The off-pump technique reduced early operative mortality and the incidences of major complications in redo CABG.

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In situ sequential LITA grafting provides acceptable early graft patency and freedom from repeat revascularization, resulting in excellent survival. This technique is a useful strategy for multivessel revascularization including the left circumflex area.

SummarySystolic anterior motion (SAM) of the mitral valve after aortic valve replacement (AVR) for severe aortic stenosis (AS) is one of the causes of perioperative left ventricular outflow tract (LVOT) obstruction in older patients. A 90-yearold woman underwent AVR with a 19-mm bioprosthesis for symptomatic aortic valve stenosis. Preoperative transthoracic echocardiography (TTE) showed left ventricular hypertrophy, with LVOT obstruction and mild mitral regurgitation (MR). Intraoperative transesophageal echocardiography and postoperative TTE showed that the degree of MR was unchanged after surgery. The patient's postoperative course was uneventful. However, she developed shortness of breath 6 months after discharge. A subsequent TTE showed significant LVOT obstruction and SAM, which resulted in moderate to severe MR. Because of the patient's advanced age, cibenzoline was administered to decrease the left ventricular pressure gradient (LVPG) and improve the left ventricular diastolic function. Two months after administration of cibenzoline, a TTE showed decreased LVPG, trivial MR, and the absence of SAM. This case clearly demonstrated that cibenzoline improved the SAM of the mitral valve that arose after AVR for AS in a remote postoperative period. ( 1-3) However, such patients rarely present with clinical symptoms. Therefore, therapy for the reduction of left ventricular pressure gradient associated with SAM has not been established. Although several reports have described this phenomenon, all of the cases were early onset, such as during the intraoperative and hospitalization periods. [4][5][6][7][8] Here, we report a case of delayed-onset SAM, after AVR leading to cardiac insufficiency that was managed with cibenzoline. Case ReportA 90-year-old woman (weight, 41.8 kg; height, 144 cm), who had complained of shortness of breath and palpitations due to severe AS, was referred to our hospital for AVR. Transthoracic echocardiography (TTE) showed a calcified, immobile aortic valve with peak and mean pressure gradients of 129 and 82 mmHg, respectively. The left ventricular (LV) end-diastolic and systolic diameters were 37 and 20 mm, respectively, with an ejection fraction (EF) of 78%. During diastole, the thickness of the interventricular septum was 16 mm and that of the posterior wall was 14 mm. The left ventricle showed secondary hypertrophy with a significant LVOT pressure gradient of 20 mmHg. Mitral regurgitation (MR) was mild, and no significant SAM was observed. Angiography showed normal coronary arteries.During AVR, her heavily calcified leaflet was removed and replaced with a 19-mm Carpentier-Edwards Perimount Magna aortic bioprosthesis (Edwards LifeSciences, Irvine, CA, USA), with supra-annular placement in the aortic position. Intraoperative transesophageal echocardiography, performed before weaning from cardiopulmonary bypass (CPB), showed mild MR and the absence of significant obstruction of the LVOT (Figure 1). Thus, weaning from CPB was uneventful. Surgery was completed without any complications. The pa...

Off-pump coronary artery bypass grafting (OPCAB) is performed in about 65% of patients who require surgical coronary revascularization, and has become the standard procedure in coronary artery bypass grafting (CABG) in Japan. As a background of the high rate of OPCAB, many clinical and experimental studies have been performed and reported in Japan. In this review, several factors associated with OPCAB are discussed based on relevant and important clinical studies published in Japan in the English language.

DE-MRI was highly effective in helping to select which patients and which areas of the left ventricle are indicated for SVR, which contributed to excellent early clinical outcomes.

Objective Recent studies on the efficacy of off-pump coronary artery bypass grafting (OPCABG) have reported encouraging results on postoperative renal function, but improvements can still be made. Methods A total of 368 patients, none needing chronic dialysis, underwent isolated OPCABG at our institution between January 1999 and March 2005. They were divided into 3 groups according to renal function as indicated by the serum creatinine levels: group N (n = 332) with normal function, group M (n = 30) with mild to moderate renal dysfunction, and group S (n = 6), with severe renal dysfunction. Creatinine ratio and early outcomes were compared among the groups. Predictors for renal impairment were determined by multiple regression analysis. Results In-hospital mortality rate was similar (group N, 0.6%; group M, 0%; group S, 0%). The percentage of patients with a creatinine ratio greater than 1.6 was significantly larger in group S (group N, 13%; group M, 13%; group S, 50%; P < 0.05). Postoperative hemodialysis, which was temporary, was required more frequently in group S (group N, 0.3%; group M, 3%; group S, 67%; P < 0.05). In group N, 38 patients (11%) had new renal impairment after OPCABG. Preoperative serum creatinine levels ≥2.5 mg/dL, ejection fraction <0.4, amount of blood transfusion, and more than 4 bypasses were potent predictors for postoperative renal impairment. Conclusions Clinical results of OPCABG on renal function were satisfactory regardless of preoperative renal function. However, perioperative renal function should be closely monitored in patients with known risk factors, even when OPCABG is performed.

Ischemic mitral regurgitation (IMR) is one of the most important risk factors affecting prognosis of patients who suffer from myocardial infarction. The mechanisms of IMR, the indications for surgical intervention, the operative procedures, and the limitations of surgical procedures are discussed in this review article.