J Cardiovasc Surg
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Review Comparative Study
Minimally invasive direct coronary artery bypass grafting: a systematic review.
Recently minimally invasive direct coronary artery bypass grafting (MIDCAB) has become an interesting alternative to conventional coronary artery bypass grafting, especially in patients with a high-grade left anterior descending coronary artery (LAD) stenosis unsuitable for balloon angioplasty. Although MIDCAB offers several advantages such as the avoidance of sternotomy and cardiopulmonary bypass, concerns have been raised about the technical accuracy of the anastomoses that can be performed on a beating heart. Therefore, clinical and angiographic outcomes after MIDCAB are the subject of current controversy. ⋯ Clinical outcomes and immediate graft patency after MIDCAB are acceptable. However, long-term follow-up results and further randomized prospective clinical trials comparing this new technique with standard revascularization procedures are needed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Myocardial function in early hours after coronary artery bypass grafting in patients with left ventricular dysfunction: comparison of blood and crystalloid cardioplegia.
This study was done to evaluate a myocardial function in the early hours after coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction and to compare blood and crystalloid cardioplegia. ⋯ Blood cardioplegia shows earlier improvement of myocardial function after the operation. It could be beneficial in patients with severe left ventricular dysfunction.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized study of diluted versus non-diluted cardioplegia (minicardioplegia) in primary coronary artery bypass surgery.
Sanguineous (blood) cardioplegia has been established as the prime option for myocardial protection but the choice of dilution (4:1 blood to crystalloid ratio) versus use of blood from the cardiopulmonary bypass alone (minicardioplegia) remains controversial. The purpose of this prospective randomized clinical trial was to compare the clinical outcome and enzymatic endpoints (troponin I, CK-MB isoenzyme release) in patients undergoing primary CABG surgery. ⋯ Clinical outcomes are similar in patients undergoing primary CABG surgery with tepid cardioplegia and moderate hypothermic bypass with diluted or minicardioplegia. Minicardioplegia may be the optimal method of myocardial protection because of low cost, ease of use and lack of hemodilutive effect.
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Randomized Controlled Trial Clinical Trial
Preoperative shift from glibenclamide to insulin is cardioprotective in diabetic patients undergoing coronary artery bypass surgery.
The cardioprotective effects afforded by volatile anesthetics, i.e. isoflurane, during heart surgery may be due to preconditioning of the myocardium through the activation of KATP channels. The aims of this study were to establish whether glibenclamide prevents the isoflurane-induced cardioprotection in diabetic patients undergoing coronary surgery (CABG) and whether this cardioprotective effect can be restored by preoperative shift from glibenclamide to insulin therapy. ⋯ This prospective randomized study shows a cardioprotective effect of preoperative administration of isoflurane during CABG. Such an effect is prevented by glibenclamide, but can be restored in diabetic patients by preoperative shift from glibenclamide to insulin.