No abstract

Background-Atrial fibrillation (AF) often occurs after coronary artery bypass grafting and can result in increased morbidity and mortality. In the present pilot study, our aim was to investigate whether sodium nitroprusside (SNP), as a nitric oxide donor, can reduce the frequency of post-coronary artery bypass grafting AF. Methods and Results-To investigate the effectiveness of SNP in the prophylaxis of AF, we conducted a prospective, randomized, placebo-controlled clinical study on 100 consecutive patients in whom we performed elective and initial CABG operations. A control group of 50 patients were treated with placebo (dextrose 5% in water), whereas the SNP group (nϭ50 patients) was treated with SNP (0.5 g · kg Ϫ1 · min Ϫ1 ) during the rewarming period. High-sensitivity C-reactive protein levels were measured before surgery and 5 days postoperatively. All patients were monitored postoperatively with telemetry. Baseline characteristics were similar in both treatment groups. AF occurred in 12% of the SNP group and 27% of the control group. The occurrence of AF was significantly lower in the SNP group (Pϭ0.005). The duration of AF in the SNP group was significantly shorter than that in the control group (5.33Ϯ1.86 and 7.55Ϯ1.94 hours, respectively; Pϭ0.023). C-reactive protein levels were higher postoperatively in the control group than in the SNP group (PϽ0.05). Postoperative AF significantly prolonged postoperative hospital stay (PϽ0.05). Conclusions-The

No abstract

SNP administration during rewarming period of non-pulsatile CPB in patients undergoing CABG surgery is associated with improved renal function compared with conventional medical treatment providing adequate preload and mean arterial pressures.

BackgroundAlthough off-pump coronary artery bypass (OPCAB) surgery has many beneficial effects compared with on-pump surgery, switch to on-pump surgery has significantly higher risks of operative mortality. Benefits of OPCAB over on-pump surgery strategies concerning myocardial revascularization are still debatable. We have aimed to develop an "algorithm of off-pump surgical strategy" on preventing conversion to on-pump. This clinical study reports our clinical outcome of OPCAB in patients with acute coronary syndrome.MethodsBetween January 2006 and December 2008, 198 patients with acute coronary syndrome were enrolled in the study. Decision of OPCAB (142 patients) or on-pump surgery (56 patients) was made according to patients' present clinical status and our surgical background. Cardiac enzymes, duration of the surgery, graft numbers, stay in intensive care unit were recorded.ResultsOPCAP group has shorter operation time (82.78 min versus 164.22 min, p < 0.001), lesser necessity for intra-aortic balloon pumping (3.5% versus 12.5%, p = 0.053), shorter duration of intensive care unit stay (p < 0.05) and hospital stay (p < 0.001) compared to on-pump patients. EuroSCORE level was lower in OPCAP group (p < 0.001). None of the patients of OPCAB group required conversion to on-pump technique.ConclusionsThe patients who admitted to the hospital with acute coronary syndrome within "golden hours" (within 6 hours after onset) had a greater chance for OPCAB surgery. This study proves that EuroSCORE is likely to be an important factor in deciding which surgical technique to use, but a further investigation is needed to verify. According to our findings, a careful evaluation of coronary angiography, hemodynamic status, quality of target coronary vessel and timing of surgery are important for OPCAB surgery to avoid conversion to on-pump. By a careful systematic evaluation of the patients as explained with this article, it can be prevent or reduce conversion to on-pump surgery during OPCAB surgery.

No abstract

Figure 1. Carbon dioxide insufflation into the endothoracic fascia by using an injector with a 24-gauge needle.Figure 2. Subpleural emphysema along the ITA.Brief Communications

The study aimed to assess the performance of the On-X valve (Medical Carbon Research Institute, Austin, TX). Between December 2000 and January 2003 On-X valves were implanted in 400 patients aged 19-85 years (mean: 55.6+/-16), 290 males and 210 females. There were 120 cases of aortic valve replacement (AVR), 258 mitral valve replacement (MVR) and 22 combined aortic and mitral valve replacement (DVR). Additional procedures were performed in 144 patients. Patients were followed up prospectively at 3- to 6-month intervals. Mean follow-up was 38.4+/-11.8 months (maximum 55.6 months). Overall hospital mortality was 3.5%. Freedom from adverse events at 4 years in the study were as follows: thromboembolism, 99.1% for AVR, 98.3% for MVR and 94.7% for DVR patients; thrombosis, 100% for AVR, 99.2% for MVR and 94.7% for DVR; bleeding events, 99.1% for AVR, 99.2% for MVR and 88.8% for DVR; prosthetic endocarditis, 98.2% for AVR, 99.2% for MVR and 94.7% for DVR. Overall survival at 4 years was 92+/-1%. At echocardiographical examination within 1 year of the AVR, the mean aortic valve gradient was 12.8+/-6, 10.3+/-3, 9.0+/-4, 8.3+/-3, and 6.2+/-3 mmHg for 19, 21, 23, 25, 27/29 mm valve sizes, respectively. MVR mean gradient was 4.9+/-2, 4.5+/-1.2 and 4.0+/-0.8 mmHg for 25, 27/29, 31/33 mm valve sizes, respectively. On-X valve is a highly effective mechanical valve substitute with low morbidity and mortality and good functional results.