The protocols and policies followed in this study were approved by the Stanford University Institutional Review Board (IRB 38337). Because of the retrospective nature and minimal risk of our study, individual participant consent was waived. Our study used a validated 'before and after' group level study design to examine the effect of introducing Del Nido cardioplegia as the only variable that was changed in our CABG protocol. All patients who underwent isolated CABG performed by an experienced specialist in coronary revascularization surgery at our institution during a 2-year period from October 2014 to October 2016 were assessed for inclusion. In July 2015, our institution's perfusion protocol for CABG surgery was changed from using BC to solely using DN. Overall, 27 consecutive BC patients (October 2014 to July 2015) and 54 consecutive DN patients (August 2015 to August 2016) were identified. Re-operative procedures and minimally invasive direct coronary artery bypass surgeries, which
Objective Endoscopic radial artery (RA) harvesting performed concurrently with internal mammary artery (IMA) takedown and endoscopic saphenous vein (SV) harvesting creates a crowded and inefficient operating room environment. We assessed the effect of a presternotomy RA harvest strategy on surgery time and costs. Methods A total of 41 patients underwent elective, first-time, isolated multivessel on-pump coronary artery bypass grafting including an IMA, RA, and SV graft. The first 20 patients (Phase I) underwent endoscopic RA harvesting concurrently with IMA takedown and endoscopic SV harvesting after sternotomy, requiring two sets of endoscopic harvesting equipment per case, each used by a separate individual. The final 21 patients (Phase II) underwent endoscopic RA harvesting during anesthesia line placement, completing the procedure before sternotomy, thus requiring only one set of endoscopic harvesting equipment reused by a single individual. Results There were no differences in baseline patient characteristics, number of bypasses, duration of SV or RA harvest time, or duration of cardiopulmonary bypass or cross-clamp time between the two groups. Total surgery time was reduced by 32 minutes in Phase II ( P = 0.044). Relative to a total hospital direct cost of 100.00 units, total surgery costs were reduced from 29.33 units in Phase I to 25.62 units in Phase II ( P = 0.001). No anesthesia- or RA harvest-related complications occurred in either group. Conclusions Endoscopic RA harvesting can be safely performed during anesthesia line placement prior to sternotomy. Our simple but innovative strategy improves intraoperative workflow, reduces the time and cost of surgery, and advances the delivery of high-quality patient care.
As the world responds to the global crisis of the COVID-19 pandemic an increasing number of patients are experiencing increased morbidity as a result of multi-organ involvement. Of these, a small proportion will progress to end-stage lung disease, become dialysis dependent, or both. Herein, we describe the first reported case of a successful combined lung and kidney transplantation in a patient with COVID-19. Lung transplantation, isolated or combined with other organs, is feasible and should be considered for select patients impacted by this deadly disease.
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