(Circulation. 2000;102:1530.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery
A Prospective, Randomized Study
From Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK (R.A., M.C., C.T.L., M.J.U., G.D.A.), and Epidemiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy (G.C.).
Correspondence to Prof Gianni D. Angelini, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, UK. E-mail N.Holloway-Dee{at}bristol.ac.uk
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Abstract |
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Background—Atrial fibrillation (AF) increases the morbidity of CABG. The pathophysiology is uncertain, and its prevention remains suboptimal. This prospective, randomized study was designed to define the role of cardiopulmonary bypass (CPB) and cardioplegic arrest in the pathogenesis of this complication.
Methods and Results—Two hundred patients were prospectively randomized to (1) on-pump conventional surgery [(100 patients, 79 men, mean age 63 (40 to 77) years)] with normothermic CPB and cardioplegic arrest of the heart or (2) off-pump surgery [(100 patients, 82 men, mean age 63 (38 to 86) years)] on the beating heart. Heart rate and rhythm were continuously monitored with an automated arrhythmia detector during the first 72 hours after surgery. Thereafter, routine clinical observation was performed and continuous monitoring restarted in the case of arrhythmia. The association of perioperative factors with AF was investigated by univariate analysis. Significant variables were then included into a stepwise logistic regression model to ascertain their independent influence on the occurrence of AF. There were no significant baseline differences between groups. Thirty-nine patients in the on-pump group and 8 patients in the off-pump group had postoperative sustained AF (P=0.001). Univariate analysis showed that CPB inclusive of cardioplegic arrest, postoperative inotropic support, intubation time, chest infection, and hospital length of stay were predictors of AF (all P<0.05). However, stepwise multivariate regression analysis identified CPB inclusive of cardioplegic arrest as the only independent predictor of postoperative AF (OR 7.4; CI 3.4 to 17.9).
Conclusions—CPB inclusive of cardioplegic arrest is the main independent predictor of postoperative AF in patients undergoing coronary revascularization.
Key Words: prevention • tachyarrhythmias • fibrillation • coronary disease • cardiopulmonary bypass
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Introduction |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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Atrial fibrillation (AF) is a frequent complication of CABG.1 2 Its incidence varies depending on the definition used, the mode of monitoring, and the clinical profile of patients.3 Although it is not a life-threatening event, it may lead to hemodynamic compromise, thromboembolic events, anxiety, and increased costs.1 2 3 The underlying cause of AF has been related to a variety of preoperative and postoperative factors.4 5 6 7
Strategies directed toward management and reduction of postoperative AF have focused mainly on antiarrhythmic drugs.1 2 8 9
Myocardial ischemia and inadequate cardioplegic protection of the atria have been reported to increase the incidence of postoperative AF.3 10 Myocardial revascularization on the beating heart does not require atrial cannulation, cardiopulmonary bypass (CPB), and cardioplegic arrest,11 12 13 14 15 and it has been suggested to be associated with a reduction in the incidence of postoperative AF.12 14
The present prospective, randomized study investigated the incidence of AF in similar cohorts of patients undergoing CABG with or without CPB and cardioplegic arrest. Further analysis included variables considered by other authors to have a possible association with AF.
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Methods |
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Patient Selection
Over a 19-month period (March 1997 to August 1998), 538 patients underwent first-time CABG under the supervision of a single consultant. On the basis of their eligibility for off-pump surgery, 200 patients were individually prospectively randomized for myocardial revascularization with either (1) on-pump conventional surgery (100 patients, 79 men, mean age 63 [40 to 77] years) with normothermic CPB and cardioplegic arrest of the heart or (2) off-pump surgery (100 patients, 82 men, mean age 63 [38 to 86] years) on the beating heart. The randomization sequence was obtained by card allocation and strictly respected. Exclusion from the randomization study was based on criteria that included history of supraventricular arrhythmia, left ventricular ejection fraction of <30%, recent myocardial infarction (MI) (<1 month), repeat operation, renal and respiratory impairment, previous stroke or transient ischemic attack, and coagulopathy. Patients with coronary disease involving branches of the circumflex artery distal to the first obtuse marginal branch and posterior branches originating from the left system were also excluded from the study because these were believed to be technically difficult for adequate revascularization at the beginning of our experience with off-pump surgery.
