Off-Pump Versus On-Pump: Long-Term Outcomes After Coronary Artery Bypass in a Veteran Population.

OBJECTIVES: The authors sought to investigate long-term outcomes after revascularization with and without use of cardiopulmonary bypass and hypothesized that off-pump would be comparable with on-pump. The primary outcome of interest was survival, and secondary outcomes were need for reintervention for revascularization or new diagnosis of myocardial infarction occurring any time after surgery during the 8- to 12-year follow-up period. DESIGN: Retrospective cohort analysis. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: All patients undergoing primary isolated coronary bypass between January 1, 2004, and December 31, 2008 (n = 555). INTERVENTIONS: Coronary artery bypass on-pump (n = 238) or off-pump (n = 317). MEASUREMENTS AND MAIN RESULTS: Demographic and clinical variables were documented, including information on mortality, new myocardial infarction, and need for reintervention in the 8- to 12-year period after surgery. The on-pump and off-pump groups were similar regarding all demographic and clinical variables (p > 0.05), except for higher incidence of prior percutaneous coronary intervention in the off-pump group. There were more perioperative complications in the on-pump group (p = 0.007) and a greater number of grafts used (p = 0.000). Kaplan-Meier survival analysis demonstrated no significant difference (p > 0.05) in overall survival, reintervention-free survival, or postoperative myocardial infarction-free survival between patients who underwent bypass grafting on-pump or off-pump over extended follow-up averaging 10years. CONCLUSIONS: The present study's data did not show differences in key long-term outcomes between patients who underwent revascularization with or without cardiopulmonary bypass, supporting the idea that both methods achieve similar late results regarding overall survival, need for reintervention, and postoperative myocardial infarction.

Gordonia sternal wound infection treated with ceftaroline: case report and literature review.

Introduction. Case reports have emerged with identification of Gordonia bronchialis infections including sternal wound infections and foreign bodies such as central lines and shunts. Case presentation. We present a case that demonstrates the need to consider Gordonia infection as a cause of sternal wound infection and highlights the utility of novel diagnostics to aid in the identification of unusual pathogens that can cause post-operative infections. We report here the first successful use of ceftaroline for treatment of a G. bronchialis sternal wound infection. Conclusion. There are only case reports and in vitro assays to date to guide treatment of this infection, and we now add ceftaroline as a new drug to consider, though adequate surgical debridement is paramount.

Vascular Thoracic Outlet Syndrome.

Vascular thoracic outlet syndrome generally affects young, active, otherwise healthy patients. The diagnosis is suspected by clinical presentation, and can be confirmed with angiography or venography. Conservative management has been associated with significant morbidity and long-term residual disability. We have used a multimodal treatment protocol that includes thrombolysis, anticoagulation, surgical decompression, and interventional procedures. Catheter-directed recombinant tissue-type plasminogen activator and intravenous heparin infusion are instituted at the time of diagnosis to promote recanalization and prevent propagation of thrombus. Surgical decompression of the thoracic outlet can be readily achieved by first rib resection during the same hospitalization. Postoperative venograms are obtained in all patients. Residual stenoses can be managed with angioplasty alone in some patients but more commonly require stent placement. We believe thrombolysis, anticoagulation, surgical decompression, and percutaneous interventions act synergistically to improve results of therapy in patients with vascular thoracic outlet syndrome.