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Not Just Acid Reflux: The Need to Think Worst First
Discussion Heart disease is the leading cause of death in the United States.1 This year, 720,000 Americans will have a new coronary event—defined as first hospitalized myocardial infarction (MI) or coronary heart disease death—and around 335,000 will have a recurrent event. Approximately 35% of people who experience a coronary event in a given year and around 14% of patients who have an acute coronary syndrome will die from it.1 Roughly 60% of patients with an acute coronary syndrome are transported to the emergency department via ambulance.2–4. Up to one-third of patients experiencing an MI may not complain of chest...
Source: JEMS Special Topics - January 13, 2019 Category: Emergency Medicine Authors: Stephen Sanko, MD, FACEP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial
Publication date: Available online 25 August 2018Source: The LancetAuthor(s): Marco Valgimigli, Enrico Frigoli, Sergio Leonardi, Pascal Vranckx, Martina Rothenbühler, Matteo Tebaldi, Ferdinando Varbella, Paolo Calabrò, Stefano Garducci, Paolo Rubartelli, Carlo Briguori, Giuseppe Andó, Maurizio Ferrario, Ugo Limbruno, Roberto Garbo, Paolo Sganzerla, Filippo Russo, Marco Nazzaro, Alessandro Lupi, Bernardo CorteseSummaryBackgroundThe Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox (MATRIX) programme was designed to assess the comparative safety and effectiveness of ra...
Source: The Lancet - August 25, 2018 Category: General Medicine Source Type: research

Study Design of the Graft Patency After FFR-Guided Versus Angiography-Guided CABG Trial (GRAFFITI)
This study is the first prospective randomized trial investigating potential clinical benefits, associated with FFR-guided surgical revascularization. Trial registration: NCT01810224
Source: Journal of Cardiovascular Translational Research - August 1, 2018 Category: Cardiology Source Type: research

Off-Pump Coronary Artery Bypass Grafting with Mini-Sternotomy in the Treatment of Triple-Vessel Coronary Artery Disease.
Authors: Su P, Gu S, Liu Y, Zhang X, Yan J, An X, Gao J, Xin Y, Zhou J Abstract We have developed off-pump coronary artery bypass approach with lower distal mini-sternotomy (TM-OPCAB) for multivessel coronary revascularization. The aim of this retrospective study is to provide evidence for the feasibility and safety of this technique in the treatment of triple-vessel diseases.Two hundred eighty-eight patients with triple-vessel coronary artery disease who underwent TM-OPCAB or standard off-pump coronary artery bypass surgery (S-OPCAB) were included in this study after propensity-score matching. We retrospectively r...
Source: International Heart Journal - April 25, 2018 Category: Cardiology Tags: Int Heart J Source Type: research

Preoperative renal impairment and off-pump coronary artery bypass grafting: The jury is still out
The superiority of off-pump or on-pump coronary artery bypass grafting (CABG) remains to be demonstrated. Through the years, retrospective and prospective studies have suggested that off-pump CABG is associated with improved outcomes, such as reduced renal injury, reduced bleeding and need for transfusion, and shortened hospital stay. The Randomized On/Off Bypass trial, however, demonstrated that off-pump CABG led to lower 5-year survival and event-free survival than did on-pump CABG.1 The more robust CABG Off or On Pump Revascularization Study, in contrast, showed that the rate of the composite outcome of death, stroke, m...
Source: The Journal of Thoracic and Cardiovascular Surgery - April 7, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Mustafa Zakkar, Gianni D. Angelini Tags: Editorial commentary Source Type: research

Does left atrial appendage ligation during coronary bypass surgery decrease the incidence of postoperative stroke?
The study objective was to evaluate the association between surgical left atrial appendage ligation and in-hospital stroke incidence after coronary artery bypass grafting among patients with atrial fibrillation.
Source: The Journal of Thoracic and Cardiovascular Surgery - March 12, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Yen-Yi Juo, Katherine Lee Bailey, Young-Ji Seo, Esteban Aguayo, Peyman Benharash Tags: Perioperative management Source Type: research

Which aortic clamp strategy is better to reduce postoperative stroke and death: Single center report and a meta-analysis
Background: Stroke is severe complication of coronary artery bypass grafting (CABG) which may be associated with clamp strategy, there are 2 strategies to clamp aorta including single aortic clamp (SAC) and partial aortic clamp (PAC). It is controversial that which clamping strategy is better to reduce the postoperative stroke and death, so this study aims to investigate which is better for reducing postoperative stroke and death within 30 days. Methods: We collected 469 patients who had on-pump CABG in Fuwai Hospital during January 2014 to July 2015. The SAC group consisted of 265 patients while the PAC group include...
Source: Medicine - March 1, 2018 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Meta-analysis study comparing percutaneous coronary intervention/drug eluting stent versus coronary artery bypass surgery of unprotected left main coronary artery disease: Clinical outcomes during short-term versus long-term (> 1 year) follow-up
AbstractBackground:Results on the safety and long-term efficacy of drug-eluting stent placement in unprotected left main coronary artery disease (ULMCAD) compared with those of coronary artery bypass surgery (CABG) remain inconsistent across randomized clinical trials and recent meta-analysis studies. We aimed to compare the clinical outcomes and safety over short- and long-term follow-ups by conducting a meta-analysis of large pooled data from randomized controlled trials and up-to-date observational studies.Methods:A systematic review of PubMed, Google Scholar, Medline, and reference lists of related articles was perform...
Source: Medicine - February 1, 2018 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

