Vein graft preservation with an endothelial damage inhibitor in isolated coronary artery bypass surgery: an observational propensity score-matched analysis.

Background: Preservation solutions may be used intraoperatively during coronary artery bypass grafting (CABG) to flush and preserve vein grafts. The aim of this study is to evaluate the effect of DuraGraft, an endothelial damage inhibitor (EDI) preservation solution on major adverse cardiac events (MACEs) after CABG. Methods: We conducted an observational, prospective, longitudinal, single-center study that included patients who underwent isolated CABG. The cohort treated with an EDI was matched 1:1 with a control group treated with conventional vein preservation, and matching was adjusted for possible confounding factors through propensity score (PS) matching. Three years follow-up was conducted, and the occurrence of MACE [defined as all cause-death, acute coronary syndrome (ACS), and new unplanned revascularization] was analyzed using Kaplan-Meier method. Results: The study included 180 patients, 90 in each group. There were no significant differences in baseline characteristics across study groups. The EDI group had a significantly better event-free survival at 3 years (89% vs. 78%, log-rank test P=0.035), with an incidence rate ratio of 0.41 [95% confidence interval (CI): 0.16-0.96]. In the pre-specified subgroups analysis, the use of an EDI was associated with a significantly better event-free survival in diabetic patients (log-rank test P=0.041) and those with two or more saphenous vein grafts (log-rank test P=0.015). Conclusions: The utilization of an EDI for vein flushing and storage after vein harvest in CABG procedures has been shown to significantly decrease the incidence of MACE at 3 years post-surgery. This protective effect is particularly notable in diabetic patients and in individuals who have multiple vein grafts.

Effects of Urbanization on the Diversity, Abundance, and Composition of Ant Assemblages in an Arid City.

Cities within arid regions make up a significant but understudied subset of the urban ecosystems of the world. To assess the effects of urbanization, fragmentation, and land-use change in an arid city, we sampled the ant assemblages in three habitat types in Tucson, Arizona: irrigated neighborhood parks, urban desert remnants, and preserved desert. We analyzed the abundance, species richness, evenness, as well as the species and functional group composition of ant assemblages. We found no significant differences in species richness or evenness. However, irrigated parks had significantly greater ant abundances. Although some exotic species were present in the urban habitats, they did not have significant effects on ant diversity. Ant assemblages from all three habitat types were distinct from each other in their composition. Irrigated parks included a significantly higher proportion of species typically found in cooler and wetter climates. The differences in abundance and species composition between irrigated parks and the other habitats are likely the effect of irrigation removing water as a limiting factor for colony growth and increasing resource availability, as well as producing a localized cooling effect. Our results show that arid urban ecosystems may include considerable biodiversity, in part thanks to increased landscape heterogeneity resulting from the irrigation of green areas.

Myocardial protection in on-pump coronary artery bypass grafting surgery: analysis of the effectiveness of the use of retrograde Celsior®.

BACKGROUND: We analyzed the adequacy of the myocardial protection achieved with a single dose of retrograde crystalloid Celsior®, compared with an accepted standard (microplegia), in on-pump coronary artery bypass grafting surgery (CABG). METHODS: This was a retrospective comparative clinical study conducted in a single institution that included all the patients operated on who had elective isolated on-pump CABG, from March 2006 to June 2014. We evaluated maximum postoperative troponin T (TnT) as a marker of myocardial damage, adjusted for possible confounders using propensity score matching. We also analyzed markers of recovery of myocardial function, and the safety of the intravenous use of Celsior®. RESULTS: During the study period, 261 patients were included, divided in two groups: (a) continuous retrograde blood-based microplegia (114 patients); (b) retrograde single-dose crystalloid Celsior® (147 patients). The propensity score adjusted maximum TnT was significantly lower in the Celsior group [average treatment effect = -0.55 ng/dl; 95% confidence interval (CI) -1.10 to -0.1 ng/dl; p = 0.048]. There were no differences in the postoperative use of intra-aortic balloon of counterpulsation or in the requirements of high-dose inotropic medications. In-hospital mortality was equivalent in both study groups ( p = 0.73); surgical re-exploration because of bleeding was equivalent ( p = 0.37). There were no differences in prolonged mechanical ventilation ( p = 0.65) and intensive care unit length of stay ( p = 0.87). CONCLUSION: An isolated single dose of retrograde Celsior® may be an effective and safe myocardial protection strategy in on-pump CABG.

