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Outcomes of surgical aortic valve replacement in moderate risk patients: Implications for determination of equipoise in the transcatheter era
Objective: To determine the contemporary outcomes of surgical aortic valve replacement (SAVR) in a moderate surgical risk population.Methods: We studied 502 consecutive adults who had undergone isolated SAVR from January 2002 to June 2011 for severe aortic valve stenosis with a Society of Thoracic Surgery predicted risk of mortality of 4% to 8%. We included concomitant coronary artery bypass and aortic annular enlargement but not other concomitant procedures. The updated Valve Academic Research Consortium definitions were used, as appropriate.Results: The median age was 80 years (range, 49-96), 323 (64.3%) had New York Hea...
Source: The Journal of Thoracic and Cardiovascular Surgery - October 7, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Sebastian A. Iturra, Rakesh M. Suri, Kevin L. Greason, John M. Stulak, Harold M. Burkhart, Joseph A. Dearani, Hartzell V. Schaff Tags: Acquired Cardiovascular Disease Source Type: research

Early clinical and angiographic outcomes after robotic-assisted coronary artery bypass surgery
Objective: Robotic-assisted coronary artery bypass grafting has emerged as an alternative to traditional coronary artery bypass grafting or percutaneous intervention for patients with coronary artery disease. However, the safety and efficacy of this minimally invasive procedure have not been established in large series.Methods: From October 2009 to September 2012, 307 consecutive robotic-assisted coronary artery bypass grafting procedures were performed at a single US institution by 2 surgeons. Isolated, off-pump, left internal thoracic artery to left anterior descending coronary artery grafting was planned via a 3- to 4...
Source: The Journal of Thoracic and Cardiovascular Surgery - October 29, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Michael E. Halkos, Henry A. Liberman, Chandan Devireddy, Patrick Walker, Aloke V. Finn, Wissam Jaber, Robert A. Guyton, John D. Puskas Tags: Acquired Cardiovascular Disease Source Type: research

Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality
Conclusions: Blood pressure management during cardiopulmonary bypass using physiologic endpoints such as cerebral autoregulation monitoring might provide a method of optimizing organ perfusion and improving patient outcomes from cardiac surgery.
Source: The Journal of Thoracic and Cardiovascular Surgery - September 30, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Masahiro Ono, Kenneth Brady, R. Blaine Easley, Charles Brown, Michael Kraut, Rebecca F. Gottesman, Charles W. Hogue Tags: Perioperative Management Source Type: research

Standardizing definitions for hybrid coronary revascularization
The optimal revascularization strategy for patients with multivessel coronary artery disease remains controversial. Coronary artery bypass grafting (CABG) surgery is still considered the criterion standard, but percutaneous coronary intervention (PCI) has become the preferred strategy for most patients with coronary artery disease. Numerous studies have compared outcomes after CABG and multivessel PCI. In general, it is accepted that CABG surgery has the advantage of superior long-term freedom from repeat revascularization, as well as a survival benefit in certain high-risk groups, but that these benefits come at the expen...
Source: The Journal of Thoracic and Cardiovascular Surgery - November 25, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Ralf E. Harskamp, Johannes O. Bonatti, David X. Zhao, John D. Puskas, Robbert J. de Winter, John H. Alexander, Michael E. Halkos Tags: Editorial Source Type: research

Surgical revascularization for patients with diabetes: Do all roads lead to Rome?
The BARI 2D trial (Bypass Angioplasty Revascularization Investigation 2 Diabetes Trial)1 randomly allocated patients with type 2 diabetes and stable coronary artery disease (CAD) and evidence of myocardial ischemia to undergo, at the discretion of the treating physician, either early revascularization with a percutaneous intervention (PCI) or coronary artery bypass grafting (CABG) with optimal medical therapy (OMT), or OMT alone. Patients in the OMT group were also randomly assigned to insulin-sensitizing strategy (metformin and thiazolidinedione) or an insulin-providing strategy (insulin or secretagogue.) The 5-year follo...
Source: The Journal of Thoracic and Cardiovascular Surgery - August 28, 2014 Category: Cardiovascular & Thoracic Surgery Authors: Tomas A. Salerno Tags: Editorial commentary Source Type: research

To cool or not to cool?
To cool or not to cool—that is the question that is raised by the recent study by Greason and colleagues1 appearing in this issue of the Journal. Greason and colleagues1 used the Society of Thoracic Surgeons database to evaluate patients undergoing nonemergency on-pump isolated coronary artery bypass grafting (CABG) with specific attention to the effect of lowest intraoperative recorded core body temperature on the primary end point of operative mortality and secondary end points of stroke, reoperation for bleeding, and a combined infection end point.
Source: The Journal of Thoracic and Cardiovascular Surgery - September 30, 2014 Category: Cardiovascular & Thoracic Surgery Authors: Jennifer S. Lawton Tags: Editorial commentary Source Type: research

Does Preoperative Carotid Stenosis Screening Reduce Perioperative Stroke in Patients Undergoing Coronary Artery Bypass Grafting?
Source: The Journal of Thoracic and Cardiovascular Surgery - February 9, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Khalil Masabni, Sajjad Raza, Eugene H. Blackstone, Heather L. Gornik, Joseph F. Sabik Source Type: research