In Situ Skeletonized Right Internal Mammary Artery Bypass Grafting to Left Anterior Descending Artery.
This study aimed to evaluate the feasibility and the mid-term efficacy of an in situ skeletonized right internal mammary artery (IMA) bypass grafting to a left anterior descending artery (LAD), and to determine risk factors for IMA graft failure in a single-center study.From January 2012 to December 2015, 189 patients (173 males, 50.6 ± 6.0 years old) undergoing first isolated coronary artery bypass grafting surgery with the in situ skeletonized right IMA grafting to the LAD were included in this study. Baseline characteristics, peroperative data, and follow-up outcomes were investigated and analyzed.The length of the in ...
Source: International Heart Journal - December 31, 2017 Category: Cardiology Tags: Int Heart J Source Type: research

Incidence of perioperative stroke in clampless aortic anastomosis during off-pump coronary artery bypass grafting
This study aimed to assess if clampless off-pump coronary artery bypass grafting (OPCAB) decreases the incidence of perioperative stroke (POS) rate and in-hospital mortality. The secondary aim was to evaluate 12-year rates of overall mortality. Between January 2003 to December 2015, data of 645 consecutive patients undergoing isolated CABG were retrospectively collected. 363 underwent aortic no-touch OPCAB (No-touch group) and 282 underwent OPCAB with the Heartstring device (HS group). In-hospital mortality and perioperative stroke rate as primary endpoint, as well as long-term follow-up outcome were analysed. In-hospital ...
Source: Heart and Vessels - December 12, 2017 Category: Cardiology Source Type: research

Off-pump versus On-pump Coronary Artery Bypass Grafting in Frail Patients: Study Protocol for the FRAGILE Multicenter Randomized Controlled Trial
In this study, the authors introduce the new national, multicenter, randomized, controlled trial "FRAGILE", to be developed in the main cardiac surgery centers of Brazil, to clarify the potential benefit of off-pump CABG in frail patients. Methods: FRAGILE is a two-arm, parallel-group, multicentre, individually randomized (1:1) controlled trial which will enroll 630 patients with blinded outcome assessment (at 30 days, 6 months, 1 year, 2 years and 3 years), which aims to compare adverse cardiac and cerebrovascular events after off-pump versus on-pump CABG in pre-frail and frail patients. Primary outcomes will be all-cause...
Source: Revista Brasileira de Cirurgia Cardiovascular - December 5, 2017 Category: Cardiovascular & Thoracic Surgery Source Type: research

Efficacy and Efficiency of Perioperative Stellate Ganglion Blocks in Cardiac Surgery: A Pilot Study
Nationally, postoperative atrial fibrillation (POAF) occurs in up to 40% of patients after coronary artery bypass grafting (CABG), 50% of patients after valve surgery, 64% of patients after mitral valve and CABG, and 49% after aortic valve replacement.1 Atrial fibrillation worsens a patient ’s hemodynamic status and increases the risk of congestive heart failure, embolic events, and longer intensive care unit stays, leading to increased patient morbidity and strain on financial resources. In the United States, POAF carries a higher risk of stroke, worsened survival, and an additional 4.9 days and $10,000 to $11,500 in hospital stay costs.
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 20, 2017 Category: Anesthesiology Authors: Christopher W. Connors, Wendy Y. Craig, Scott A. Buchanan, Justin M. Poltak, James B. Gagnon, Craig S. Curry Tags: Letter to the Editor Source Type: research

Carotid Artery Disease as a Predictor of In-Hospital Postoperative Stroke After Coronary Artery Bypass Grafting From 1999 to 2011
In this study, the risk factors for stroke after coronary artery bypass grafting (CABG) were examined. In particular, the role of asymptomatic carotid artery stenosis (both unilateral and bilateral) as a predictor of in-hospital postoperative stroke was investigated. Finally, the trends surrounding in-hospital postoperative stroke from 1999 to 2011 also were examined. The purpose of the study was to appropriately identify patients at high risk for stroke after CABG and spark discussion about the perioperative management of such patients.
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 20, 2017 Category: Anesthesiology Authors: Amol Mehta, Ravi Choxi, Thomas Gleason, Lawrence Wechsler, Tudor Jovin, Parthasarathy D. Thirumala Tags: Original Article Source Type: research

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