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.

Optimal concentration of epidural fentanyl in bupivacaine 0.1% after thoracotomy.

Background: The aim of this prospective, double-blind, randomized controlled trial was to investigate the analgesic and adverse effects of three commonly used concentrations of thoracic epidural fentanyl with bupivacaine in patients undergoing thoracotomy for lung resection.

Methods: We studied 99 patients who were randomized to receive fentanyl 2 microg ml(-1) (group 2), fentanyl 5 microg ml(-1) (group 5) and fentanyl 10 microg ml(-1) (group 10) in bupivacaine 0.1% via a thoracic epidural.

Anomalous origin of left internal mammary artery.

We present a case of a left internal mammary artery (LIMA) originating from the third part of the subclavian artery. Awareness of this possibility is particularly important when considering reintervention after coronary artery bypass surgery and the LIMA appears to be missing rather than obviously occluded.

Efficacy of thoracoscopic lung biopsy in interstitial lung diseases: comparison with open lung biopsy.

Objective: To determine the efficacy of video-assisted thoracoscopic surgery (VATS) compared to open lung biopsy.

Design: Descriptive, observational case series.

Place And Duration Of Study: The Cardio-thoracic Centre, Liverpool, UK, from January 1995 to December 1999.

Bronchoscopic insertion of Gianturco stents for the palliation of malignant lung disease: 10 year experience.

Malignant large airway obstruction is life threatening and may not be amenable to urgent radiotherapy. Palliative airway stenting is difficult and traditionally carried out under general anaesthesia and fluoroscopy. We have shown that self expanding Gianturco metal stents can be placed under local anaesthesia using fibreoptic bronchoscopy and direct vision for the treatment of malignant airway tumours, and report our 10 year experience.

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.

Infection control measures for adult cardiac surgery in the UK--a survey of current practice.

The aim of the study was to define current UK practice for antimicrobial prophylaxis and preoperative screening for bloodborne viruses and methicillin-resistant Staphylococcus aureus (MRSA) before routine cardiac surgery. An e-mail survey was sent to the Association of Cardiothoracic Anaesthetists (ACTA) Linkmen in all 36 UK adult cardiac surgical units, during May 2001. Questions were asked regarding MRSA, hepatitis B, C and human immunodeficiency virus (HIV) screening.

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.

Valvular heart operation is an independent risk factor for acute renal failure.

Background: Acute renal failure (ARF) after cardiac operation with cardiopulmonary bypass is associated with a high mortality rate. The purpose of this study was to determine and quantify whether valvular heart operation is an independent risk factor for developing ARF.

Methods: We retrospectively analyzed 5,132 consecutive patients who underwent cardiac operation involving cardiopulmonary bypass between April 1997 and March 2001.

The effect of obesity on mid-term survival following coronary artery bypass surgery.

Objective: Several studies have shown no significantly increased risk of in-hospital mortality for obese patients after coronary artery bypass grafting (CABG). However, the effect of obesity on mid-term survival has not been adequately studied. We set out to examine whether mid-term survival following CABG is affected by obesity.

Anomalous course of the right coronary artery in the right atrial wall: a word of caution.

We report a case of anomalous course of the right coronary artery in the wall of right atrium which was encountered during coronary artery bypass surgery. As the stenotic lesion in the vessel was proximal, the large posterior descending branch of the right coronary was grafted. Such an anomalous course of the right coronary artery has not been previously described in the literature and lack of knowledge of such an abnormal course may result in inadvertant damage during cannulation of the inferior vena cava or coronary sinus.

The simultaneous use of a biventricular implantable cardioverter defibrillator (ICD) and transcutaneous electrical nerve stimulation (TENS) unit: implications for device interaction.

Undesirable sensing of external sources of electromagnetic interference by ICDs is well known. A transcutaneous electrical nerve stimulation (TENS) device has been reported to interfere with an ICD resulting in an inappropriate shock and patients with implanted defibrillators or pacemakers have been cautioned about the use of such units to treat chronic pain. We describe a patient regularly using TENS therapy for pain who subsequently received a biventricular ICD for malignant ventricular arrhythmias and medically refractory cardiac failure.

In-hospital resource utilization in coronary angioplasty: the impact of increased coronary stenting rates and antiplatelet therapy.

BACKGROUND: The technique of coronary stenting has evolved over recent years, with improved stent technology and effective antiplatelet therapies to prevent stent thrombosis. In Europe, reductions in stent and equipment costs have resulted from increased market competition. The impact of these changes on the in-hospital procedural cost of percutaneous coronary intervention (PCI) in the current clinical setting is not known.

Gastroesophageal reflux and tracheal aspiration in the thoracotomy position: should ranitidine premedication be routine?

Unlabelled: Aspiration of gastric contents may contribute to pulmonary complications after thoracotomy. The incidence of gastroesophageal reflux (GER) and tracheal acid aspiration in patients undergoing thoracotomy in the lateral position is unknown. Ranitidine premedication reduces gastric volume, increases gastric pH, and may reduce GER.

Clinical outcomes of long coronary stents: a single-center experience.

BACKGROUND: Coronary artery stenting is particularly useful during percutaneous coronary intervention for long lesions previously associated with a low procedural success rate and a high complication rate of dissection and occlusion. Current treatment options include implantation of a single long stent, multiple contiguous stents, or 'spot' stenting. However, multiple stent implantation may result in sections of overlapping stent or gaps of unstented segments and is an independent predictor of restenosis.

Risk of morbidity and in-hospital mortality in obese patients undergoing coronary artery bypass surgery.

Objectives: Obesity is often perceived to be a risk factor for adverse outcomes following coronary artery bypass graft (CABG) surgery. Several studies have been unclear about the relationship between obesity and the risk of adverse outcomes. The aim of this study was to examine the relationship between obesity and in-hospital outcomes following CABG, while adjusting for confounding factors.

Intravenous hydration versus naso-jejunal enteral feeding after esophagectomy: a randomised study.

Objective: Patients undergoing esophagectomy are typically nutritionally depleted and cannot establish oral feeding for up to a week after surgery. We have investigated the routine use of enteral feeding via a naso-jejunal tube.

Methods: Forty consecutive patients undergoing a transthoracic esophagectomy for cancer were randomised to receive enteral feeding or intravenous crystalloid fluids after surgery.

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.

Long-term survival after permanent pacemaker implantation: analysis of predictors for increased mortality.

Aims: To determine long-term time-related survival and evaluate risk factors for increased mortality in patients following their first permanent pacemaker implantation.

Methods And Results: Analysis of patient records from implant to follow-up. Patient-specific time-lines were constructed to date of last review or death.