Off-pump coronary artery bypass surgery in women.

OBJECTIVE: Gender is a well-known risk factor for mortality and morbidity after coronary artery bypass grafting and various reasons have been proposed to explain the poorer results observed in women. The study objective was to determine whether female gender was still an operative risk factor with the adoption of off-pump coronary artery bypass surgery. METHODS: Of 2123 consecutive patients who underwent isolated CABG between November 2002 and December 2007, 1966 (92.6%) (481 women and 1485 men) were operated without cardiopulmonary bypass and form the study population. Women were older (69.0 vs. 64.7 years; p = 0.001) and had more severe angina (CCS class 3.1 vs. 2.7; p = 0.001), smaller body surface area (1.6 vs. 1.8 m2; p = 0.001), higher body mass index and greater incidence of diabetes (48.3% vs. 34.2%; p = 0.005) than men. There were no statistically significant differences in the incidence of three-vessel disease (69.5% vs. 71.9%) or left main disease (22.2% vs. 27.0%) but ejection fraction was higher in women (61.3% vs. 59.0%; p = 0.01). Risk factors for in-hospital mortality were identified by univariate analysis and logistic regression. RESULTS: The number of distal anastomoses was lower in women than in men (2.8 vs. 3.0; p = 0.001). In-hospital mortality was 2.0% in women and 0.8% in men (p = 0.01) and female gender was one of the eight risk factors for in-hospital mortality identified by univariate analysis. Using a logistic regression model, only age (OR: 1.7; 95% CI 1.01-1.14; p = 0.02) and logistic EuroSCORE (OR: 1.07; 95% CI 1.03-1.10; p < 0.001) were independently associated with in-hospital mortality. Logistic EuroSCORE was the only independent risk factor for major morbidity (OR: 1.07 95% CI 1.04-1.10; p < 0.001). CONCLUSION: Women who undergo coronary artery bypass grafting have an unfavorable clinical profile compared to men, resulting in higher unadjusted in-hospital mortality. However, in an unselected patient population undergoing off-pump CABG, female gender was not found to be an independent risk factor for mortality or major morbidity.

Assessing TNT and DNT groundwater contamination by compound-specific isotope analysis and 3H-3He groundwater dating: a case study in Portugal.

Trinitrotoluene (TNT) and dinitrotoluene (DNT) originating from 50 years of explosives production have heavily contaminated two stacked aquifers in the vicinity of Lisboa, Portugal. To assess if these poly-nitroaromatic compounds (P-NACs) are being degraded in the subsurface, tracer-based groundwater dating techniques combined with compound-specific isotope analyses (CSIA) were applied. The groundwater residence times were distinctly different in the two aerobic aquifers, as determined by the tritium ((3)H)-(3)He method. In the contaminated zones, the upper aquifer exhibited groundwater ages of 25 years, whereas the lower (presumably confined) aquifer contained hardly any tritium which indicates water ages >55 years. P-NACs-containing waste waters are known to have leaked into the upper, unconfined aquifer. However, P-NACs were present in both aquifers in high concentrations (up to 33000 microg L(-1) TNT), which implies a hydraulic connection, although tritium concentrations and chemical data suggest two separated aquifers. Based on the (3)H-(3)He groundwater dating and the presence of very high P-NAC concentrations, the contamination of the lower aquifer must have happened during the early stage of the explosive production, i.e. >50 years ago. Despite this 'old' contamination, TNT and DNT have not been transformed until to date as is demonstrated by the negligible changes in their carbon isotopic signatures (delta(13)C). Thus, P-NACs are very recalcitrant to degradation at the investigated site. If the aquifers remain aerobic, TNT and DNT are expected to persist in the subsurface for many decades to centuries. The presented approach of assessing time scales of natural attenuation at the field scale by the combination of CSIA and (3)H-(3)He water dating has the potential to be applied to any other groundwater contaminants, such as chlorinated hydrocarbons, gasoline components, heterocyclic carbenes, or polyaromatic hydrocarbons.

Less invasive coronary artery bypass surgery: early results in 1083 patients operated off-pump.

OBJECTIVE: To analyze the early results of coronary surgery without cardiopulmonary bypass using the EuroSCORE risk model. METHODS: Out of a series of 1104 consecutive patients undergoing CABG during a 20-month period and whose data were prospectively collected, 1083 patients (98.1%) were operated without cardiopulmonary bypass (CPB) and represent the patient population. Mean age was 65.6 +/- 9.9 years (31-90), 23.1% were female, 77.9% hypertensive, 38.0% diabetic, 22.8% had peripheral vascular disease, 73.0% triple-vessel disease, 54.7% previous myocardial infarction and 67.0% were in CCS class III or IV. Three hundred and forty-one patients (31.5%) were operated on urgently. Surgery was performed with the aid of cardiac stabilizers and intracoronary shunts. RESULTS: The mean number of distal anastomoses was 2.9; the left internal mammary artery was used in 99% of patients. In 10 patients (0.9%), conversion to CPB was required, without mortality or morbidity. Sixteen patients (1.5%) had myocardial infarction; mean troponin T and CK-MB at 24 h were 0.20 +/- 0.43 ng/ml and 28.2 +/- 49.9 U/l respectively. Twenty patients (1.8%) had neurologic deficit, 10 (0.9%) required hemofiltration or dialysis, 229 (21%) received blood transfusions and 135 (14.2%) had atrial fibrillation. Median intubation time was 9 h, and median ICU stay was one day. Median hospital stay was 5 days. Twelve patients died in hospital (1.1%). Thirty-day observed mortality and EuroSCORE-predicted mortality were 1.3% and 4.0% respectively (p < 0.01). CONCLUSION: Off-pump CAB surgery has become our preferred method in almost all patients undergoing coronary surgery, without compromising completeness of revascularization. Observed mortality was significantly lower than that predicted by EuroSCORE and the incidence of complications was reasonably low considering the population's risk factors.