The Annals of thoracic surgery
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Moderate aortic stenosis in coronary artery bypass graft surgery (CABG) patients more than 70 years old is not unusual. The risk-benefit of performing a concomitant aortic valve replacement (AVR) is often difficult to assess. To stratify the risk-benefit ratio, we reviewed outcomes of CABG patients more than 70 years old with preoperative moderate aortic stenosis (valve area 1.0 to 1.6 cm(2) or indexed valve area 0.6 to 1.0 cm(2)/m(2)). ⋯ For CABG patients more than 70 years old with minimal comorbidities especially in the presence of aortic gradients of 26/15 mm Hg or greater, concomitant AVR for moderate aortic stenosis should be performed during CABG and may be performed with minimal additional operative risk. Patients with significant comorbidities should be managed with CABG alone, owing to an increased perioperative risk, poor midterm survival, and minimal risk of AVR at 5 years.
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We present a patient with aortic root aneurysm and severe aortic regurgitation who had a previous off-pump reduction ascending aortoplasty and external wrapping with concomitant coronary bypass grafting. Preliminary aortic dissection and erosion of the aortic intima were detected during the operation. This complication warrants the re-evaluation of the indications for reduction ascending aortoplasty and emphasizes the necessity for close follow-up.
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The aim of this review was to analyze our results with extracorporeal membrane oxygenation (ECMO) support for primary graft failure (PGF) in heart transplant recipients. ⋯ Extracorporeal membrane oxygenation provides excellent circulatory support for patients with PGF after heart transplantation with good wean and survival to discharge rates.
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Cardiopulmonary bypass-induced oxidative stress initiates inflammation that can damage the myocardium. This study tested whether cardioplegia enriched with the intermediary metabolite and antioxidant pyruvate dampens postbypass myocardial inflammation. ⋯ Pyruvate-enriched cardioplegia dampens cardiopulmonary bypass-induced myocardial inflammation. Increased GSH/GSSG and TIMP-2 may mediate pyruvate's effects.
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Left main coronary artery (LMCA) stenosis (≥50%) has historically been recognized as a risk factor among patients undergoing coronary artery bypass grafting. ⋯ Off-pump coronary artery bypass grafting is feasible and safe in patients with critical LMCA stenosis and LMCA disease is not recognized as a risk factor after off-pump coronary artery bypass grafting in either the short or the long term.