External aortic clamping may be safer than endoaortic balloon occlusion with respect to aortic dissection and conversion to sternotomy. However, mortality, length of stay, stroke, cross-clamp time and other cardiovascular complication rates were similar between the 2 techniques.

Background: Minimally invasive direct coronary artery bypass (MIDCAB) grafting is regarded as an alternative to conventional coronary artery bypass grafting (CABG) through full sternotomy, particularly for patients with isolated proximal left anterior descending (LAD) artery stenosis deemed unsuitable for percutaneous coronary intervention. However, the technically demanding nature of the procedure and lack of long-term published outcomes have precluded its universal adoption. We report the comparative shortterm outcomes and long-term survival of MIDCAB and conventional CABG through full sternotomy for grafting of isolated LAD. Methods: From February 1996 to October 2017, a total of 668 patients underwent MIDCAB (n=508) and full sternotomy (n=160) CABG for isolated proximal LAD stenosis. Their data were prospectively entered into the institutional cardiac surgery database (Patients Analysis & Tracking System; Dendrite Clinical Systems, Ltd, Oxford, England, United Kingdom) and analyzed retrospectively. Information on patient deaths was obtained from the institutional database and the National General Register Office for all patients.Results: The two groups were comparable with respect to preoperative demographics and risk profile.MIDCAB was associated with longer operative time (177±32 versus 141±12 min; P=0.003). The two groups did not significantly differ with regard to other complications including operative mortality. At a mean follow-up of 12.95±0.47 years, survival was also similar.Conclusions: This large single centre study with longest follow-up validates the status of MIDCAB as an effective strategy for grafting of LAD. However, it fails to show superiority of the minimally invasive approach compared to conventional CABG through full sternotomy.Keywords: Proximal left anterior descending artery; minimally invasive direct coronary artery bypass grafting (MIDCAB grafting); minimally invasive direct coronary artery bypass (MIDCAB); minimally invasive revascularization; left internal mammary artery (LIMA)

…………………………………………………………………………………… 1 Introduction ………………………………………………………………………………… 1 Purpose and Scope ……………………………………………………………………… 2 Approach …………………………………………………………………………………… 4 Results …………………………………………………………………………………… 6 Merced, CA ……………………………………………………………………………… 6 White River Basin, IN …………………………………………………………………… 7 Model Summaries …………………………………………………………………………… 9 Complex models ………………………………………………………………………… 9 LEACHP …………………………………………………………………………… 9 HYDRUS2D ………………………………………………………………………… 9 RZWQM …………………………………………………………………………… 10 VS2DT ……………………………………………………………………………… 11 Simple models …………………………………………………………………………… 11 CALF ……………………………………………………………………………… 11 GLEAMS …………………………………………………………………………… 12 PRZM …………………………………………………………………………… 12 Summary …………………………………………………………………………………… 12 References …………………………………………………………………………………… 13 Appendix-Published Model Comparison Studies …………………………………………… 15 Tables 1. Model summary ……………………………………………………………………… 3 2. Simulation layers and sediment properties ………………………………………… 4 3. Model parameters associated with chemical transport of bromide, atrazine, and atrazine degradates …………………………………………………………………… 5 AbstractSeven unsaturated-zone solute-transport models were tested with two data sets to select models for use by the Agricultural Chemical Team of the U.S. Geological Survey's National Water-Quality Assessment Program. The data sets were from a bromide tracer test near Merced, California, and an atrazine study in the White River Basin, Indiana. In this study the models are designated either as complex or simple based on the water flux algorithm. The complex models, HYDRUS2D, LEACHP, RZWQM, and VS2DT, use Richards' equation to simulate water flux and are well suited to process understanding. The simple models, CALF, GLEAMS, and PRZM, use a tipping-bucket algorithm and are more amenable to extrapolation because they require fewer input parameters. The purpose of this report is not to endorse a particular model, but to describe useful features, potential capabilities, and possible limitations that emerged from working with the model input data sets. More rigorous assessment of model applicability involves proper calibration, which was beyond the scope of this study.Uncalibrated ("cold") simulations were run using all seven models to predict the transport of bromide (Merced) and the transport and fate of atrazine and three of its transformation products (White River Basin). Among the complex models, HYDRUS2D successfully predicted both the surface retention and accumulation of bromide at depth at the Merced site, whereas RZWQM and VS2DT predicted only the latter. RZWQM predictions of atrazine were closest to observed values at the White River Basin site, where preferential flow has been observed. LEACHP predicted smaller solute concentrations than observed at both the Merced and White River Basin sites. Among the simple models, CALF predicted the highest values of atrazine and deethylatrazine at the measurement depth of 1.5 meters. CALF includes the Addiscott flow option for preferential flow, and also acc...

Background: In the contemporary era of drug-eluting stents (DES) the issue of optimal revascularization strategy for patients with isolated disease of the left anterior descending (LAD) artery has gained more significance. We aimed to evaluate the current best evidence on the subject by performing a systematic review and meta-analysis of the studies comparing minimally invasive direct coronary artery bypass (MIDCAB) grafting with DES in patients with isolated LAD disease. Methods: A literature search was conducted from 1966 through March 2018 using MEDLINE, EMBASE, and other scientific databases to identify relevant articles. Analyzed outcomes included all-cause mortality, myocardial infarction (MI), major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR). The random effects model was used to calculate the outcomes of both binary and continuous data to control any heterogeneity between the studies. Heterogeneity amongst the trials was determined by means of the Cochran Q value and quantified using the I 2 inconsistency test. All P values were 2-sided and a 5% level was considered significant.

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