The effect of cardiopulmonary bypass and myocardial ischaemia on the occurrence of atrial fibrillation (AF) after coronary artery bypass graft (CABG) was studied in 136 patients undergoing off-pump CABG who were matched for age and number of distal anastomoses with 136 patients undergoing on-pump CABG. Possible risk factors for postoperative new-onset AF were recorded. AF occurred in 64 (24%) of the 267 patients for whom data could be analysed. AF occurred in 29 patients (22%) in the offpump group versus 35 (26%) in the onpump group, but this difference was not statistically significant. On univariate analysis, age and length of hospital stay were significant risk factors for the occurrence of AF. In a multivariate analysis that included operative technique, age was found to be the only significant risk factor. In conclusion, the occurrence of AF after CABG does not depend on the type of operation.
Background: In our study we compared the Ringer solution, which is the standard prime solution of our department, with the HES (Hydroxyethyl starch) 130-0.4 solution, which can be a potential alternative prime solution with an indispensable material for the cardio-pulmonary bypass applications.
Postoperative intravenous amiodarone prophylaxis followed by oral amiodarone significantly reduces the incidence of atrial fibrillation after off-pump coronary artery bypass grafting and the ventricular rate during atrial fibrillation.
Hypothermic total circulatory arrest and open proximal anastomosis techniques are not commonly used in abdominal or juxtarenal abdominal aortic aneurysm repair. Proximal aortic clamping is usually adequate for surgical repair of abdominal aortic pathologies. We present two cases of giant-sized abdominal aortic aneurysms, one was juxtarenal and one was a Crawford type IV thoracoabdominal aneurysm, that were repaired by using open proximal anastomosis under hypothermic total circulatory arrest and a transabdominal approach. This technique may be useful for both thoracoabdominal and large abdominal aortic aneurysms because it offers the opportunity to not clamp the aorta and operate in bloodless surgical field.
Intracoronary stenting is the definitive procedure after failed balloon angioplasty. It provides confirmed revascularization even when the target vessel has a severely calcified lesion leading to dissection or recoiling. 1,2 With the increasing use of flexible intracoronary stents there has been a rise in related complications including stent misplacement, stent embolization, acute and subacute stent thrombosis, and an increased risk of major bleeding due to anticoagulation therapy. 1-3 We report a case in which a balloon-expandable coronary stent was inadvertently dislodged from the coronary balloon catheter and became entrapped in the ostium of the left main coronary artery.A 54-year-old man with unstable chest pain was referred to our cardiology department for an angiographic study. He was diabetic and hypercholesterolemic. His coronary angiogram revealed a long-segment concentric lesion of 95% narrowing in the proximal part of the left anterior descending coronary artery (LAD), 70% narrowing in mid-right coronary artery, and 30% narrowing in the proximal left circumflex artery. Elective percutaneous transluminal coronary angioplasty was carried out in these vessels. Residual stenosis in the LAD was greater than 50% due to elastic recoil. Because of threatened closure of the LAD, insertion of a balloon-expandable coronary stent, 26 mm in length and 3.5 mm in width, was attempted. Placement of the stent was unsuccessful and as it was being withdrawn, the unexpanded stent was dislodged from the coronary balloon catheter to the ostium of the left main coronary artery. The patient suffered ischemia, chest pain, bradycardia, and hypotension. Retrieval was not attempted for fear of stent loss in the ascending aorta and due to the patient's hemodynamic instability. It was decided to remove the stent surgically. An intra-aortic balloon pump was positioned and rapid induction of anesthesia and institution of cardiopulmonary bypass with moderate hypothermia were carried out. As the patient's condition was not stable, the left internal thoracic artery was not prepared. An aortotomy was performed on the ascending aorta. One third of the stent was in the lumen of the ascending aorta. The stent was successfully removed with forceps from the ostium of the left main coronary artery. Triple coronary artery bypass was performed using saphenous veins. Prompt revascularization of the LAD was achieved first. The saphenous vein grafts were used to deliver additional cold blood cardioplegia. The mean time from the onset of ischemia to revascularization of the target vessel was 35 minutes. The patient's postoperative course was uneventful and he was discharged on the 8th postoperative day. Angiography was performed 13 months later, all the grafts were patent and the patient was symptom-free and leading an active life.Commercially available retrieval devices such as a gooseneck snare, biliary forceps, and a multipurpose basket have been recommended to operators involved in intracoronary stent placement. 4 In this patient, removal of t...
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