bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patency Outcomes of Aortic Connectors
Authors: Zenati Marco A. , Sonel Ali , Hattler Brack , Shroyer A. Laurie , Collins Joseph , Messenger John , Baltz Janet H. , Mohr Lisa M. , Gabany Jennifer M. , Novitsky Dimitri , Grover Frederick 
Published: May 2008

Objective Controlled outcome analysis of mechanical aortic connectors for proximal saphenous vein bypass graft anastomosis is lacking. We report the clinical and angiographic outcome of patients receiving the Symmetry aortic connector (St. Jude Medical, Inc St. Paul, MN, US) within a multicenter, prospective, randomized study. Methods Twenty-five patients at 3 study sites received aortic connectors at the time of coronary artery bypass surgery. Protocol-defined angiographic follow-up was completed in 19 of 25 patients (76%) at time-points up to 14 months postoperatively; 32 connector anastomoses were evaluated in these 19 patients. Beating heart surgery was performed in 17 patients, and 2 were performed with cardiopulmonary bypass. Age was 69.7 ± 8.1 year; all patients were males. Results The connector anastomosis patency rate was 15.6% (5/32). There were no deaths during the follow-up period. Four patients (21%) suffered myocardial infarction and 2 additional patients (10.5%) required percutaneous coronary interventions; one of who required 3 percutaneous coronary interventions, the other received one percutaneous coronary intervention. Conclusions In this nonrandomized cohort of patients, occlusion rate with Symmetry connectors was significantly greater than anticipated. Patients who have received these connectors during coronary artery bypass surgery may require closer follow-up and evaluation. While the manufacturer has stopped producing this device, there has been no recall of the product, clinical support remains ongoing, and next generation connectors have now been marketed. Consideration should be given to discontinuation of the clinical use of Symmetry connectors.
Initial Experience with Robotic Epicardial Off-Pump Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation
Authors: Casselman Filip , Bakir Ihsan , Brugada Pedro , Geelen Peter , Wellens Francis , Van Praet Frank , Gegrieck Ivan , Vermeulen Yvette , Vanermen Hugo 
Published: May 2008

Objective To evaluate the feasibility and results of isolated endoscopic pulmonary vein isolation for paroxysmal atrial fibrillation using robotics. Methods Between November 2004 and December 2005, 13 patients (38.5% female) underwent robotic pulmonary vein isolation at our institution. Mean age was 46.8 ± 8.4 years and mean preoperative duration of atrial fibrillation was 52.7 ±31.5 months. Indication for surgery was symptomatic drug-refractory paroxysmal atrial fibrillation or recurrence after percutaneous treatment (n = 3). Mean preoperative left atrial dimension was 38.5 ± 6.9 mm. The surgical procedure was performed off-pump as an isolated right chest approach. All procedures were performed using the Flex 10 microwave ablator (Guidant, Indianapolis, IN), which was positioned from the right side through the transverse sinus and around the 4 pulmonary veins. Postoperative drug regimen included sotalol and Coumadin. Mean follow-up was 8.5 ± 3.4 months. Results The procedure was successful in 11 patients. One patient needed conversion to median sternotomy for right pulmonary artery bleeding and a second patient had severe transverse sinus adhesions requiring conversion to a bilateral video-assisted small thoracotomy approach. No other morbidity occurred. Mean procedure time in successful cases was 2.7 ± 0.8 hours (range 1.7 to 4 hours). Permanent sinus rhythm was successfully restored in 10 of 13 patients (76.9% beyond 6 months). Nonsuccessful patients had markedly reduced symptoms and frequency of events. One patient required a left and another a right atrial flutter ablation during follow-up. Conclusions Robotic pulmonary vein isolation is a feasible procedure that has the potential to become a valid option in the treatment of paroxysmal atrial fibrillation.
Displacement of the Beating Heart with a Low-Profile Suction-Based Apical Positioning Device in a Closed Chest
Authors: Mykytenko James , Vassiliades Thomas A. , Vinten-Johansen Jacob 
Published: May 2008

