Surgical myocardial revascularization (CABG) in patients with pulmonary disease: beating heart versus cardiopulmonary bypass.

BACKGROUND: Adverse effects on the respiratory system can be severe in many instances after coronarv artery bypass grafting (CABG) with cardiopulmonary bypass (CPBP). Recently, operative techniques without CPBP have gained widespread consent, thanks to the newly developed retractors that allow satisfactory immobilisation of the surgical field. METHODS: Thirty-seven patients operated upon in our Institution between April 1997 and April 1998 showed an obstructive and/or restrictive pulmonary disease. Twenty-one patients were operated on without CBPB (group A), while 16 patients were operated using CPBP (group B, control). The allocation in each group had been randomised. RESULTS: The length of the operation in group A was less than in group B (196+/-35 minutes vs 235+/-60 minutes), (p=0.014). A significant difference was found in postoperative bleeding: 562+/-381 ml vs 776+/-378 (p=0.046), in postoperative red cell count, hemoglobin level and Hct. Permanence on the ventilator was 19.1+/-13 hours in group B and 13.1+/-6.1 hours in group A (p=0.03). The length of stay in ICU was significantly different: 33.8+/-16.2 hours for group A vs 53.6+/-29.3 hours for group B (p=0.01). No respiratory failure occurred in group A; two patients experienced slow weaning from ventilation assistance and one died from that complication in group B. CONCLUSIONS: Myocardial revascularization without CPBP allows a better postoperative clinical course in patients with advanced pulmonary disease.

[The complications of implantable cardioverter-defibrillators and their treatment]. / Complicanze dei defibrillatori cardiovertitori impiantabili e loro trattamento.

Infection of implantable cardioverter defibrillator (ICD) is a devastating event. In an effort to more fully understand ICD infection, the authors reviewed patients records recommending a strategy for management based on their satisfactory experience. From March 1993 through May 1998, 85 ICD were implanted in 64 male and 21 female patients. Transmediastinal approach was performed in 8 (9.5%) cases and transvenous in 77 (91.5%). All device-related infections were examined. Seven (8.25%) device-related infections occurred with a mean time interval of 3 months. In all cases bacterial infection was demonstrated. All infections involved the generator with or without other components involvement. First approach was conservative in all cases but it wasn't successful. Then the authors always used a surgical therapy, in 3 cases removing electrodes by traction and in 4 resorting to cardiopulmonary bypass (CPB). Two deaths were registered. Explantation of ICD resolved in all cases infective complications with no early or additional reinfections. In the last cases with devices implanted by transvenous approach and subpectoral generator implant, no infective complications were observed. In authors experience a complete removal of the ICD generator as well as of all its components is to be preferred as soon as the infections develops.