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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

We don't know what we need to know about atrial fibrillation
Atrial fibrillation (AF) is encountered in older patients and sometimes preoperatively in patients undergoing coronary artery bypass (CAB). Prior single-center studies, Society of Thoracic Surgeons database studies, and a Cochrane review indicate that AF is associated with increased risk for these patients.1-3 The meta-analysis from Saxena and colleagues4 confirms these prior reports and notes an association of preoperative AF with higher stroke, renal failure, reoperation for bleeding, prolonged ventilation, and higher early and late mortality.
Source: The Journal of Thoracic and Cardiovascular Surgery - January 5, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Patrick M. McCarthy Tags: Editorial commentary Source Type: research

Timing of surgery for pulmonary embolism: An evolving paradigm
The article in this issue of the Journal from Lee and coworkers1 presents the outcome of acute pulmonary embolism (PE) from a statewide database in New York State between 1999 and 2013. Although the study has inherent limitations because of the use of a large, disparate database, Lee and coworkers1 noted several important points. The 30-day mortality was similar between patients treated with thrombolysis and those treated with surgical embolectomy. Thrombolysis was associated with a lower risk of major bleeding but with a higher risk of stroke.
Source: The Journal of Thoracic and Cardiovascular Surgery - October 20, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Marc de Perrot Tags: Editorial commentary Source Type: research

You can't always get what you want
In the current issue of the Journal, Schnittman and colleagues1 provide an elegant retrospective analysis of isolated mitral valve replacement (MVR) operations in patients aged 18 to 50  years using New York and California administrative claims data. They found an alarming overall trend in the increase in bioprostheses (BPs) from 10% to 34% between 1997 and 2014. After excluding endocarditis and congenital abnormalities, they laudably examined 373 comprehensively propensity-matche d pairs of isolated MVR receiving mechanical prostheses (MPs) versus BP from 1997 to 2006 to assess 15-year survival and readmissions for strok...
Source: The Journal of Thoracic and Cardiovascular Surgery - September 16, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Harold G. Roberts, Lawrence M. Wei, Vinay Badhwar Tags: Editorial commentary Source Type: research

Take me to your bleeder: Recombinant factor VIIa —finding its way in cardiac surgery
In this issue of the Journal, Dr Zindovic and colleagues1 examined whether data from the Nordic Consortium for Acute Type A Aortic Dissection database indicated that use of recombinant factor VIIa (rFVIIa) was associated with mortality, stroke, or renal replacement therapy after acute type A aortic dissection (ATAAD) surgical repair. Bleeding in ATAAD repair is a concern to all surgeons performing such operations. Any adjunct to attenuate bleeding is appreciated, and in ATAAD, rFVIIa has been suggested to do so.
Source: The Journal of Thoracic and Cardiovascular Surgery - September 4, 2017 Category: Cardiovascular & Thoracic Surgery Authors: John Bozinovski Tags: Editorial commentary Source Type: research

Left Atrial Appendage Exclusion: An Alternative to Anticoagulation in Non-Valvular Atrial Fibrillation
One in every five strokes is due to atrial fibrillation. Anticoagulation has been the evidence-based practice for stroke risk reduction. Anticoagulation is however also associated with a lifelong commitment to a risk of bleeding-related morbidity and mortality. There is a need for alternatives to anticoagulation in atrial fibrillation. In this review, we summarize the evidence behind the technologies that are proposed to reduce the risk of stroke in atrial fibrillation patients who cannot receive or do not want anticoagulation.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 2, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Kareem Bedeir, David R. Holmes, James L. Cox, Basel Ramlawi Source Type: research

