The Annals of thoracic surgery
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Conventional coronary artery bypass grafting using cardiopulmonary bypass carries relatively high mortality and morbidity for patients with left ventricular dysfunction. ⋯ Coronary artery bypass grafting without cardiopulmonary bypass is a viable alternative to conventional coronary artery bypass grafting particularly for patients with extreme left ventricular dysfunction or those with coexisting risk factors, such as acute myocardial infarction and cardiogenic shock.
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Pulmonary resection is rarely required for trauma, and its mortality is reportedly high. ⋯ Pulmonary resection is infrequently required for lung injury. Overall mortality is lower than previously reported, but pneumonectomy has a high mortality. Blunt trauma has a higher mortality than penetrating trauma. Injury severity scores are higher for nonsurvivors than survivors; this shows the importance of associated injuries on outcome.
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Competitive status of percutaneous transluminal coronary angioplasty and stenting has stimulated an interest in minimally invasive direct coronary artery bypass grafting. ⋯ Minimally invasive direct coronary artery bypass grafting is safe and effective with good early and midterm clinical results, especially with left internal mammary artery-to-left anterior descending coronary artery grafting via minithoracotomy. Regional cardiac wall immobilization of coronary artery target sites enhances the early graft patency in a predictable manner (96.2%), and this method should be an essential part of all minimally invasive direct coronary artery bypass graft operations with left internal mammary artery-to-left anterior descending artery grafts via minithoracotomy. Further study is required to establish the long-term efficacy of minimally invasive direct coronary artery bypass grafting and the treatment of coronary artery disease.
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Conventional reoperative coronary artery bypass grafting using cardiopulmonary bypass carries relatively high mortality and morbidity. ⋯ Reoperative coronary artery bypass grafting without cardiopulmonary bypass has acceptable early and midterm outcome, and should be considered a viable alternative for properly selected patients.
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We describe a device for coronary artery stabilization during minimally invasive coronary artery bypass grafting performed without cardiopulmonary bypass via a small (8 to 10 cm) left anterolateral thoracotomy. This device facilitates the anastomosis of the left internal mammary artery to the left anterior descending coronary artery on the beating heart. The device consists of a simple coronary stabilizer mounted on a wound spreader. We have used this device successfully in 35 primary minimally invasive coronary artery bypass grafting operations.