Off-Pump CABG Improves Short-Term Outcomes in High Risk Patients As Compared to On-Pump CABG: Meta-analysis
Off-pump CABG significantly reduced postoperative stroke compared to on-pump CABG. Additionally, benefits from off-pump CABG arise in high risk patients.
Source: The Journal of Thoracic and Cardiovascular Surgery - August 14, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Mariusz Kowalewski, Wojciech Pawliszak, Pietro Giorgio Malvindi, Marek Pawel Bokszanski, Damian Perlinski, Giuseppe Maria Raffa, Magdalena Ewa Kowalkowska, Katarzyna Zaborowska, Eliano Pio Navarese, Michalina Kolodziejczak, Janusz Kowalewski, Giuseppe Tar Source Type: research

Reply to the Editor
It is time for the debate about on-pump versus off-pump CABG to be finally settled. Off-pump CABG was introduced with the hope of avoiding the morbidity of cardiopulmonary bypass, but randomized trials, including Veterans Affairs Randomized On/Off Bypass, Coronary Artery Bypass Surgery Off or On Pump Revascularization study, and the German Off-Pump Coronary Artery Bypass Grafting in Elderly Patients, have shown no clear advantage for off-pump CABG with regard to hard clinical end points such as mortality and stroke.
Source: The Journal of Thoracic and Cardiovascular Surgery - August 28, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Faisal G. Bakaeen Tags: Letter to the editor Source Type: research

Meta-analysis of the messenger: The price of small trials diverting our attention from the real target
The meta-analysis of Kowalewski and colleagues1 appearing in this issue of the Journal has presented a thorough comparison of on- and off-pump coronary artery bypass grafting with regard to 3 perioperative outcomes: death, myocardial infarction, and stroke. Data were presented to confirm that there was no selection bias in the articles, and Forest plot analyses were performed to provide the reader with confidence that the trials were relatively homogeneous as the confidence intervals generally overlapped.
Source: The Journal of Thoracic and Cardiovascular Surgery - August 24, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Fraser Rubens Tags: Editorial commentary Source Type: research

Trans-aortic, Video-Assisted Removal of a Mobile Left Ventricular Apical Thrombus in a Patient with Aortic Stenosis and Severe Left Ventricular Dysfunction
We describe the removal of a mobile and protruding left ventricular thrombus using a video-assisted technique during an aortic valve replacement and coronary artery bypass procedure.
Source: The Journal of Thoracic and Cardiovascular Surgery - September 27, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Christina Williamson, Lori B. Sheehan, David M. Venesy, Richard S. D’Agostino Source Type: research

Off-pump versus on-pump coronary artery bypass grafting: Who benefits?
We read with great interest the editorial commentary by Rubens1 regarding our recently available meta-analysis2 suggesting improved outcomes with off-pump coronary artery bypass grafting (CABG) relative to conventional on-pump CABG in high-risk patients. In brief, the analysis by including 100 randomized controlled trials (RCTs; N = 19,192 patients) comparing off-pump versus on-pump CABG demonstrated, apart from significant 28% reduction of the odds of 30-day cerebral stroke, that the benefits of off-pump CABG are more pronounced in patients at higher baseline risk.
Source: The Journal of Thoracic and Cardiovascular Surgery - November 15, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Wojciech Pawliszak, Mariusz Kowalewski, Lech Anisimowicz Tags: Letter to the editor Source Type: research

Topical amiodarone to prevent postoperative atrial fibrillation: Need for further study
Postoperative atrial fibrillation (AF) is a common complication after cardiac surgery that increases hospital stay and the risk of stroke.1 Prophylactic systemic administration of amiodarone in the perioperative period prevents postoperative AF2; however, its challenging side-effect profile limits its routine and widespread use as prophylaxis.3 It was therefore with great interest that we recently read the report by Feng and colleagues4 describing their success in applying a topical amiodarone-releasing hydrogel on the atrial surface during coronary artery bypass grafting operations.
Source: The Journal of Thoracic and Cardiovascular Surgery - January 23, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Jordan Beau, Alexander Kulik Tags: Letter to the editor Source Type: research

One-Stop Hybrid Coronary Revascularization versus Off-Pump Coronary Artery Bypass in Patients with Diabetes Mellitus
Using propensity score matching, We compared the inhospital and midterm outcomes after one-stop HCR with OPCAB in patients with DM, and found that one-stop HCR had less blood loss, lower PRBC requirement, faster recovery, and similar MACCE rate but reduced stroke rate over 30 months follow-up.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 13, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Zhizhao Song, Liuzhong Shen, Zhe Zheng, Bo Xu, Hui Xiong, Lihuan Li, Shengshou Hu Source Type: research

On-pump versus off-pump: It's all about the grafts!
Originally proposed as a less-invasive form of revascularization, off-pump coronary artery bypass (OPCAB) surgery promised to reduce morbidity, decrease resource use, and provide a better surgical option for high-risk patients. Early enthusiasm has yielded to a more balanced approach. Meta-analyses of prospective randomized control trials suggest a benefit in reducing perioperative stroke and potentially renal impairment,1,2 whereas longer-term studies suggest decreased graft patency and increased need for revascularization.
Source: The Journal of Thoracic and Cardiovascular Surgery - October 23, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Paul Kurlansky Tags: Editorial commentary Source Type: research

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