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In a randomized trial, patients with coronary artery disease and an ejection fraction of 35% or less were randomly assigned to undergo either coronary-artery bypass grafting (CABG) or CABG plus surgical ventricular reconstruction. At a median of 48 months, there was no significant difference between the two groups in the primary outcome of death or hospitalization for cardiac causes. Patients with coronary artery disease and an ejection fraction of 35% or less were randomly assigned to undergo either coronary-artery bypass grafting (CABG) or CABG plus surgical ventricular reconstruction. At a median of 48 months, there was no significant difference in the primary outcome of death or hospitalization for cardiac causes. Coronary artery disease is the predominant cause of heart failure, which is a major cause of death and disability throughout the world. Evidence-based medical therapy has been shown to reduce symptoms and increase survival in patients with heart failure and coronary artery disease. 1 In addition, selected patients may benefit from surgical revascularization by means of coronary-artery bypass grafting (CABG), especially if the coronary anatomy is suitable for such surgery and if there is evidence of myocardial viability. 2 , 3 The reduction in left ventricular function that can occur after myocardial infarction is typically accompanied by left ventricular remodeling, a process that . . .

Stored red cells undergo progressive structural and functional changes over time. In a study of 6002 patients undergoing cardiac surgery at a single institution, those who received blood stored for 14 days or less had lower rates of complications and death than those who received blood stored for more than 14 days. In a study of patients undergoing cardiac surgery, those who received blood stored for 14 days or less had lower rates of complications and death than those who received blood stored for more than 14 days. More than 14 million units of blood are transfused annually in the United States. 1 Considerable evidence suggests that transfusion increases the risk of serious complications and death in critically ill patients, 2 – 4 especially in patients who are undergoing cardiac surgery. 5 – 12 Some studies have suggested that the risk of complications after transfusion also increases when transfused blood has been stored for long periods. 13 – 18 Blood collection and storage systems licensed by the Food and Drug Administration allow red cells to be stored for up to 42 days. (The median duration of storage of transfused red-cell units in the United States . . .

Remote ischaemic preconditioning has been associated with reduced risk of myocardial injury after coronary artery bypass graft (CABG) surgery. We investigated the safety and efficacy of this procedure. Eligible patients were those scheduled to undergo elective isolated first-time CABG surgery under cold crystalloid cardioplegia and cardiopulmonary bypass at the West-German Heart Centre, Essen, Germany, between April, 2008, and October, 2012. Patients were prospectively randomised to receive remote ischaemic preconditioning (three cycles of 5 min ischaemia and 5 min reperfusion in the left upper arm after induction of anaesthesia) or no ischaemic preconditioning (control). The primary endpoint was myocardial injury, as reflected by the geometric mean area under the curve (AUC) for perioperative concentrations of cardiac troponin I (cTnI) in serum in the first 72 h after CABG. Mortality was the main safety endpoint. Analysis was done in intention-to-treat and per-protocol populations. This trial is registered with ClinicalTrials.gov, number NCT01406678. 329 patients were enrolled. Baseline characteristics and perioperative data did not differ between groups. cTnI AUC was 266 ng/mL over 72 h (95% CI 237–298) in the remote ischaemic preconditioning group and 321 ng/mL (287–360) in the control group. In the intention-to-treat population, the ratio of remote ischaemic preconditioning to control for cTnI AUC was 0·83 (95% CI 0·70–0·97, p=0·022). cTnI release remained lower in the per-protocol analysis (0·79, 0·66–0·94, p=0·001). All-cause mortality was assessed over 1·54 (SD 1·22) years and was lower with remote ischaemic preconditioning than without (ratio 0·27, 95% CI 0·08–0·98, p=0·046). Remote ischaemic preconditioning provided perioperative myocardial protection and improved the prognosis of patients undergoing elective CABG surgery. German Research Foundation.

A total of 4752 patients were randomly assigned to CABG with (on-pump) or without (off-pump) cardiopulmonary bypass. At 1 year, there was no significant difference in neurocognitive function or quality of life or in the composite of death, MI, stroke, or renal failure. Coronary-artery bypass grafting (CABG) reduces mortality among patients with extensive coronary artery disease. 1 CABG is usually performed with the use of cardiopulmonary bypass (on-pump CABG). With this approach, perioperative mortality is about 2%, and myocardial infarction, stroke, or renal failure requiring dialysis develop in an additional 5 to 7% of patients. The technique of performing CABG on a beating heart (off-pump CABG) was developed to reduce perioperative complications, some of which may be related to the use of cardiopulmonary bypass and to the cross-clamping of the aorta associated with the on-pump CABG procedure, and to improve long-term outcomes. A number . . .

A total of 4752 patients for whom CABG was planned were randomly assigned to undergo the procedure on-pump or off-pump. At 30 days, the rates of death, myocardial infarction, stroke, or renal failure requiring dialysis did not differ significantly between the two groups. Coronary-artery bypass grafting (CABG) reduces mortality in patients with extensive coronary artery disease. 1 CABG has generally been performed with the use of cardiopulmonary bypass (on-pump). With this approach, perioperative mortality is about 2%, with an additional 5 to 7% of patients having complications such as myocardial infarction, stroke, and renal failure requiring dialysis. The technique of operating on a beating heart (off-pump) for CABG was developed to decrease perioperative complications, some of which may be related to the use of cardiopulmonary bypass and to cross-clamping of the aorta associated with the on-pump CABG procedure. Several previous trials have compared off-pump . . .

