Total arterial revascularisation as a primary strategy for coronary artery bypass grafting.

BACKGROUND: Bilateral internal thoracic arteries confer improved survival benefit after coronary artery bypass grafting (CABG). Despite increasing evidence, the use of arterial conduits has not been accepted as a primary practice in most of the centres in the UK for various reasons. A series of patients has been analysed to assess the feasibility of total arterial revascularisation as a primary strategy in patients requiring first time CABG. METHODS: Altogether 245 patients undergoing first time CABG by one surgeon, from June 1999 to October 2000, were studied. Group 1 consisted of 165 patients undergoing total arterial revascularisation (using bilateral internal thoracic and radial arteries) and group 2 consisted of 80 patients undergoing conventional CABG (using one internal thoracic artery and supplemental veins). Thirty day mortality and early morbidity with particular reference to resternotomy for bleeding, cerebrovascular accidents, renal failure, and sternal dehiscence were the main outcome measures. RESULTS: Patients in group 1 were younger (mean (SD) 60 (10) v 65 (9) years; p<0.001), had lower Parsonnet scores (mean (SD) 5 (5) v 11 (7); p<0.001), and better left ventricular function. Both groups received a similar number of grafts. The percentage of patients undergoing total arterial revascularisation rose from 44% in the first three months to over 75% in the three latter three month periods. Overall 30 day mortality was 1.3%, one patient (0.6%) in group 1 and two patients (2.5%) in group 2. There was a similar incidence of postoperative complications and length of median postoperative stay in both groups. CONCLUSION: Total arterial revascularisation can be adopted as a primary strategy in most patients undergoing CABG with no increase in mortality or morbidity.

Coronary artery bypass grafts in situs inversus.

Coronary artery bypass grafting in dextrocardia is rare. A case is described for the first time where both arterial and venous conduits were used. The subtle changes required in the conduct of the operation are highlighted.

Pericardiectomy in calcific constrictive pericarditis aided by Midas Rex drill.

Surgery for constrictive pericarditis has become a rare entity now. Various non-cardiac surgical measures are sometimes tried to remove the calcific plaques on the surface without damaging the underlying cardiac structures. We report a case of severe calcific pericarditis in which the Midas Rex neurosurgical drill was successfully used to facilitate pericardiectomy. Such a case has not been previously reported in the literature.

Minimally invasive repair of atrial septal defects--a case series.

INTRODUCTION: Repair of atrial septal defects in adults has become so safe that emphasis is now placed on improving cosmesis without compromising safety. The results of our series of minimally invasive repair of atrial septal defects done through a lower partial sternotomy are reported. MATERIALS AND METHODS: Eight adult patients underwent minimally invasive repairs of atrial septal defects over a period of 1 year (Group 1). Conventional repairs of atrial septal defects were performed in 26 patients over the same period (Group 2). We describe the technique and compare our results on time taken for surgery, bypass time, cross clamp time, time to extubation and total hospital stay. Early complications and complications at 1 year are also presented. RESULTS: No difference in the demographic data was found between the two groups. The time taken for surgery was more, while cross clamp times and bypass times were shorter in Group 1. There was also no difference in the amount of blood loss, early postoperative complications and later complications like cardiac rhythm or wound pain. CONCLUSION: The improved cosmetic appearance, both in males and females, is an important factor to recommend minimally invasive repair of atrial septal defects in an adult population. Surgical closure of atrial septal defects can be performed through a lower partial sternotomy without compromising access or safety with good cosmetic outcome.

Primitive neuroectodermal tumour of the chest wall--a report of two cases and review of literature.

INTRODUCTION: Primitive neuroectodermal tumours (PNETs) of the chest wall are rare entities and little is known regarding its biological activity and prognostic factors. Two cases are reported and the available literature reviewed to highlight the presentation and management of these tumours. CLINICAL FEATURES: We report 2 patients who were diagnosed with PNET of the chest wall in our centre. As there are no clinical features or basic diagnostic measures which are characteristic of these tumours, diagnosis is based on special tests. With the advent of newer immunohistochemical methods, it is now diagnosed more confidently. TREATMENT: Both patients received multidisciplinary modalities of treatment, comprising extensive surgical resection, chemotherapy and radiotherapy. OUTCOME: One patient succumbed to the disease one year after diagnosis and the other is currently disease-free, both clinically and radiologically at 24 months. CONCLUSION: Despite multidisciplinary modalities of treatment, the prognosis of PNET is still generally poor. Early diagnosis and treatment are important to improve the chances of survival.