Background Despite advances in surgical and postoperative care, myocardial injury or infarction (MI) is still a common complication in patients undergoing coronary artery bypass surgery (CABG). Several studies that aimed to reduce postoperative myocardial injury, including those investigating statin loading, have been conducted but did not indicate any clear benefits. Evolocumab, a PCSK9 inhibitor, has been reported to lower lipids and prevent ischemic events in various medical conditions. However, the effect of evolocumab in cardiovascular surgery has not been evaluated. The objective of this trial is to evaluate the cardioprotective effects of evolocumab in elective CABG patients with multivessel coronary artery disease. Methods EVOCABG is a prospective, randomized, open, controlled, multicenter, superiority, phase III clinical trial. Patients with multivessel coronary artery disease without initial cardiac enzyme elevation will be recruited (n=100). Participants will be randomly allocated into two groups: a test group (evolocumab (140mg) administration once within 72 h before CABG) and a control group (no administration). The primary outcome is the change in peak levels of serum cardiac marker (troponin-I) within 3 days of CABG surgery compared to the baseline. Secondary outcomes include post-operative clinical events including death, myocardial infarction, heart failure, stroke, and atrial fibrillation. Discussion This trial is the first prospective randomized controlled trial to demonstrate the efficacy of evolocumab in reducing ischemic-reperfusion injury in patients undergoing CABG. This trial will provide the first high-quality evidence for preoperative use of evolocumab in mitigating or preventing ischemic-reperfusion-related myocardial injury during the surgery. Trial registration Clinical Research Information Service (CRIS) of the Republic of Korea KCT0005577. Registered on 4 November 2020.

Perivascular epithelioid cell tumors (PEComas) are very rare mesenchymal neoplasms, composed of histologically and immunohistochemically distinctive cells that form a sheetlike appearance around vessel lumens. Although most are benign, a malignant subset does exist, complicating clinical diagnostic efforts. Proper evaluation and management are thus essential for long-term patient survival. Herein, we present a rare case of a benign pulmonary PEComa that was diagnosed postoperatively in a 45-year-old woman.

Great saphenous vein is a conduit commonly used for coronary artery bypass grafting. However, several complications could occur at leg wound site for vein harvesting. Here, we describe a huge sac of hematoma as an uncommon complication of saphenous vein harvest for coronary artery bypass grafting.A 62-year-old gentleman was readmitted with swelling at left thigh 30 days after coronary artery bypass grafting. Lower extremity computed tomography was suggestive of an oval and thick sac implying a hematoma or seroma. After using ultrasound scanning for the mass, an incision through the previous surgical wound showed a huge mass. Inspection after incision the mass revealed an old hematoma within the sac.Pathologic findings demonstrated chronic inflammation with the hematoma surrounded by a fibrotic sac. The patient’s postoperative course was uneventful without recurrence.Our experience suggests the possibility of a huge hematoma within a thick fibrotic sac at the previous vein harvest site for coronary artery bypass grafting.

Great saphenous vein is a conduit commonly used for coronary artery bypass grafting. However, several complications could occur at leg wound site for vein harvesting. Here, we describe a huge sac of hematoma as an uncommon complication of saphenous vein harvest for coronary artery bypass grafting. A 62-year-old gentleman was readmitted with swelling at left thigh 30 days after coronary artery bypass grafting. Lower extremity computed tomography was suggestive of an oval and thick sac implying a hematoma or seroma. After using ultrasound scanning for the mass, an incision through the previous surgical wound showed a huge mass looking like a ‘sweet potato’. Inspection after incision the mass revealed an old hematoma within the sac. Pathologic findings demonstrated chronic inflammation with the hematoma surrounded by a fibrotic sac. The patient's postoperative course was uneventful without recurrence. Our experience suggests the possibility of a huge hematoma within a thick fibrotic sac at the previous vein harvest site for coronary artery bypass grafting. We hope that this case will contribute to the management of leg wound complications in similar cases.