No abstract

No abstract

Introduction Coronary artery bypass grafting (CABG) is one of the most commonly performed operations with approximately 200 000 procedures performed annually in the United States of America and an incidence of 62 per 200 000 inhabitants in Western Europe. 1 It has evolved over the past century from a high-risk procedure to a relatively safe one with a current mortality rate of 1%-2% in elective patients. 2 Nonetheless, it is still a highly complex surgery and has been associated with a number of complications. The complications from this major surgery can be classified in various ways; some are catastrophic, such as death and stroke, while others can be self-limiting without any long-term residual effects, such as atelectasis, lower respiratory infection, or transient acute kidney injury. 2,3 CABG can be considered as a large operation incorporating many smaller operations. There may be variations in these smaller operations that can have both advantages and disadvantages. However, the end goal is to bypass a blocked or narrow coronary artery by anastomosis of a vessel conduit. 3 This may be done with or without cardio-pulmonary bypass, with arterial or venous grafts, and with open or endoscopic harvesting of conduits. The overall risk of this operation is determined by the Euroscore, which is a statistical determination of risk using logistic regression. 4,5 It is determined by patient-related factors (age, gender, renal impairment, peripheral vascular disease, mobility, previous cardiac surgery, chronic lung disease, active endocarditis, critical pre-operative state, insulin dependent diabetes), cardiac-related factors (NYHA dyspnea classification, CCS angina classification, left ventricular function, recent myocardial infarction, and pulmonary hypertension) and operation factors (urgency, weight of intervention, and involvement of thoracic aorta). 5 For the purposes of valid patient consent, it is considered mandatory to discuss the risk of death, peri-operative myocardial infarction, stroke, and sternal wound infection. 6 The general complications of CABG surgery are briefly discussed below followed by a discussion of the specific complications associated with cardiopulmonary bypass and graft patency. Extent of Complications Complications can be broadly divided into catastrophic events, such as death and stroke, or less serious complications, such as pulmonary, renal, or sternal wound complications. Death Mortality following CABG is reported to be between 1%-2% for elective procedures; however, it can be confounded by many factors including the urgency of the case, previous acute myocardial events, the presence of multiple comorbidities such as diabetes or chronic renal failure, or poor coronary vessels that are not amenable for grafting. 4-6 Stroke Post-operative stroke has an incidence of 1.4% to 3.8%. 2 The risk factors for this complication include increased age,

Objective To review the currently available literature to define the role of thoracic endovascular aortic repair (TEVAR) in patients with connective tissue disorders (CTD). Methods A comprehensive electronic database search was performed in PubMed, SCOPUS, Embase, Google scholar, and OVID to identify all the articles that reported on outcomes of utilizing TEVAR in patients with CTD during elective and emergency settings. The search was not limited to time or language of the published study. Results All the relevant studies have been summarized in its correspondence section. The outcomes were analyzed in narrative format. The role of TEVAR has been elaborated as per each study. Currently, there is limited large cohort size studies outlining the use of TEVAR in patients with CTD. The use of endovascular repair in patients with CTD is limited due to progressive aortic dilatations and high possibility of further reinterventions at later stage of life. Conclusion Open repair remains the gold standard method of intervention in young patients with progressive CTD, especially in the setting of acute type A aortic dissection. However, TEVAR can be sought as a reliable alternative in emergency setting of diseases involving the descending thoracic aorta; yet the long-term data needs to be published to support such practice.

No abstract

No abstract

Objective To assess the performance of tomographic ultrasonography (TUS) in providing images that will enable optimum choice of vein segment to harvest for coronary artery bypass grafting (CABG). Methods This was a prospective study of diagnostic accuracy. The index test was tomographic ultrasonography. The reference standard was intraoperative observation. The study was performed at the Vascular Imaging and Cardiothoracic Department at Wythenshawe Hospital, Manchester. Patients undergoing CABG who require vein mapping were included in the study. The main outcome measures were the number of tributaries identified in harvested vein segments, presence of varicosities, and usable length of vein. Results The TUS correctly identified 89 out of 111 vein tributaries in 10 patients resulting in a sensitivity of 80.2%. This resulted in a p value of 0.000001 using an exact binomial test, with a prior probability of 0.5. TUS had a sensitivity of 66.7% and a specificity of 100% in the identification of varicosities over 14 patients. TUS had 90% agreement with intraoperative observation in assessing usable length of vein over 14 patients. Conclusions Our results show that TUS has a high sensitivity in identifying vein tributaries. This can be used to select veins with fewer tributaries for harvesting should TUS be used for preoperative vein mapping before CABG.

Objective. To compare the efficacy and cost-effectiveness of simple nonadherent dressings with other more expensive dressing types in the treatment of venous leg ulcers. Study Design. Retrospective cohort study. Location. The leg ulcer clinic at the University Hospital of South Manchester. Subjects and Methods. The healing rates of twelve leg ulcer patients treated with simple nonadherent dressings (e.g., NA Ultra) were compared with an equal number of patients treated with modern dressings to determine differences in healing rates and cost. Main Outcome Measures. Rate of healing as determined by reduction in ulcer area over a specified period of time and total cost of dressing per patient. Results. Simple nonadherent dressings had a mean healing rate of 0.353 cm2/week (standard deviation ± 0.319) compared with a mean of 0.415 cm2/week (standard deviation ± 0.383) for more expensive dressings. This resulted in a one-tailed p value of 0.251 and a two-tailed p value of 0.508. Multiple regression analysis gave a significance F of 0.8134. Conclusion. The results indicate that the difference in healing rate between simple and modern dressings is not statistically significant. Therefore, the cost of dressing type should be an important factor influencing dressing selection.