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Background: Gastrointestinal (GI) complications following coronary artery bypass grafting (CABG), although infrequent, are associated with significant morbidity and mortality. It has been suggested that systemic inflammatory response plays an important role in these complications. Cardiopulmonary bypass (CPB) is well known to cause increased systemic inflammation, and therefore it has been proposed that performing CABG using an off-pump technique could substantially minimize the risk of GI complications. Prolonged CPB duration has been shown to be an independent predictor of GI complications; however, the effect of avoiding CPB altogether through off-pump procedures has not been thoroughly examined. We sought to compare the incidence of GI complications in patients undergoing on-pump and off-pump CABG.Methods: We analyzed prospectively entered data on 2451 patients who underwent isolated CABG between January 2000 and October 2004. We compared GI complication rates in 5 predetermined areas (GI bleed, ileus, pancreatitis, ischemic bowel and cholecystitis) among patients who had on-pump CABG with those of patients who had off-pump CABG. We also compared in-hospital mortality due to these complications between the 2 groups.Results: We compared data for a total of 2010 patients in the on-pump group and 441 in the off-pump group. In the on-pump group, 30 (1.49%) patients experienced GI complications compared with 4 (0.91%) in the off-pump group (p = 0.34). Gastrointestinal bleed was the most common complication in the off-pump group. Eight patients in the on-pump group experienced ischemic bowels compared with no patients in the off-pump group. Six patients (0.3%) in the on-pump group died from GI complications, whereas no patients in the off-pump group died from such complications (p = 0.25).Conclusion: We found no significant difference in the total number of GI complications between the off-pump and on-pump groups; however, trends could be seen in the types of GI complications that occurred in the 2 groups. Owing to the relatively infrequent occurrence of GI complications, a larger scale study would be beneficial to determine whether the differences observed would be significant. [ABSTRACT FROM AUTHOR]

BACKGROUND: Investigation into the surgical application of robot technology continues to expand. We report on the first case series of robotic-assisted mitral valve (RAMV) repair in Canada with use of the da Vinci telemanipulation system (Intuitive Surgical, Sunnyvale, Calif.). METHODS: Between February 2004 and August 2004, 10 patients with normal left ventricular function and severe mitral valve regurgitation underwent RAMV repair with use of the da Vinci system. Peripheral cardiopulmonary bypass, transthoracic aortic cross-clamping and antegrade cardioplegia were used in all cases. A minithoracotomy in the fourth intercostal space and 2 ports in the third and fifth intercostal spaces allowed surgical access. All mitral valve valvuloplasties and band annuloplasties were done endoscopically with robotic assistance. RESULTS: Nine of 10 patients had successful valve repair, and 1 had conversion to mitral valve replacement due to persistent regurgitation. There were no deaths, strokes or need for sternotomy. One patient required re-exploration for bleeding. CONCLUSION: Minimally invasive RAMV repair is feasible and safe with promising early postoperative results when performed by experienced surgical personnel accomplished in both mitral valve procedures and robotic techniques. [ABSTRACT FROM AUTHOR]

Background: Studies conducted before 1999 of patients who had coronary artery bypass graft surgery (CABG) have shown a tendency toward increasing preoperative risk factors. This study examines whether this trend of increasing risk in patients who have cardiac surgery has continued since 1999 and whether its effect on mortality and morbidity has changed.Methods: We prospectively collected data for 2754 patients who had cardiac surgery, divided them into 4 cohorts based on the year of operation (2000-2003) and analyzed the data according to 56 predefined preoperative, operative and postoperative variables.Results: There were no significant changes in most preoperative risk factors over time, except for significant decreases in the proportion of elective (p = 0.016) and emergency/salvage operations (p < 0.001) and increases in urgent procedures and in the number of patients with congestive heart failure (CHF) (p < 0.001). The proportion of CABG procedures decreased significantly, whereas the proportion of valve, CABG plus valve, and non-CABG surgeries increased. A significant increase in multiarterial graft use and a decrease in off-pump coronary artery bypass procedures were observed. Postoperative complication rates did not change during the 4 years except for a significant decrease in wound infections. No significant changes in overall mortality and mortality across types of procedure were observed. Median observed/expected ratios for expected length of stay in hospital and risk of mortality did not change significantly over time.Conclusion: Patients' risk factors, except for CHF, did not change from 2000 to 2003. Despite more complicated procedures, the postoperative complication rates did not change except for a decrease in wound infections. These results suggest that the assumption of an inexorably increasing patient risk profile should be re-evaluated. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Obesity has been described as a risk factor for the development of coronary artery disease, but it has not been determined whether obesity is associated with adverse outcomes after cardiac surgery. Therefore, we analyzed a large cohort of patients who had undergone cardiac surgery to determine whether obesity is a predictor of mortality, morbidity or early readmission to hospital. METHODS: At the London Health Sciences Centre, an academic tertiary care centre, we prospectively entered data from the cardiac surgical database from July 1999 to April 2002. We collected data on 1310 consecutive, unselected patients who underwent cardiac surgery during that time. We assessed the degree of obesity using the body mass index (BMI), and we prospectively documented the occurrence of 10 major complications after surgery. They included stroke, reoperation for bleeding, life-threatening cardiac arrest or arrhythmia, new renal failure requiring dialysis, septicemia, mediastinitis, sternal dehiscence, respiratory failure, postoperative myocardial infarction and low cardiac output necessitating intra-aortic balloon pump use. Univariable and multivariable analyses were conducted to determine the factors associated with and predictive of postoperative death and major complications. RESULTS: An increased BMI did not increase the risk of early postoperative death. Furthermore, increased BMI was not a predictor of a patient experiencing any of the major complications, except sternal dehiscence. An increased BMI was associated with a higher likelihood of readmission to hospital within 30 days of discharge. CONCLUSION: Obesity was not associated with adverse outcomes after cardiac operations, aside from the increased risks of sternal dehiscence and early hospital readmission. [ABSTRACT FROM AUTHOR]