Background Whether mitral valve repair (MVRep) during coronary artery bypass grafting (CABG) improves survival in patients with ischemic mitral regurgitation (MR) remains unknown. Methods and Results Patients with ejection fraction ≤ 35% and coronary artery disease amenable to CABG were randomized at 99 sites worldwide to medical therapy (MED) with or without CABG. The decision to treat the mitral valve during CABG was left to the surgeon. The primary endpoint was mortality. Of 1212 randomized patients, 435 (36%) had none/trace, 554 (46%) mild, 181 (15%) moderate, and 39 (3%) severe MR. In the medical arm, 70 deaths (32%) occurred in patients with none/trace, 114 (44%) with mild and 58 (50%) in moderate-severe MR. In patients with moderate-severe MR, there were 29 deaths (53%) among 55 patients randomized to CABG who did not receive mitral surgery (HR vs. MED 1.20, 95% CI 0.77–1.87) and 21 deaths (43%) among 49 patients who received mitral surgery (HR vs. MED 0.62, 95% CI 0.35–1.08). After adjustment for baseline prognostic variables, the HR for CABG with mitral surgery vs. CABG alone was 0.41 (95%CI 0.22–0.77; p=0.006). Conclusions While these observational data suggest that adding MVRep to CABG in patients with LV dysfunction and moderate-severe MR may improve survival compared with CABG alone or MED alone, a prospective randomized trial would be necessary to confirm the validity of these observations.

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Coronary bypass grafting without aortic cross-clamping and without CPB offers superior myocardial protection.

The external vein graft support with mesh tubing reduces intimal and medial layer thickening and cell proliferation in composite vein grafts transplanted in the arterial position.

BackgroundThe available scientific literature contains descriptions of manual, semi-automated and automated methods for analysing angiographic images. The presented algorithms segment vessels calculating their tortuosity or number in a given area. We describe a statistical analysis of the inclination of the vessels in the fundus as related to their distance from the center of the optic disc.MethodsThe paper presents an automated method for analysing vessels which are found in angiographic images of the eye using a Matlab implemented algorithm. It performs filtration and convolution operations with suggested masks. The result is an image containing information on the location of vessels and their inclination angle in relation to the center of the optic disc. This is a new approach to the analysis of vessels whose usefulness has been confirmed in the diagnosis of hypertension.ResultsThe proposed algorithm analyzed and processed the images of the eye fundus using a classifier in the form of decision trees. It enabled the proper classification of healthy patients and those with hypertension. The result is a very good separation of healthy subjects from the hypertensive ones: sensitivity - 83%, specificity - 100%, accuracy - 96%. This confirms a practical usefulness of the proposed method.ConclusionsThis paper presents an algorithm for the automatic analysis of morphological parameters of the fundus vessels. Such an analysis is performed during fluorescein angiography of the eye. The presented algorithm automatically calculates the global statistical features connected with both tortuosity of vessels and their total area or their number.

Objectives To define the prognostic contribution of global and regional left ventricular (LV) function measurements in patients with ischaemic cardiomyopathy randomised to coronary artery bypass graft surgery (CABG) with (N = 501) or without (N = 499) surgical ventricular reconstruction (SVR). Methods Novel multivariable methods to analyze global and regional LV systolic function were used to better formulate prediction models for long-term mortality following CABG with or without SVR in the entire cohort of 1000 randomised SVR hypothesis patients. Key clinical variables were included in the analysis. Regional function was classified according to the discreteness of anteroapical hypokinesia and akinesia into those most likely to benefit from SVR, those least likely and those felt to have intermediate likelihood of benefit from SVR. Results The most prognostic clinical variables identified in multivariable models include creatinine, LV end-systolic volume index (ESVI), age, and NYHA class. Addition of LV ejection fraction, LV end-diastolic volume index and regional function assessment did not contribute additional power to the model. Subgroup analysis based on regional function did not identify a cohort in which SVR improved mortality. Conclusions ESVI is the single parameter of LV function most predictive of mortality in patients with LV systolic dysfunction following CABG with or without SVR in multivariable models that include all key clinical and LV systolic function parameters. Assessment of regional cardiac function does not enhance prediction of mortality nor identify a subgroup for which SVR improves mortality. These results do not support elective addition of LV reconstruction surgery in patients undergoing CABG.

In routine clinical practice the addition of GCCI to standard infection prophylaxis reduces the risk of both SSWI and DSWI in high-risk patients undergoing cardiac surgery.

Background: Systolic dyssynchrony is present in a considerable number of patients with heart failure (HF) undergoing coronary artery bypass grafting (CABG). Surgical revascularization offers an optimal setting for totally epicardial cardiac resynchronization therapy (CRT) system implantation. Aim: To assess the efficacy of totally epicardial CRT implantation during CABG, in patients with HF. Methods: Twenty three patients with HF and dyssynchrony underwent totally epicardial CRT system implantation during CABG. This randomised, single-blind, cross-over study compared clinical and echocardiographic parameters during two periods: 3 months of active CRT (CRT+) and 3 months of inactive CRT (CRT−) pacing. Results: Twenty two patients underwent randomisation and completed both study periods. In the CRT+ group more patients improved by two NYHA classes (p = 0.028), had a longer 6-minute walk test distance (p = 0.047) and better quality of life (p = 0.003) compared with the CRT− group. Echocardiography revealed an improved LV ejection fraction (p b 0.001), smaller LV end-systolic volume (p = 0.04), reduced mitral regurgitation (p = 0.026) and improved LV synchrony in the CRT+ group compared with the CRT− group. Conclusion: CRT delivered by a totally epicardial system implanted during CABG is associated with additional improvement of clinical and echocardiographic parameters in patients with HF and systolic dyssynchrony.