Double cobra head technique of distal coronary anastomosis.

In 1967, Dr. René Favaloro introduced the use of reversed greater saphenous vein graft for coronary artery bypass grafting, since then a lot of efforts were made to improve the venous graft patency rate. We introduce a novel double cobra head technique of distal coronary anastomosis for better distal runoff. We expect our technique will help in difficult situations such as limited conduit availability and target vessel with bifurcation lesions. Refining our surgical techniques is essential to keep ourselves well equipped to compete with the rapidly evolving stent culture.

In the VEST trial: are we missed to address the pathology incurred by the external stent?

In the VEST IV trial, the author concluded that external stenting of saphenous vein graft mitigates its remodeling and also significantly reduces the diffuse intimal hyperplasia and development of lumen irregularities at 4.5 years after coronary artery bypass grafting surgery. We also have valuable a suggestion in addition to external stenting that might nullify the pathology caused by the stent and might enhances graft patency.

Weight gain potential-a neglected entity during valve replacement.

INTRODUCTION: During valve replacement, appropriate valve size will be chosen based on many factors, neglecting the potential of the patient for gaining weight. We aimed at evaluating the weight gain potential and its effect on hemodynamics in post mitral valve replacement (MVR) patients. MATERIAL AND METHODS: In 118 post-MVR patients, demographic and echocardiographic data at the time of discharge and follow-up were obtained and analyzed. Primary aim of study is to analyze the hemodynamics of patients based on weight gain/loss. Secondary aim is to evaluate the same in patient-prosthesis mismatch (PPM) subgroup and to evaluate the study population for the potential to gain/loss weight. RESULTS: Among 118 patients, 87 patients (73.7%) gained weight. In 87 weight gained patients, left atrial (LA) size (p = 0.011) and pulmonary artery systolic (PA) pressure (p = 0.028) at follow-up were significantly elevated than the discharge values. Among 53 PPM patients (incidence, 44.9%), 34 patients gained weight and their PA pressure was found to be elevated at follow-up (p = 0.021) whereas weight lost group does not show any significant difference (p = 0.972). Frequency of weight gain was more among patients who weighed < 50 kg preoperatively (28 out of 30) (p = 0.013) and 20 to 30 years age group patients (p = 0.043). No sex predilection was noted (p = 0.149). CONCLUSION: In post-MVR patients, weight gain has definitive influence over hemodynamics. In PPM subgroup, weight gained patients had significantly increased PA systolic pressure at follow-up. Young, < 50 kg weighed, and PPM patients should be advised to maintain their weight post MVR for better hemodynamics.

Uncommon Anatomic Variation of Left Internal Mammary Artery: God-Created Y-Graft Conduit.

The left internal mammary artery is the most accepted and widely used conduit in coronary artery bypass grafting. This report presents a rare case of very early bifurcation of the left internal mammary artery at the level of the third intercostal space.

Role of surgical ventricular restoration post surgical treatment of heart failure (STICH) trial.

OBJECTIVE: To compare the outcomes of isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) with or without CABG for patients with ischemic cardiomyopathy (ICM). METHODS: Retrospectively, 49 patients with ICM and severe LV dysfunction (LVEF < 35%) who underwent SVR with or without CABG from January 2009 to December 2016 at a single institution was compared with 49 patients who underwent isolated CABG. The two groups were matched for preoperative clinical and echocardiographic parameters including left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV). Primary outcomes analyzed included early mortality, late mortality, and major adverse cardiac or cerebrovascular events (MACCE). Secondary outcomes analyzed included echocardiographic parameters of left ventricular volume and function-indexed left ventricular end-diastolic volume (LVEDVi), indexed left ventricular end-systolic volume (LVESVi), and LVEF. Cox and survival analysis was performed. RESULTS: Early and late mortality in SVR vs. CABG groups were 4 (8.1%) and 6 (12.2%) vs. 1 (2%) and 5 (10.2%) respectively. Mean improvement in LVEF was 3.39 ± 7.51 compared to 4.97 ± 5.45 between the two groups at 3-month follow-up. Mean improvement in LVEF was 5.1 ± 8.3 in the SVR group vs 5.9 ± 7.1 in the CABG group at the last follow-up. There was no statistically significant improvement between the two groups in terms of LVEF at 3 months or the last follow-up. There were statistically significant differences between LVEDVi and LVESVi between the two groups at 3 months and the last follow-up. The 5-year rates of survival were 85 ± 6 and 82 ± 9% for SVR and CABG groups respectively. The 5-year rates of freedom from MACCE were 75 ± 7 and 60 ± 11% for SVR and CABG groups respectively. CONCLUSION: Compared with isolated CABG, SVR plus CABG results in equivalent late mortality and better left ventricular reverse remodeling (as evidenced by LV volume reduction) and better freedom from MACCE at 5-year follow-up.