10-year follow-up of off-pump multivessel coronary artery bypass grafting.

On-pump total arterial grafting is associated with improved long-term outcomes compared to conventional grafting using left internal thoracic artery and saphenous vein grafts, but there are no data to confirm the same for off-pump total arterial grafting. We assessed the impact of off-pump total arterial grafting on medium-term outcomes. From September 1998 to September 2008, 580 consecutive patients who had off-pump multivessel arterial grafting only were compared with a control group of 806 patients undergoing off-pump coronary artery bypass with internal thoracic artery and saphenous vein grafts, performed by the same surgeon. Perioperative data were collected prospectively. Medium-term univariate and risk-adjusted comparisons between the 2 groups were carried out. After adjusting for clinical covariates, total arterial grafting did not emerge as a significant independent predictor of medium-term mortality, readmission to hospital, or the composite outcome of death and readmission. At medium-term follow-up, off-pump total arterial grafting, despite being a safe and effective myocardial revascularization strategy, offered no mortality or morbidity benefits.

For patients undergoing coronary artery bypass grafting at higher risk of stroke is the single cross-clamp technique of benefit in reducing the incidence of stroke?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether, for patients undergoing coronary artery bypass grafting at higher risk of stroke, the single cross-clamp (SC) technique is of benefit in reducing the incidence of stroke. Using the reported search 458 papers were identified. Six randomised controlled trials (RCTs), of which one was a duplicate publication, represented the best evidence on the subject. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated for these. We conclude that current best available evidence, from six RCTs randomising 490 patients, suggests that there is no benefit of SC technique over multiple cross-clamp (MC) technique in terms of reduction in the incidence of stroke (SC=2/206 vs. MC=7/284; P=ns) although there is some advantage of SC technique in causing less neuropsychological deficits and release of serum S-100 protein, a surrogate marker of cerebral injury.

Cardiac surgery under perfusionless hypothermia: Siberian experience.

Between January 1995 and December 1999, 942 patients (452 males and 490 females) aged 1 to 51 years underwent definitive surgery under perfusionless hypothermia for correction of congenital heart defects, predominantly uncomplicated ventricular or atrial septal defects (80%). Hypothermia of 24 degrees C to 28 degrees C was achieved in 15 to 45 minutes (mean, 25.7 +/- 1.2 minutes) by application of crushed ice over the body and head. Aortic crossclamp time ranged from 10 to 76 minutes (mean, 26.1 +/- 0.25 minutes). Cardiac restoration time ranged from 1 to 10 minutes (mean, 2.1 +/- 0.08 minutes). Eight patients (0.85%) died postoperatively: 4 from acute cardiac insufficiency, 2 as a consequence of technical faults, 1 from persistent pulmonary hypertension, and 1 had sudden cardiac arrest. None of the surviving patients showed any gross neurological deficit. Perfusionless hypothermic cardiac surgery, when applied appropriately, is safe and simple, and might still have a place in treating a selected group of patients with uncomplicated congenital heart defects.