How to Adjust Neochordae Length Accurately in Degenerative Mitral Regurgitation.

We describe a simple technique for the accurate adjustment of polytetrafluoroethylene neochordae length in degenerative mitral regurgitation using the annuloplasty ring's own suture as a reference instead of using sophisticated or less precise maneuvers. Two threads of the annuloplasty ring suture are placed at the level of the mitral valve annulus plane to be used as a reference to tie the neochordae.

Mortality risk prediction in infective endocarditis surgery: reliability analysis of specific scores.

OBJECTIVES: We assessed the prognostic utility of risk scores in surgery for infective endocarditis (IE) to evaluate their reliability in mortality risk prediction. METHODS: An observational retrospective study was developed to include all patients who underwent surgery for active IE from 2002 to 2016. Classical and endocarditis-specific risk scores were calculated. RESULTS: A total of 180 patients were included in the study. The 30-day mortality rate was 26.82% [95% confidence interval (CI) 20.26-33.20%]. Classical risk scores were confirmed to have a suboptimal prognostic ability. Therefore, 4 IE-specific risk scores were calculated. Discrimination was evaluated using the area under the receiver operating characteristic curve. It was 0.76 (95% CI 0.68-0.82) for the Society of Thoracic Surgeons-IE (STS-IE) score; 0.68 (95% CI 0.58-0.76) for the De Feo-Cotrufo score; 0.73 (95% CI 0.66-0.79) for the PALSUSE score and 0.65 (95% CI 0.57-0.72) for the Costa score. The STS-IE score had higher discrimination when compared with the De Feo-Cotrufo score (P = 0.055) and the Costa score (P = 0.024); however, there was no significant difference when we compared the STS-IE score with the PALSUSE score (P = 0.58). Calibration was assessed using the Hosmer-Lemeshow test; an adequate calibration was confirmed in all 4 scores. CONCLUSIONS: Specific risk scores had better prognostic performance than classical risk scores. The STS-IE score had the highest discrimination and was adequately calibrated. The PALSUSE score also showed optimal discrimination and calibration. The De Feo-Cotrufo score had a lower discrimination in our sample; however, the De Feo-Cotrufo score is recommended in the current guidelines. The Costa score had the lowest discrimination.

Celsior Versus Microplegia: Analysis of Myocardial Protection in Elective Aortic Valve Replacement.

BACKGROUND: Previous studies have analyzed the efficacy of crystalloid cardioplegic solutions, but the use of Celsior (Genzyme Corp, Boston, MA) as a crystalloid cardioplegic solution has not been evaluated. METHODS: In this observational retrospective study, Celsior crystalloid solution was compared with an all-blood continuous myocardial protection (microplegia). The study included all patients who underwent elective aortic valve replacement operations in whom the myocardial protection was Celsior or microplegia. The primary end points were surrogates of myocardial protection and death at 30 days. The secondary end point was the safety analysis of the use of Celsior. RESULTS: The study included 631 patients, divided in two groups: 219 (34.7%) with microplegia and 412 (65.3%) with Celsior. Troponin T release accurately predicted postoperative death (area under the receiver operating characteristic curve = 0.85). Troponin T increased with the duration of clamp time, and the adjusted time-related increase was lower in the Celsior group. There were no statistically significant differences in the postoperative use of inotropic medication or intraaortic balloon pump. Adjusted postoperative death was lower in Celsior group (odds ratio, 0.33; 95% confidence interval, 0.15 to 0.76). There were no allergic reactions attributed to Celsior and no unexpected toxicity with the use of Celsior (coagulopathy, renal dysfunction, liver dysfunction, or encephalopathy). CONCLUSIONS: Isolated crystalloid Celsior may be an optimal and safe myocardial protection strategy in aortic valve replacement operations.