Background Off-pump, multivessel, endoscopic coronary artery bypass requires cardiac displacement within an intact chest. The current study evaluated right ventricular performance and systemic hemodynamics while exposing the posterior surface of the heart using a novel, low-profile, apical suction-based cardiac positioner in a closed-chest, beating-heart model. Methods Six pigs underwent instrumentation with continuous monitoring of arterial pressure by fluid-filled transducer and cardiac output and coronary blood flow by ultrasound transit time flow probe. Right ventricular (RV) pressure-volume loops were generated by an impedance catheter. Heart rate was maintained between 80 and 100 beats per minute pharmacologically. The cardiac positioner displaced the heart endoscopically through a port. Data were obtained in 5 sequential phases: (1) baseline/free-beating, (2) positioner coaptation, (3) addition of Trendelenburg, (4) cardiac displacement with Trendelenburg, and (5) cardiac displacement without Trendelenburg. Results Cardiac displacement without Trendelenburg (Phase 5) resulted in a significant (P < 0.05) decrease in cardiac output, coronary blood flow, RV systolic pressure (RVSP), mean arterial pressure, RV end-diastolic volume (RVEDV), and RV end-systolic volume (RVESV) compared with baseline (Phase 1). With Trendelenburg added to cardiac displacement (Phase 4), all parameters improved, but only RVSP, mean arterial pressure, and RVEDV were comparable to baseline (Phase 1). There were no local complications from device coaptation. Conclusions The low-profile endoscopic cardiac positioner is safe and effective in the closed-chest, beating-heart porcine model. Nevertheless, cardiac displacement in a closed chest does cause impairment in ventricular performance that can be ameliorated by the addition of Trendelenburg and further technological progress.
Videothoracoscopic Resection of Benign Neurogenic Tumors of the Posterior Mediastinum
Authors: Ciriaco Paola , Negri Giampiero , Bandiera Alessandro , Casiraghi Monica , Ferla Luca , Torracca Lucia , Zannini Piero 
Published: May 2008

Objective Videothoracoscopy is becoming the preferred approach for the removal of neurogenic mediastinal tumors. Tumors extending into the spinal canal (dumbbell type) require a combined neurosurgical approach. The aim of the study was to evaluate the feasibility of videothoracoscopic resection of benign neurogenic tumors (BNT) of the posterior mediastinum, including dumbbell-type tumors, through a retrospective review of our experience. Methods Between January 1993 and November 2005, 30 patients underwent resection of a BNT of the posterior mediastinum at our institution. Twenty-five tumors developed in the costovertebral sulcus, and five were dumbbell type. Preoperative assessment included chest CT scan, nuclear magnetic resonance for dumbbell-type tumors, and spinal angiography when the tumor was located in the vicinity of the Adamkiewicz artery. Results Mean tumor size was 5.6 ±1.4 cm (range, 4 to 11). Videothoracoscopic resection was possible in 26 patients, 5 of whom had dumbbell-type tumors requiring a combined neurosurgical approach. Reasons for conversion to thoracotomy were pleural adhesions in one case and bleeding in three. Mean operative time was 215 ± 42 minutes (range, 180 to 280) for the patients with dumbbell-type tumors and 140 ± 55 minutes (range, 95 to 230) for those without. There were no operative and/or postoperative complications. Histology showed 25 schwannomas, 4 ganglioneuromas, and 1 neurofibroma. Mean postoperative stay was longer for the patients with dumbbell-type tumors (6.5 ± 1 versus 4 ± 1 day). Conclusions BNT of the posterior mediastinum, including dumbbell-type tumors, can be safely resected thoracoscopically. The feasibility of a videothoracoscopic approach should be assessed on the basis of the preoperative evaluation. Pleural adhesions and bleeding may determine conversion to thoracotomy.
Outcomes after Off-Pump Reoperative Coronary Artery Bypass Grafting
Authors: Morris Cullen D. , Puskas John D. , Pusca Sorin V. , Lattouf Omar M. , Cooper William A. , Vassiliades Thomas A. , Chen Edward P. , Thourani Vinod H. , Kilgo Patrick D. , Guyton Robert A. 
Published: May 2008

Objective Application of off-pump techniques to reoperative coronary artery bypass (redo CABG) has been limited by technical difficulty and potential for embolism of atheromatous debris from diseased grafts, resulting in myocardial infarction and rapid hemodynamic deterioration. We compared outcomes after off-pump (OPCAB) and on-pump (ONCAB) in redo CABG. Methods A retrospective chart review was performed for patients who underwent redo CABG at a single academic institution between January 1997 and December 2004. Outcomes were compared between groups based on intention to treat. Propensity scores were calculated for each patient using 23 preoperative risk factors. Logistic regression was applied for each end point as a function of group and propensity score. Results A total of 771 consecutive patients had redo CABG (639 ONCAB and 132 OPCAB); 22 patients (16.7%) were converted from OPCAB to ONCAB for hemodynamic in stability, severe adhesions, or graft injury; 7 patients (1.1%) were converted from ONCAB to OPCAB for severe aortic calcification. Propensity-matched comparison of outcomes after OPCAB versus ONCAB for redo CABG showed that OPCAB was associated with a reduction in postoperative complications, transfusion, atrial fibrillation, and length of stay. OPCAB patients received fewer grafts with similar use of left internal mammary artery conduit; conversion from OPCAB to ONCAB did not reduce the benefit of OPCAB. Conclusions OPCAB can be safely and effectively applied to reoperative CABG in selected cases.
Routine Off-Pump Coronary Artery Bypass: Reasons for On-Pump Conversion
Authors: Hirose Hitoshi , Amano Atsushi 
Published: May 2008

