Distal carotid perfusion in combined carotid endarterectomy and OP-CABG.

An alternative method of maintaining carotid perfusion during combined carotid endarterectomy and off-pump coronary artery bypass grafting involves insertion of a cannula in the ascending aorta after a median sternotomy. This cannula is connected to a perfusion cannula, the distal end of which is inserted into the carotid artery beyond the carotid arteriotomy. This technique of aortico-carotid shunting and carotid perfusion was utilized in nine patients who underwent successful combined carotid endarterectomy and off-pump coronary artery bypass grafting.

Marsupialization of intramyocardial left anterior descending artery: a novel approach for easy access during revascularization.

The left anterior descending (LAD) artery is the most important vessel bypassed during coronary revascularization procedures. This artery usually runs a superficial course, making it easy for localization and grafting. However, many times it takes a course deep in the myocardium or is embedded in thick epicardial fat, which results in technical challenges to the surgeon for localization and grafting. So far, many techniques are described for overcoming these problems, but all require cardiopulmonary bypass (CPB), and in fact, intramyocardial LAD is considered a relative contraindication for off-pump coronary artery bypass grafting (OPCAB). In the present era of enhanced interest in OPCAB, these techniques are not as helpful as they are for conventional CABG with CPB. Here, we describe a novel approach of marsupialization of the LAD for revascularization of intramyocardial LAD that is useful for off-pump as well as conventional revascularization procedures and makes grafting simple and reproducible.

Ultra low dose aprotinin decreases blood loss and transfusion requirements in high risk two valve replacement surgery.

The efficacy of ultra-low-dose-aprotinin (ULDA) in 'high-risk' two valve replacement surgery, was evaluated in this prospective, randomized, double-blind study. Forty adult high-risk patients undergoing elective two valve replacement surgery, were included. The patients were divided into 2 groups of 20 each. In Group I, aprotinin in a dose of 1,000,000 KIU was administered from the end of anaesthesia induction to the time of sternotomy after a 1 ml of test dose. In Group II (control), 100 ml of normal saline was administered in a similar fashion. Coagulation parameters, blood loss, and amount of transfusion of blood / blood products were measured at specific intervals. The postoperative chest tube drainage in the first 24 hours was significantly less 203+/-35 ml (p<0.05) in Group I as compared with 490+/-104 ml in group II and consequently, Group I patients received significantly less (p<0.05) red cell concentrates and platelet transfusion. There was a significant decrease in the length of postoperative elective ventilation, intensive care unit (ICU) stay and direct costs involved in the hospital expenses with the use of ULDA. We conclude that ULDA is safe and effective in 'high-risk' two-valve replacement surgery to reduce postoperative bleeding, postoperative length of intubation and ICU stay; use of ULDA is associated with significant direct cost savings.