Field and Laboratory Evaluations of Chlorantraniliprole as a Termiticide in Southern Arizona.

The desert subterranean termite, Heterotermes aureus (Snyder), is the predominant termite of economic importance in the arid southwest. Chlorantraniliprole, a relatively new nonrepellent, slow acting termiticide has been shown to be capable of being transferred among colony members through social interactions, and thus may be effective beyond its original site of application. Using field grids, we evaluated the colony-level effects of chlorantraniliprole on H. aureus foraging activity. Repeated laboratory soil bioassays at 3, 15, 27 and 39 mo postapplication were performed to determine the effects of chlorantraniliprole on termite mortality and tunneling activity. Additionally, field tests of chlorantraniliprole were completed on 10 structures infested with H. aureus. In the experimental grids, the zone surrounded by a chlorantraniliprole perimeter was the only section in which a significant decrease in the number of termites collected occurred, but this was observed in both treatment and controls plots. Overall, no significant colony-level effects of chlorantraniliprole application were observed within the grids. Laboratory bioassays resulted in high mortality and significantly lower tunneling activity of exposed termites at all time points. In structures, the initial application of chlorantraniliprole was sufficient to control infestations in 6 out of 10 cases without supplemental applications. Additional treatments were confined to areas that had not been treated previously. Results show that chlorantraniliprole is capable of achieving control of desert subterranean termites under most conditions. This is likely a result of its high toxicity instead of colony-level effects resulting from termiticide transfer.

Evaluation of Liquid and Bait Insecticides against the Dark Rover Ant (Brachymyrmex patagonicus).

Dark rover ants (Brachymyrmex patagonicus, Mayr) are an exotic ant species native to South America that has recently spread through the southern US. We evaluated the residual activity of three liquid insecticides (indoxacarb, fipronil and lambda-cyhalothrin) as potential barrier treatments against these ants. The factors we considered include the use of a porous or non-porous surface, a short or long exposure time and the changes in insecticide activity after treatment during a 90 day period. We also tested the effect of baits containing three different active ingredients (imidacloprid, sodium tetraborate and indoxacarb) on colony fragments of this species for a 15 day period. Both lambda-cyhalothrin® and indoxacarb® resulted in high levels of ant mortality up to 90 days after application. The results of exposure to fipronil® resembled those from the control treatment. Application of insecticides on a porous surface and the shorter exposure time generally resulted in greater ant survival. Of the baits tested, only the imidacloprid based one decreased ant survival significantly during the evaluation period. Within three days, the imidacloprid bait produced over 50% mortality which increased to over 95% by the end of the experiment. Results from the other two bait treatments were not significantly different from the control.

Repair of multiple aneurysms of the thoracic aorta with a hybrid prosthesis.

Complex aneurysmal disease of the thoracic aorta is commonly treated with the elephant trunk technique using two-stage surgery. However, this procedure is associated with high morbidity and mortality. We present the surgical technique used to correct diffuse aneurysmal aortic disease that involves the aortic arch and the descending aorta. The frozen elephant trunk technique using the E-vita Open prosthesis (hybrid procedure), that combines surgical and interventional technologies, was useful to simplify the conventional surgical procedure in a single-stage approach with optimal results.

Endocarditis por Tropheryma whipplei / Endocarditis due to Tropheryma Whipplei

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Síndrome de Guillain-Barré secundario a cirugía de revascularización miocárdica / Guillain-Barré syndrome following coronary artery bypass surgery

Presentamos el caso de un paciente que presentó un Síndrome de Guillain-Barré tras una cirugía de revascularización miocárdica con circulación extracorpórea. Asimismo, revisamos tanto la necesidad de un diagnóstico precoz de este síndrome para mejorar su evolución, como el proceso inmunológico que se desencadena en pacientes sometidos a circulación extracorpórea

We present a case of Guillain-Barré syndrome occurring after coronary artery bypass with cardiopulmonary bypass. The early diagnosis and their relation with immune mediate process triggered by Cardiopulmonary Bypass are discussed