Discussion
Dr T. E. MacGillivray (Boston, Mass). Thank you very much, Dr Pomar, Dr Sundt. I am grateful to Dr Masabni for sending me a copy of his manuscript in advance, and I congratulate you on an excellent presentation. Back when I was a cardiac surgery resident, one of my attendings would frequently lament, “If it weren't for the bleeding and the strokes, cardiac surgery would be the greatest job in the world!” Although we all know that bleeding eventually stops, the catastrophic impact of stroke can last forever.
Source: The Journal of Thoracic and Cardiovascular Surgery - November 13, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Bleeding and Cerebral Injury Following Aortic Arch Repair: Two Achilles’ Heels
Aortic arch surgery continues to be hampered by the potentially devastating complications of bleeding and stroke. Ongoing efforts by cardiovascular surgeons have resulted in improvements in results, but further advancement is still required.
Source: The Journal of Thoracic and Cardiovascular Surgery - September 5, 2015 Category: Cardiovascular & Thoracic Surgery Authors: John S. Ikonomidis Source Type: research

Bleeding and cerebral injury following aortic arch repair: Two chinks in the armor
Aortic arch repair remains a complex, technically challenging procedure, even in the most experienced of hands. It has been very interesting to watch the progression of techniques and strategies employed to overcome the ever-present risks of stroke and hemorrhage associated with these operations. The question is, Have we made progress?
Source: The Journal of Thoracic and Cardiovascular Surgery - September 5, 2015 Category: Cardiovascular & Thoracic Surgery Authors: John S. Ikonomidis Tags: Expert opinion Source Type: research

The Addition of Hemi-arch Replacement to Aortic Root Surgery Does Not Affect Safety
Hemi-arch reconstruction is the conventional approach for proximal aortic arch replacement but carries risks of neurologic events and coagulopathy. Addition of hemi-arch reconstruction to aortic root replacement may prevent future arch pathology. In this series, addition of a hemi-arch had low mortality and did not increase stroke or bleeding complications.
Source: The Journal of Thoracic and Cardiovascular Surgery - March 19, 2015 Category: Cardiovascular & Thoracic Surgery Authors: S.C. Malaisrie, B. Duncan, C.K. Mehta, M.V. Badiwala, D. Rinewalt, J. Kruse, Z. Li, A.-C. Andrei, P.M. McCarthy 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

Impact of concurrent surgical valve procedures in patients receiving continuous-flow devices
Conclusions: Patients frequently require concurrent VPs at the time of LVAD placement; these patients are sicker and have higher early mortality. Furthermore, right ventricular dysfunction is increased in these patients. Further studies to develop selection criteria for concurrent valve interventions are important to further improve clinical outcomes.
Source: The Journal of Thoracic and Cardiovascular Surgery - January 14, 2014 Category: Cardiovascular & Thoracic Surgery Authors: Ranjit John, Yoshifumi Naka, Soon J. Park, Chittoor Sai-Sudhakar, Christopher Salerno, Kartik S. Sundareswaran, David J. Farrar, Carmelo A. Milano Tags: Acquired Cardiovascular Disease Source Type: research

Reoperative aortic valve replacement in the octogenarians—minimally invasive technique in the era of transcatheter valve replacement
Conclusions: Octogenarians who undergo re-AVR are thought to be high-risk surgical candidates. The present single-center series revealed acceptable in-hospital outcomes and operative mortality. Mre-AVR was associated with better survival compared with Fre-AVR and might benefit this population.
Source: The Journal of Thoracic and Cardiovascular Surgery - November 4, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Tsuyoshi Kaneko, Dan Loberman, Igor Gosev, Fadi Rassam, Siobhan McGurk, Marzia Leacche, Lawrence Cohn 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

Repair of retrograde ascending dissection after descending stent grafting
Conclusions: Retrograde ascending dissection can present as an early or a late complication after descending stent grafting because of aortic instability or disease progression and has usually been associated with descending dissection or intramural hematoma. It is a life-threatening complication that can be managed safely with early recognition and rapid delivery of open or hybrid repair.
Source: The Journal of Thoracic and Cardiovascular Surgery - October 21, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Jahanzaib Idrees, Amr Arafat, Douglas R. Johnston, Lars G. Svensson, Eric E. Roselli Tags: Acquired Cardiovascular Disease Source Type: research

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