Objective To assess the feasibility of routine off-pump coronary artery bypass (OPCAB) and investigate risk factors for on-pump conversion. Methods Between July 1, 2002, and June 30, 2004, OPCAB was attempted for all patients who required isolated coronary artery bypass in our institution. The perioperative results of patients were prospectively entered into a structured database, and the results were analyzed to identify the risks of requirement for cardiopulmonary bypass. Results Off-pump coronary artery bypass was successfully performed in all but 9 patients, giving an OPCAB success rate of 97.3% (329/338). The reason for cardiopulmonary bypass was hemodynamic instability occurring during reoperative surgery in 7, and cardiogenic shock in 2. The OPCAB success rate was significantly higher in primary coronary artery bypass grafting (99.3%, 314/316) than in reoperative coronary artery bypass grafting (68.1%, 15/22; P < 0.0001), and higher in patients without cardiogenic shock (97.9%, 329/336) than in those with cardiogenic shock (0%, 0/2; P < 0.0005). Mean number of distal anastomoses performed under OPCAB was 3.5 ± 1.4. There were 2 hospital deaths (0.6%). During a mean follow-up period of 1.0 ± 0.4 years, 7 patients developed angina, which was treated with catheter intervention; there were no other cardiac events. Conclusion Routine OPCAB is feasible with acceptable short-term results. Patients undergoing reoperation or in persistent cardiogenic shock are more likely to require conversion to on-pump coronary artery bypass grafting.
Effects on Lung Function in Patients Undergoing Coronary Artery Surgery on versus off Cardiopulmonary Bypass: A Randomized Trial
Authors: Niranjann Gunaratnam , Asimakopoulos George , Madden Brendan , Cockerill Gillian , Thompson Matthew , Chandrasekaran Venkatachalam 
Published: May 2008

Background Coronary revascularization is associated with respiratory dysfunction and poor gas exchange postoperatively. Cardiopulmonary bypass (CPB) has been implicated as a possible explanation for this phenomenon. This study investigated respiratory function in patients undergoing coronary artery bypass grafting (CABG) on-CPB versus off-CPB to determine whether the off-CPB condition results in improved postoperative pulmonary function. Methods Forty patients were randomized into 1 of 2 groups: CABG on-CPB (group A) or off-CPB (group B). Pulmonary function tests, including spirometry and diffusion studies, were performed preoperatively and on postoperative day 5. Arterial blood gases on 100% oxygen were taken preoperatively (TP1), 15 minutes after sternal closure (TP2), and 3 hours postoperatively (TP3). Results The arterial partial pressure of oxygen (PaO2) on FiO2 1.0 decreased from 59.5 ± 11.5 kPa and 55.7 ± 12.2 kPaat TP1 to 39.5 ± 16 kPa and 39.7 ± 13 kPa at TP2 in groups A and B, respectively (P < 0.001), with no significant difference between groups. At TP3, the PaO2 partially recovered toward preoperative levels (P < 0.05). Spirometry revealed a significant reduction in FEV1 and FVC on the fifth postoperative day (P < 0.001), with no significant difference between groups. The corrected transfer factor for carbon monoxide reduced significantly in group A from 7.9 ± 2.5 mmolmin–1 · kPa–1 preoperatively to 5.1 ± 1.6 mmolmin–1 · kPa–1 postoperatively (P < 0.05). This reduction was not seen in group B. Conclusions Coronary artery surgery is associated with a marked reduction in lung function as measured by pulmonary function tests and PaO2. Diffusion studies revealed that on-CPB patients had significantly reduced diffusion capacities postoperatively compared with patients in the off-CPB group.
A Comparative Study of Imaging Techniques in Aortic Dissection, DeBakey Type I: Intraoperative Live Three- Dimensional Epicardial Echocardiography, Multiplane Transesophageal Echocardiography, and Multislice Computed Tomography
Authors: Mishra Manisha , Khurana Poonam , Meharwal Zile S. , Trehan Naresh 
Published: May 2008

