Redo Coronary Artery Bypass Grafting in the era of Advanced PCI

Abstract Objective: To review the evidence behind the role and relevance of redo coronary artery bypass grafting (CABG) in the current practice of percutaneous coronary intervention (PCI). Methods: A comprehensive electronic literature search was performed to identify articles that discuss the practice of PCI and redo CABG in patients that require coronary revascularization. All relevant studies are summarized in narrative manner to reflect current indications and preference. Results: The advancement in utilization of PCI has reduced the rate of redo CABG in patients with previous CABG that requires revascularization of an already treated coronary disease or a new onset of coronary artery stenosis. Redo CABG is associated with satisfactory perioperative outcomes but higher mortality at immediate postoperative period when compared to PCI. Conclusion: Redo CABG patients are less likely to develop comorbidities associated with revascularisation, but the operative mortality is higher and long-term survival rates are similar in comparison to PCI. There is a need for further research into the role of redo CABG in the current advanced practice of PCI.

Blowing the whistle: Perceptions of surgical staff and medical students in a public South African hospital

Understanding perspectives on whistleblowing is important in tackling a resistance to speaking out. This study aimed to elicit the views of medical students and doctors in Edendale Hospital, South Africa using a mixed-methods questionnaire study incorporating free text and tick-box answers. Thematic analysis and descriptive statistics were used to interpret the results. Fifty-eight doctors and medical students responded (87% response rate); the majority were surgeons at Edendale hospital. Seventeen percent did not understand the concept of whistleblowing, while 42% felt unable to report an adverse event. Motivation for reporting adverse events was overwhelmingly in the interests of patient safety (91%), but reluctance was mainly due to the potential consequences on workplace relationships (24%). The most common innovation suggested was a reporting structure (54%). These observations indicate workplace relationships are an important barrier to whistleblowing. Further research should expand on these concerns and explore staff knowledge about whistleblowing