Journal of cardiac surgery
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Comparative Study
Does the trainee's level of experience impact on patient safety and clinical outcomes in coronary artery bypass surgery?
There is a relative dearth of information on how the resident's level of training affects patient outcomes in cardiac surgery. We designed this study to determine if there were any significant differences in patient demographics and clinical outcomes of coronary artery bypass procedures (CABG) performed by residents of PGY 4/lower, residents of PGY 5/6, fellows, or consultants. ⋯ Preoperative patient demographics and operative data were similar in all groups except that patients requiring IABP preoperatively were more likely operated on by consultants and arterial revascularization was performed more commonly by consultants and fellows. Postoperative mortality and morbidity rates were similar among all groups, thus demonstrating that with appropriate supervision, trainees of all levels can safely be taught CABG.
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We have previously reported that sensory, motor neocortex, and hippocampus are selectively vulnerable to injury in an acute porcine model of HCA at 18 degrees C. This study was undertaken to assess whether further cooling to 10 degrees C can reduce neurological injury during HCA. ⋯ This data support that cerebral protection may be better at very cold temperatures compared to 18 degrees C hypothermia. Regions selectively vulnerable to neuronal injury are offered more neural protection by profound hypothermia. These affects are observed in the acute state, suggesting activation of the apoptotic mechanisms at early stages can be inhibited by profound hypothermia.
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The goal of this study was to assess the safety of early postoperative clopidogrel in patients undergoing on-pump and off-pump coronary artery bypass graft (CABG) surgery. ⋯ When given according to a predefined postoperative protocol, early postoperative clopidogrel can safely be administered in on-pump and off-pump CABG patients, without increasing the risk of bleeding complications. Evaluation of the benefits of clopidogrel therapy early after CABG in a randomized setting is ongoing.
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Evaluate aortic root preserving/sparing procedures for various pathologies associated with ascending aortic aneurysms, including aortic valve regurgitation. ⋯ Excellent early results can be achieved by aortic root preserving procedures and concurrent aortic valve leaflet repairs when appropriately selected for a diverse class of pathologies.
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We describe a safe, easy, and fast technique of exposing the left anterior descending artery (LAD), when this is embedded under the myocardium or excessive epicardial fat tissue, during coronary artery bypass grafting (CABG) or off-pump coronary artery bypass (OPCAB). The vessel is opened as distal as possible, then a fine intravascular probe is introduced retrogradely. Through palpation of the tip, the course of LAD is confined together with the site of distal anastomosis formation. The suggested technique minimizes the risk of injuring the vessel or ventricles, reduces the ischemia-time, and allows the performance of anastomosis as paroximal as possible in the cases of OPCAB with embedded LAD.