Objective To compare the accuracy of intraoperative live 3-dimensional epicardial echocardiography, multiplane transesophageal echocardiography (TEE), and multislice computed tomography (MSCT) imaging in the detection of thoracic aortic dissection, site of intimal tear, and involvement of arch vessel. Methods Of 24 patients studied from October 2003 to September 2004, 12 had aortic dissection. They were examined preoperatively with contrast material-enhanced MSCT and multiplane TEE. Intraoperative live 3-dimensional epicardial echocardiographic evaluation of the ascending aorta and arch was performed. Imaging results in terms of detection of aortic dissection, site of intimal tear, and involvement of coronary arteries and arch vessels were confirmed at intraoperative exploration by the operating surgeon as the reference standard. Results Sensitivity in the detection of thoracic aortic dissection was 100% for all techniques. Specificity was 92%, 92%, and 100% for live 3-dimensional epicardial echocardiography, multiplane TEE, and MSCT imaging, respectively. In the assessment of aortic arch vessel involvement, sensitivity was 92%, 58%, and 92%, and specificity was 75%, 50%, and 83%, respectively. For the detection of the site of intimal tear, sensitivity was 92%,92%, and 58%, and specificity was 83%,75%, and 50%, respectively. Conclusion Intraoperative live 3-dimensional epicardial echocardiography is as valuable as multiplane TEE and MSCT imaging in the detection of thoracic aortic dissection. In the assessment of the aortic arch vessel involvement, MSCT and live 3-dimensional epicardial echocardiography are superior (P < 0.05), whereas live 3-dimensional epicardial echocardiography and TEE are superior in detection of site of intimal tear (P < 0.05).
Right Atrial Surgery without Caval Snaring
Authors: Dandolu Reddy , Eaton Douglas , Ali Aras , Schwann Nannette , Wechsler Andrew 
Published: May 2008

Background During tricuspid valve replacement in a patient with previous mitral valve surgery, we made an incidental observation that the right atrium can be opened without caval snaring and without air entering the venous reservoir. We tested this hypothesis on an animal model. Methods Two patients underwent right atrial surgery using percutaneous cannulation, and no air was entrained without caval snaring. This principle was tested in an animal model using 2 pigs weighing 80 kg each. Percutaneous cannulae were placed under epicardial echo guidance with their tips 4 cm from the right atrium. A “collapsible bag with air drainage system” was introduced into the venous return system to quantify air return from the superior vena cava (SVC) and inferior vena cava (IVC). Two types of percutaneous cannulae with (Cardiovations Quick Draw) and without (Biomedicus) proximal side holes were tested. Results In the animal model using Biomedicus cannulae, upon opening the right atrium, air was entrained from the SVC cannula at 60 mL/minute with no air in the IVC. There was no difference in the amount of air between the two cannulae. Pressures measured were 5 cm of water in the IVC and −20 cm water in the SVC. Epicardial ultrasound demonstrated complete collapse of both vena cavae. Partial clamping of the SVC cannula reduced the amount of air to 60 cc/min, and placing a small straight clamp at the SVC atrial junction eliminated the air. No air was noted in IVC cannula. Conclusions Inferior vena caval drainage by percutaneous cannula does not entrain air with either type of cannula and without snaring (both in clinical cases and animal model). This might be explained by the presence of a competent Eustachian valve. However, the SVC is not immune to air. Minimal air (approximately 60 mL/minute) could be managed by partial clamping or completely be avoided by placing a small straight clamp without snaring.
Three-Dimensional Reconstruction of Ultrafast 16-Slice Computed Tomography Images and CT Angiography versus Conventional Coronary Angiography at One Year in Multivessel Coronary Artery Bypass Surgery
Authors: Malhotra Rajneesh , Mishra Manisha , Khurana Poonam , Aggarwal Monika , Mishra Yugal , Meharwal Zile Singh , Kohli Vijay , Bapna Ramesh Kumar , Kasliwal Ravi Ratan , Mehta Yatin , Trehan Naresh 
Published: May 2008

