Background The impact of coronary artery endarterectomy during coronary artery bypass grafting (CABG) has been debated. We examined the early and late outcomes of CABG with endarterectomy (CE) compared to CABG alone. Methods Patients undergoing isolated CABG operations from 2003 to 2008 were retrospectively reviewed. We identified 99 patients who underwent CE and 3:1 propensity matched them to 297 CABG-alone patients based upon clinical factors: Society of Thoracic Surgeons (STS) predicted risk of mortality, age, gender, year of surgery, and ejection fraction. Patient risk factors as well as short-and long-term outcomes were compared by univariate and Kaplan-Meier analysis. Results Preoperative risk factors were similar between patients undergoing CE or CABG alone. Cross-clamp times (95.6 vs. 71.8 minutes, p = 0.0001) and perfusion times (121.8 vs. 92.7 minutes, p = 0.0001) were longer in patients undergoing CE. Operative mortality (4.0% vs. 1.3%, p = 0.112) and postoperative complications were not significantly different between groups. Patients undergoing coronary endarterectomy incurred longer ICU (75.06 vs. 48.64 hours, p = 0.001) and hospital stays (9.01 vs. 7.7 days, p = 0.034). Long-term mortality (mean follow-up = 27.7 ± 17.7 months) was equivalent despite revascularization technique (p = 0.13); however, patients undergoing CE encountered worse overall freedom from myocardial infarction (MI) (p = 0.03). Conclusion Patients undergoing CABG with coronary CE required longer ventilatory support and ICU stay yet have comparable operative mortality, major complication rates, and long-term survival to isolated CABG. Coronary endarterectomy should be considered an acceptable adjunct to CABG for patients with extensive coronary artery disease to achieve complete revascularization.

Objectives Ischemia-reperfusion (IR) injury after lung transplantation remains a major source of morbidity and mortality. Adenosine receptors have been implicated in both pro- and anti-inflammatory roles in IR injury. This study tests the hypothesis that the adenosine A2B receptor (A2BR) exacerbates the pro-inflammatory response to lung IR injury. Methods An in-vivo left lung hilar clamp model of IR was utilized in wild-type C57BL6 (WT) and A2BR knockout (A2BR−/−) mice as well as in chimeras created by bone marrow transplantation between WT and A2BR−/− mice. Mice underwent either sham surgery or lung IR (1 hour ischemia and 2 hours reperfusion). At the end of reperfusion, lung function was assessed using an isolated buffer-perfused lung system. Lung inflammation was assessed by measuring pro-inflammatory cytokine levels in bronchoalveolar lavage fluid, and neutrophil infiltration was assessed via myeloperoxidase levels in lung tissue. Results Compared to WT mice, lungs of A2BR−/− mice were significantly protected after IR as evidenced by significantly reduced pulmonary artery pressure, increased lung compliance, decreased myeloperoxidase and reduced pro-inflammatory cytokine levels (TNF-α, IL-6, KC, RANTES, MCP-1). A2BR−/−→A2BR−/− (donor→recipient) and WT→A2BR−/−, but not A2BR−/−→WT, chimeras showed significantly improved lung function after IR. Conclusions These results suggest that the A2BR plays an important role in mediating lung inflammation after IR by stimulating cytokine production and neutrophil chemotaxis. The pro-inflammatory effects of A2BR appear to be derived by A2BR activation primarily on resident pulmonary cells and not bone marrow-derived cells. A2BR may provide a therapeutic target for prevention of IR-related graft dysfunction in lung transplant patients.

The Damus-Kaye-Stansel (DKS) anastomosis was originally described for the treatment of transposition of the great arteries but it is now used mainly for the treatment of single ventricle anomalies in patients who are at risk of developing systemic ventricular outflow tract obstruction (SVOTO). In most instances, DKS is performed as a concomitant procedure at time of bidirectional cavopulmonary connection in these patients. This tutorial we demonstrate our modified double-barrel approach, along with anterior patch augmentation of the distal ascending aorta. We have found that this technique is very effective in mitigating SVOTO risk while preserving semilunar valve anatomy and function.