Radial artery harvest using the sharp scissors method for patients with pathological findings on Allen's test.

PURPOSE: The pathological findings on Allen's test tend to be contraindicative for radial artery (RA) harvest. However, the employment of a meticulous harvest technique might help protect the collateral vessels from the interosseous arteries and thus help to maintain forearm circulation. We herein report successful RA harvest using the sharp scissors method in patients with pathological findings on Allen's test. METHODS: Ten patients with pathological findings on Allen's test underwent RA harvest using only sharp scissors and metal clips. The distal end of the RA was left approximately 5 cm from the wrist. Using forearm thermography, the skin temperature of the harvest site was compared with that of the non-harvest site. All patients underwent postoperative forearm angiography one month after surgery. RESULTS: No ischemic events in the forearm or harvest site complications were observed. Thermography showed no difference in the skin temperatures between the harvest and non-harvest sites in all patients. Moreover, forearm angiography 1 month postoperatively showed that the interosseous arteries to be well developed and connected to the distal end of the RA in all patients. CONCLUSIONS: These results suggest that a meticulous RA harvest using sharp scissors and clips can help to protect from collateral perfusion of the interosseous arteries. Using this method, RA harvest is therefore considered to be acceptable even for patients with pathological findings on Allen's test.

Risk analysis for depression and patient prognosis after open heart surgery.

BACKGROUND: The aim of the present study was to determine the predictors of depression as a complication after open heart surgery and influence of depression on the patients' prognosis. METHODS AND RESULTS: During the last 3 years, 97 patients (21.5%) of the 452 adult patients who had open heart surgery at our institute experienced depression after the operation. Patients who scored over 16 points using a Center for Epidemiological Studies Depression Scale were diagnosed with significant symptoms of depression. Depressed patients (group I, n=97) and non-depressed patients (group II, n=355) in terms of mortality and length of hospital stay were compared. Predictors for depression were identified by logistic regression analysis. The postoperative hospital stay was significantly longer in group I. Hospital mortality was also significantly higher in group I. Female gender (odds ratio (OR): 5.15, p<0.0001), emergency surgery (OR: 4.46, p<0.0001), and being over 70 years of age (OR: 4.67, p<0.0001) were found to be significant predictors for postoperative depression. CONCLUSION: The prognosis for patients who had depression developed after open heart surgery was poor. It might be important to start prophylactic medication as soon as possible after the operation, particularly for patients at risk of having depression.