Background The aim of this study was to evaluate and compare the postoperative graft patency assessment by multislice spiral computed tomography (MSCT) scan and conventional coronary angiography (CCA) in coronary artery bypass grafting (CABG) patients 1 year after surgery. Methods Sixty-nine patients who underwent isolated CABG at least 1 year before the study, were subjected to both MSCT angiography with cardiac gating and CCA. The results were evaluated and compared. Results There were 209 grafts in 69 patients. All grafts were evaluated by both MSCT angiography and CCA. Seventy-eight grafts were on the anterior wall, 83 on the lateral wall and 48 on the inferior wall of the heart. On MSCT angiography, all left internal mammary arteries were visualized with 3-dimensional reconstruction and found to be patent. Of 209 grafts, 11 grafts (5.26%) were blocked, 6 grafts on the lateral wall and 5 on the inferior wall. All patent grafts were correctly evaluated by MSCT angiography (specificity 100%). However, 2 grafts that were found to be patent on MSCT angiography were blocked on CCA (MSCT sensitivity 81.8%). Conclusions Postoperative evaluation of coronary bypass grafts is possible with very good resolution by MSCT angiography. This method allows evaluation of the bypass grafts and the quality of anastomosis with a noninvasive method that is comparable with CCA.
Dual-Beam Ultrasound versus Transit-Time Flow Meter for Intraoperative Graft Flow Measurement during Coronary Artery Bypass Grafting
Authors: Shapira Oz M. , Eskenazi Benjamin R. , Hunter Curtis T. , Korach Amit , Anter Elad , Lazar Harold L. , Shemin Richard J. 
Published: May 2008

Objective Assessment of graft flow during coronary artery bypass grafting (CABG) is increasingly practiced as a quality measure, particularly in patients undergoing minimally invasive or “off-pump” revascularization. Transit-time flow meters such as Transonic system (TS) are currently the most frequently used technology. The QuantixOR flow probe (QOR) is a novel technology comprised of dual-beam ultrasound transducer and a digital pulse-wave Doppler, allowing immediate, quantitative blood flow measurements. Excellent correlation between QOR and TS was observed in phantom and animal models. This study evaluated the QOR in patients undergoing CABG. Methods Graft flow was measured in 75 patients undergoing CABG (203 grafts). Intraobserver (n = 169) and interobserver (n = 33) variability was assessed and the QOR was compared with the TS (n = 155). Results An average of 2 probe sizes per case and “skeletonization” of a short segment of the vessel were required to measure flow in arterial conduits using TS. In contrast, measurements of flow with the QOR were achieved using a single probe without special vessel preparation for all types of conduits. Average intraobserver and interobserver variability using the QOR were 5 ± 41% and 4 ± 40%, respectively. Correlation was observed between 2 sets of measurements by the same observer (R2 = 0.746, P < 0.0001) and between 2 different observers (R2 = 0.667, P < 0.0001). Correlation was also observed between the QOR and TS (R2 = 0.542, P < 0.0001) with a variance of 12 ± 21%. Conclusions The QOR technology provides a reliable quantitative graft flow assessment that is simpler to obtain compared with TS. Correlation between the QOR and TS is excellent.
Adjunctive Atrial Fibrillation Therapy with Off-Pump Coronary Artery Bypass Grafting: Standard of Care?
Authors: Wudel James H. , Hedderich Giles S. , Jex R. Kent 
Published: May 2008

Objectives To validate the safety and applicability of a previously unreported innovative technique: bipolar epicardial radiofrequency pulmonary vein ablation for the treatment of atrial fibrillation (AF) in conjunction with off-pump coronary artery bypass surgery. Methods After the completion of off-pump coronary artery bypass grafting (OPCAB) via sternotomy, patients underwent epicardial pulmonary vein ablation using a bipolar radiofrequency clamp placed on the left atrial cuff. The left atrial appendage was removed or excluded in all patients. Results Fifteen patients (aged 59–81 years) were treated and reviewed. An average of 2.8 ± 1 grafts were performed per patient; all patients received left internal mammary artery grafts. All sets of pulmonary veins were encircled successfully and ablated. Four patients had additional lesions placed. No patient had pulmonary vein injury. There were no reoperations for bleeding and no mortality. Preoperatively, AF was continuous in 4 patients and intermittent in 11; 10 patients were taking Coumadin preoperatively and 11 were taking antiarrhythmic drugs (AAD). At the follow-up evaluation (7.6 ± 4.4 months; range 1–16 months), 12 patients (80%) are in sinus rhythm (100% in the intermittent AF group, 25% in the continuous AF group); Coumadin has been discontinued in 5 of 10 patients (50% reduction) and AAD have been discontinued in 7 of 11 patients (74% reduction). Conclusions Bipolar radiofrequency epicardial pulmonary vein ablation can be safely and reproducibly used for the treatment of AF in conjunction with OPCAB. Patients with intermittent AF should be strongly considered for adjunctive treatment at the time of OPCAB.