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Sensing Savvy

The Magic of the Left Internal Mammary Artery

Posted by Thomas Gole, DO, FAAFP on Jan 16, 2017 6:30:00 AM

The Left Internal Mammary Artery (LIMA), also known as the Left Internal Thoracic Artery (LITA), has been the gold standard conduit of choice for coronary artery bypass grafting (CABG) for several decades.

More than 30 years ago, Boylan et al published a study in the Journal of Thoracic Cardiovascular Surgery in which the long-term results of 200 patients who underwent CABG, 100 of whom received a LIMA — left anterior descending coronary artery (LAD) bypass graft and the second 100 who received a saphenous vein (SVG) to LAD bypass graft, were analyzed.

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Topics: Cardiothoracic, CABG Surgery, cardiothoracic surgery

Which Surgical Risk Score is Best?

Posted by Thomas Gole, DO, FAAFP on Jan 11, 2017 7:00:00 AM

Doctors from Inova Heart & Vascular Institute, Falls Church, Virginia, recently published their findings after comparing the precision of three risk scores used to measure the quality of cardiac surgical care. They compared the Society of Thoracic Surgeons (STS) surgical risk score, primarily used in the United States, with the European System for Cardiac Operative Risk Evaluation (EuroSCORE II, EuroSCORE I).
The original EuroSCORE I was developed between 1995 and 1999 from data of 19,000 cardiac surgery patients, most of whom had undergone coronary artery bypass grafting (CABG) surgery. About a third underwent valve surgery. The EuroScore I was updated in 2012 to be more user-friendly and applicable to a greater number of procedures.

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Topics: Cardiothoracic, CABG Surgery, cardiothoracic surgery

Beating Surgeon Burnout: Advice From Your Peers

Posted by Thomas Gole, DO, FAAFP on Oct 10, 2016 6:30:00 AM

“Doctors and other health workers pay dearly for the relentless stress of patient care, a plight compounded by mounting bureaucracy and accelerating change in the healthcare industry,” Dr. Mark Greenawald concluded after tragically losing one of his ob-gyn patients during childbirth, and being unable to successfully process the grief from the experience.

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Topics: Clinical Trends, CABG Surgery

Technology Trends Impacting Cardiothoracic Surgery You Need to Know

Posted by Anna Mueller, MS on Aug 15, 2016 7:00:00 AM

Cardiothoracic surgery, Twitter chats and website design may not seem like the perfect combination, but when it comes to accessing the latest journal articles, connecting with patients and expanding your practice, they can be invaluable.

At the 2016 STS Annual Meeting, a panel of cardiothoracic experts shared how these and other internet technology trends are impacting cardiothoracic surgery.

Here are three technology trends impacting cardiothoracic surgery you need to know:

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Topics: Cardiothoracic, CABG Surgery

Medical Errors as a Cause of Death: 4 Things to Know

Posted by Thomas Gole, DO, FAAFP on Jul 20, 2016 6:30:00 AM

As a surgeon, you're keenly aware of the danger of medical errors and extremely diligent to avoid making them.

Medical errors as a cause of death now rank as the third leading cause of death, behind heart disease and cancer in the United States. Researchers at Johns Hopkins University School of Medicine found that errors result in the deaths of around 250,000 patients per year.

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Topics: Clinical Trends, CABG Surgery

How to Increase Efficiency in the Operating Room

Posted by Thomas Gole, DO, FAAFP on Jul 18, 2016 7:00:00 AM

One of the costliest areas in a hospital is the operating room. Despite its high costs, the OR is also one of the top revenue generators, bringing in between $15 - $20 per minute, and that’s just for a basic surgical procedure.

But as budgets become tighter and patients and insurance companies seek a greater value for their money, hospitals are examining ways to increase efficiency in the operating room. Imagine the money and time wasted each time a case is delayed by a search for a piece of missing equipment.

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Topics: Hospital Administration, Cardiothoracic, CABG Surgery

Evaluating Gastroepiploic Arterial Grafts for CABG

Posted by Roger DeLong, CP, PE, MBA on May 18, 2016 6:30:00 AM

Surgeons at the University of Sapporo Japan analyzed the relationship between intraoperative transit-time flow values and post-op angiographic results of gastroepiploic arterial grafts to the right coronary artery to determine whether the flow values are reliable indicators of early graft patency in gastroepiploic to right coronary artery grafts.

Their study pool included 169 patients who underwent off-pump CABG with GEA-RCA bypass grafts. Eighty-three grafts were anastomosed and flows were measured. An angiogram was taken one week after surgery and the anastomosis of each graft was graded using FitzGibbon grading (Study 1) and graft-flow grading (Study 2).

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Topics: Graft Patency Assessment, CABG Surgery

Transit-time Flow Predicts Outcomes in CABG Patients: 1,000 Consecutive Arterial Grafts

Posted by Roger DeLong, CP, PE, MBA on May 11, 2016 7:00:00 AM

female-doctor-evaluating-study.jpgClinicians at the University of Calgary, Alberta, Canada sought to evaluate transit-time flow (TTF) as a tool to detect technical errors in arterial bypass grafts intraoperatively and predict outcomes. They measured flow in 336 consecutive patients who had an average of 3.02 grafts each. Ninety-nine percent of these bypass grafts were arterial. Three parameters: pulsatility index (PI), flow (cc/min) and diastolic filling (DF) were measured in 990 of the total 1,000 grafts.

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Topics: Transit-time Ultrasound, CABG Surgery

European Myocardial Revascularization Guidelines Call for Graft Patency Assessment with Intraoperative Flow Measurements

Posted by Roger DeLong, CP, PE, MBA on Apr 27, 2016 6:30:00 AM

intraoperative flow measurementIn 2010, the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) Task Force on Myocardial Revascularization released guidelines on myocardial revascularization that state the following with respect to intraoperative graft flow patency assessment following bypass graft construction:

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Topics: Transit-time Ultrasound, CABG Surgery

Ventricular Fibrillation and Post-op Complications Reduced by CABG Flow Assessment

Posted by Roger DeLong, CP, PE, MBA on Apr 25, 2016 7:00:00 AM

graft-patency-1.jpgIn his 2005 paper “Intraoperative Bypass Flow Measurement Reduces the Incidence of Postoperative Ventricular Fibrillation and Myocardial Markers after Coronary Revascularization,” Dr. Stefan Bauer from the Department of Cardiovascular and Thoracic Surgery, Heart Institute, Lahr/Baden, Germany, presents definitive data that demonstrate that intraoperative flow measurements for graft assessment during coronary artery bypass grafting (CABG) reduces ventricular fibrillation and postoperative complications.

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Topics: Transit-time Ultrasound, CABG Surgery