Elderly patients were randomly assigned to CABG with cardiopulmonary bypass (on-pump CABG) or without it (off-pump CABG). At 30 days and at 1 year, there was no significant difference in the composite outcome of death, stroke, MI, repeat revascularization, or new renal-replacement therapy. There is an ongoing debate about the benefits and shortcomings of coronary-artery bypass grafting (CABG) without cardiopulmonary bypass (off-pump CABG). Cardiopulmonary bypass can have detrimental effects. 1 – 4 Initial trials have shown that off-pump CABG is feasible in selected low-risk patients and offers results similar to those of CABG performed with the conventional on-pump technique (on-pump CABG). In institutions with experience in off-pump CABG, the rate of major adverse events and the rates of complete revascularization and graft patency have been similar to those with on-pump CABG. 5 – 7 These positive results have been called into question by reports of inferior graft . . .

For patients undergoing coronary-artery bypass grafting (CABG), adverse neurologic outcomes, including stroke and cognitive decline, are major concerns. Even mild cognitive deficits before surgery may be a marker for cerebrovascular disease and increased risk. Patients referred for coronary revascularization procedures are older and are likely to have more extensive extracardiac vascular disease than those referred for such procedures in the past. Despite these trends, mortality rates for coronary-artery bypass grafting (CABG), without concurrent procedures, have continued to decline. 1 Nevertheless, adverse neurologic outcomes, including stroke and cognitive decline, remain a major concern for these older patients. The development of strategies to reduce the incidence of postoperative neurologic events has been hampered by the lack of a clear understanding of the pathophysiology of such outcomes. Owing partly to the assumption that adverse neurologic events were specifically . . .

Objective The original EuroSCORE models are poorly calibrated for predicting mortality in contemporary cardiac surgery. EuroSCORE II has been proposed as a new risk model. The objective of this study was to assess the performance of EuroSCORE II in UK cardiac surgery. Design A cross-sectional analysis of prospectively collected multi-centre clinical audit data, from the Society for Cardiothoracic Surgery in Great Britain and Ireland Database. Setting All NHS hospitals, and some UK private hospitals performing adult cardiac surgery. Patients 23 740 procedures at 41 hospitals between July 2010 and March 2011. Main outcome measures The main outcome measure was in-hospital mortality. Model calibration (Hosmer–Lemeshow test, calibration plot) and discrimination (area under receiver operating characteristic curve) were assessed in the overall cohort and clinically defined sub-groups. Results The mean age at procedure was 67.1 years (SD 11.8) and 27.7% were women. The overall mortality was 3.1% with a EuroSCORE II predicted mortality of 3.4%. Calibration was good overall but the model failed the Hosmer–Lemeshow test (p=0.003) mainly due to over-prediction in the highest and lowest-risk patients. Calibration was poor for isolated coronary artery bypass graft surgery (Hosmer–Lemeshow, p<0.001). The model had good discrimination overall (area under receiver operating characteristic curve 0.808, 95% CI 0.793 to 0.824) and in all clinical sub-groups analysed. Conclusions EuroSCORE II performs well overall in the UK and is an acceptable contemporary generic cardiac surgery risk model. However, the model is poorly calibrated for isolated coronary artery bypass graft surgery and in both the highest and lowest risk patients. Regular revalidation of EuroSCORE II will be needed to identify calibration drift or clinical inconsistencies, which commonly emerge in clinical prediction models.

ObjectiveTo determine whether remote ischaemic preconditioning (RIPC) is cardioprotective in patients undergoing heart valve replacement.DesignSingle-blinded, randomised controlled trial.SettingTertiary referral hospital in China.PatientsAdult patients (31–72 years) undergoing mitral valve, aortic valve or tricuspid valve surgery.InterventionsPatients were randomised to either the RIPC (n=38) or control (n=35) group. After induction of anaesthesia, patients in the RIPC group underwent three 5 min cycles of right upper limb ischaemia, induced by an automated cuff-inflator placed on the upper arm and inflated to 200 mm Hg. Each cycle was interrupted by a 5 min period of reperfusion during which time the cuff was deflated. The control group had only a deflated cuff placed on the upper arm for 30 min.Main outcome measuresSerum troponin I concentration was measured before surgery and at 6, 12, 24, 48, and 72 h postoperatively. The cardiac function of all patients was followed postoperatively.ResultsTroponin I concentration was reduced in the RIPC group (398.7±179.3 μg/l) compared with the control group (708.4±242.5 μg/l). Mean difference was 309.7±50.8 (95% CI 210.1 to 409.3, p<0.0001). A greater improvement in postsurgical cardiac function was noted in the RIPC group than in the control group.ConclusionsThese data indicate that RIPC reduces myocardial injury and improves cardiac function in patients undergoing heart valve surgery.Trial registration numberNCT01175681.

The use of clinical registries and administrative data sets in pediatric cardiovascular research has become increasingly common. However, this approach is limited by relatively few existing datasets, each of which contain limited data, and do not communicate with one another. We describe the implementation and validation of methodology using indirect patient identifiers to link The Society of Thoracic Surgeons Congenital Heart Surgery (STS-CHS) Database to The Pediatric Health Information Systems (PHIS) Database (a pediatric administrative database). Centers submitting data to STS-CHS and PHIS during 2004 to 2008 were included (n = 30). Both data sets were limited to patients 0 to 18 years old undergoing cardiac surgery. An exact match was defined as an exact match on each of the following: date of birth, date of admission, date of discharge, sex, and center. Likely matches were defined as an exact match for all variables except ±1 day for one of the date variables. Of 45,830 STS-CHS records, 87.4% matched to PHIS using the exact match criteria and 90.3% using the exact or likely match criteria. Validation in a subset of patients revealed that 100% of exact and likely matches were true matches. This analysis demonstrates that indirect identifiers can be used to create high-quality link between a clinical registry and administrative data set in the congenital heart surgery population. This methodology, which can also be applied to other data sets, allows researchers to capitalize on the strengths of both types of data and expands the pool of data available to answer important clinical questions.