 or older or who at any age had left main coronary disease, transient ischemic attack, or stroke were eligible for preoperative carotid duplex screening. Carotid endarterectomies and open heart operations were planned as a staged (n = 59) or combined procedure (n = 55) for angiographically confirmed carotid stenosis of at least 80%.

Clinical decision-making processes in perioperative nursing.

The purpose of this phenomenological study was to reveal the processes of clinical decision making by expert perioperative nurses. Six nurses with a minimum of five years experience who considered themselves to be experts in OR nursing were asked to describe perioperative situations in which they had made a difference in patient outcomes. In every situation described, an intricate pattern of concern was present and associated with further assessments.

Nitric oxide and the vascular endothelium in myocardial ischemia-reperfusion injury.

The normal coronary vascular endothelium (VE) tonically releases nitric oxide (NO) by converting L-arginine to citrulline by a constitutive NO synthase. Reperfusion after myocardial ischemia reduces basal and stimulated release of NO. This "vascular reperfusion injury" is mediated largely by neutrophils (PMN) through specific interactions between adhesion molecules on the endothelium and the PMN, an interaction that precedes myocyte injury.

Adenosine A(3)-receptor stimulation attenuates postischemic dysfunction through K(ATP) channels.

We tested the hypothesis that selective adenosine A(3)-receptor stimulation reduces postischemic contractile dysfunction through activation of ATP-sensitive potassium (K(ATP)) channels. Isolated, buffer-perfused rat hearts (n = 8/group) were not drug pretreated (control) or were pretreated with adenosine (20 microM), 2-chloro-N(6)-(3-iodobenzyl)-adenosine-5'-N-methyluronamide (Cl-IB-MECA; A(3) agonist, 100 nM), Cl-IB-MECA + 8-(3-noradamantyl)-1,3-dipropylxanthine (KW-3902; A(1) antagonist, 5 microM), Cl-IB-MECA + glibenclamide (Glib; K(ATP)-channel blocker, 0. 3 microM), or Glib alone for 12 min before 30 min of global normothermic ischemia followed by 2 h of reperfusion.

Financial implications of implementing a hospitalist program.

The use of hospitalists, who are physicians specializing in providing hospital inpatient care, has become increasingly popular. Preliminary data suggest that hospitalists can shorten inpatient lengths of stay and lower costs without compromising clinical outcomes or patient satisfaction. The role of hospitalists, their position in the organizational framework, and their contractual and financial relationships are influenced by the structure of the healthcare organization in which they work.