Increased coronary artery disease severity in black women undergoing coronary bypass surgery.

Race and sex disparities are believed to play an important role in heart disease. The purpose of this study was to examine the association between race, sex, and number of diseased vessels at the time of coronary artery bypass grafting (CABG), and subsequent postoperative outcomes. The 13,774 patients undergoing first-time, isolated CABG between 1992 and 2011 were included. Trend in the number of diseased vessels between black and white patients, stratified by sex, were analyzed using a Cochran-Armitage trend test. Models were adjusted for age, procedural status (elective vs. nonelective), and payor type (private vs. nonprivate insurance). Black female CABG patients presented with an increasingly greater number of diseased vessels than white female CABG patients (adjusted P(trend) = 0.0021). A similar trend was not observed between black and white male CABG patients (adjusted P(trend) = 0.18). Black female CABG patients were also more likely to have longer intensive care unit and hospital lengths of stay than other race-sex groups.Our findings suggest that black female CABG patients have more advanced coronary artery disease than white female CABG patients. Further research is needed to determine the benefit of targeted preventive care and preoperative workup for this high-risk group.

The impact of prior percutaneous coronary intervention on long-term survival after coronary artery bypass grafting.

BACKGROUND: Previous studies examining the influence of prior percutaneous coronary intervention (PCI) on long-term survival after coronary artery bypass grafting (CABG) have reported conflicting results. The purpose of this study was to further examine the influence of prior PCI on long-term survival after CABG at a large tertiary referral heart institute. METHODS: Long-term survival between 1992 and 2011 was compared in non-emergent CABG cases with and without prior PCI. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. RESULTS: A total of 2532 (19%) patients had prior PCI before CABG (n=13,354). The median follow-up for study participants was 8.1 years. The median survival for patients with and without prior PCI was 15 years and 14 years, respectively (p<0.0001). Long-term survival was similar between patients with and without prior PCI after adjusting for age, sex, race, hypertension, coronary artery disease severity, congestive heart failure, and prior stroke (adjusted HR=0.99, 95%CI=0.91-1.06). CONCLUSION: Findings from outcomes research are important in the planning of appropriate postoperative patient care. Our study provides additional evidence that prior PCI is not a significant predictor of long-term survival after CABG.

Entrenamiento en tele-cirugía y cirugía robótica: seis años de experiencia / Training in tele-surgery and robotic surgery: six years experience

En los últimos 20 años todas las especialidades quirúrgicas han tratado de ofrecer procedimientos menos invasivos. El paso más reciente ha sido la adaptación de la cirugía robótica o mejor dicho de técnicas de tele-cirugía. Esta tecnología ha sido incorporada lentamente por varias razones incluyendo: el coste, la curva de aprendizaje, y las limitaciones tecnológicas. Nuestro centro ha sido uno de los pioneros en el uso y entrenamiento de la cirugía robótica. En esta monografía vamos a describir nuestros resultados y experiencia de nuestro programa de entrenamiento (AU)

Over the last 20 years there has been a move in all surgical specialties towards less invasive surgical procedures. The most recent step is robotic surgery or better described as surgical telemanipulation technology which has slowly been adapted worldwide for many reasons including: cost, learning curve, available technology, and applicability to the different surgical specialties. Nonetheless, its use continues to grow in all surgical fields. Our center has been a pioneer in the use and training of robotic surgical techniques. In this manuscript, we describe the organization and experience of our training program (AU)

Outcomes in robotic cardiac surgery.

The specialty of cardiac surgery has evolved substantially over the last 50 years, and surgical procedures that seemed impossible then are now commonly encountered in hospitals throughout the world. The latest development in this ever-evolving field is minimally invasive and robot-assisted procedures. In this article we will review the surgical outcomes reported for different series of procedures in cardiac surgery.