There is no reduction of AF rate in myocardial revascularization without cardiopulmonary bypass. However, prophylactic beta-blocker usage decreases the incidence of AF after both on-pump and off-pump myocardial revascularization.

Problems of wound healing are commonly observed after coronary bypass grafting (CABG) operations. Our aim is to determine the prevalence and the predictors of saphenous vein harvesting complications after coronary artery bypass surgery. One hundred twenty six patients operated in the specified period were included in this prospective study. In an early period 3 patients were excluded because of their mortality. Twenty patients were female and 103 were male. Forty three patients underwent an open procedure with one incision (35%), 61 patients also underwent an open procedure but with multiple incisions (49%), and 19 patients underwent a closed procedure with stripper (16%). Complications related with leg incisions after surgery were investigated. Multiple incision technique has the longest (49.28 ± 14.7 cm; p < 0.001) total incision length (compare to single incision and stripper technique). As incision length increases, the incidence of drainage ( p < 0.01), pain score ( p < 0.05), hematoma ( p < 0.05) and diffuse ecchymosis ( p < 0.05) were increased. Drainage was seen more frequently in female ( p < 0.001) and diabetic patients ( p < 0.05). Sex ( p < 0.001) and incision length ( p < 0.05) have been found independent risk factors for drainage complication. Superficial infection ( p < 0.05), pain ( p < 0.05) and dehiscence ( p < 0.05) were significantly higher in female patients. As the incision length of the multiple incision technique became longer, the risk of drainage, pain, hematoma and diffuse ecchymosis were increased. The significantly increased risk for wound complications were also seen in female gender, diabetic and obese patients.saphenectomy; saphenous vein harvesting; coronary artery bypass surgery; wound; complication © 2007 Tohoku University Medical PressDespite the widespread use and superior patency of the internal mammarian artery and other arterial conduits, the saphenous vein continues to be the most commonly used conduit for coronary artery bypass graft surgery due to its length and lack of invasiveness. Open and also closed surgical techniques exist for the harvesting greater saphenous vein. However, problems of

Left ventricular to right atrial communications are rare types of ventricular septal defects usually of congenital origin. A case of an iatrogenic shunt between the left ventricle and the right atrium as a rare complication of mitral valve replacement is reported.

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Combination antiplatelet therapy with ASA and clopidogrel seems to be more effective than ASA alone for maintaining graft patency in patients with reactive thrombocytosis.

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BACKGROUND AND OBJECTIVES:We investigated the efficacy of pleural drainage with the use of different chest tube methods in patients after coronary artery bypass graft (CABG) surgery.DESIGN AND SETTING:Prospective randomized study of 60 patients undergoing elective on-pump single CABG surgery.PATIENTS AND METHODS:The left internal mammary arterial grafts were harvested from all patients. The patients were separated into three groups: In one group (IC6, n=20), pleural tubes were inserted through the sixth intercostal space at the midaxillary line; in the second group (SX-r, n=20), rigid straight pleural tubes were inserted from the mediastinum through the subxiphoid area; and in the third group (SX-s, n=20), soft curved drainage tubes were inserted from the mediastinum through the subxiphoid area. The residual pleural effusion was examined by multislice CT scans within 8 hours of removal of the drainage tubes. Pain was evaluated according to standard methods.RESULTS:The groups did not differ with respect to volume of residual pleural effusion (P>.05). The IC6 group had a higher mean pain score than the other two groups (P<.05), whose mean pain scores did not differ significantly from each other (P>.05). IC6 group patients had a higher requirement for analgesics. The rate of atelectasis was higher in group IC6 (P<.05).CONCLUSION:CT scans revealed that different chest tube insertion sites have the same efficiency for draining of pleural effusion, although drainage tubes inserted through the thoracic cage may result in more severe pain.

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