The study was approved by the United Bristol Healthcare Trust Ethics Committee, and all patients gave informed consent.
Management of Preoperative and Postoperative Medications
Preoperative medications including ß-blockers,
diuretics, antihypertensives, and calcium channel blockers were
routinely omitted on the day of surgery. ACE inhibitors
were withdrawn on the evening before the operation. On the first
postoperative day, in accordance with the intensive care unit protocol
(if heart rate >55 bpm, systolic blood pressure >110
mm Hg), ß-blockers and antihypertensive drugs were restarted.
Anesthetic Technique
In both groups, anesthetic technique consisted of propofol
infusion at 3 mg ·
kg-1 ·
h-1 combined with
remifentanil infusion at 0.5 to 1 µg ·
kg-1 ·
min-1. Neuromuscular
blockade was achieved by 0.1 to 0.15 mg/kg pancuronium bromide or
vecuronium and the lungs ventilated to normocapnia with air and oxygen
(45% to 50%). Heparin was given at a dose of 300 IU/kg to achieve a
target activated clotting time (ACT) of 
480 seconds before
commencement of CPB in the on-pump group. An additional 3000 IU of
heparin was administered if required. In the off-pump group, heparin
(100 IU/kg) was administered before the start of the first anastomosis
to achieve an ACT of 250 to 350 seconds. On completion of all
anastomoses, protamine was given to reverse the effect of heparin and
return the ACT to preoperative levels.
Operative Technique
On Pump
CPB was instituted with the use of ascending aortic cannulation
and 2-stage venous cannulation of the right atrium. A standard circuit
was used: a Bard tubing set, which included a 40-µm filter (Sorin
Biomedica), and a hollow-fiber membrane oxygenator. Nonpulsatile flow
was used, and flow rates throughout bypass were 2.4
L/m2 per minute. Systemic temperature was kept
between 34° and 36°C. Myocardial protection was achieved by using
intermittent anterograde hyperkalemic warm blood
cardioplegia.16
Off Pump
The method of exposure and stabilization to perform the
anastomosis consisted of the technique previously described by our
group17 with or without the use of the Cardiothoracic
System (CTS) retractor and stabilizer. The target vessel was then
exposed and snared above the anastomotic site with a 4-0 prolene suture
with a soft plastic snugger to prevent coronary injury. The
coronary artery was then opened, and the anastomosis was
performed. Visualization was enhanced by the use of a surgical
blower-humidifier (Research Medical Inc).
Postoperative Management
At the end of surgery, patients were transferred to the
intensive care unit (ICU). The lungs were ventilated with 60% oxygen
with volume-controlled ventilation and a tidal volume of 10 mL/kg with
5 cm H2O of positive end-expiratory
pressure. Adjustments in FIO2
and respiratory rate were made according to routine blood gas
analysis to maintain PaO2
between 80 and 100 mm Hg and
PaCO2 between 35 and 40 mm Hg.
Forced air warming was used until a stable nasopharyngeal temperature
of 37°C was reached. Patients were extubated as soon as they met the
following criteria: hemodynamic stability, no excessive
bleeding (<80 mL/h), normothermia, and consciousness with pain
control. Fluid management after surgery consisted of 5% dextrose
infused at 1 mL ·
kg-1 ·
h-1, with additional
colloid solution or blood to maintain normovolemia and
hematocrit >24%. Potassium and magnesium deficiency was promptly
treated as necessary to maintain electrolyte balance within the normal
range.
Monitoring and Definitions
Heart rate and rhythm were continuously monitored and displayed
on a screen with an automated arrhythmia detector (Solar 8000
Patient Monitor, Marquette Medical Systems) during the first 72 hours
after surgery. Automatic printing of the ECG was related to the
inserted alarm levels and included heart rate >90 bpm and the presence
of 6 consecutive normal R-R intervals varying by 100 ms. Twelve-lead
ECG recordings were performed before surgery, 2 hours after
surgery, and then daily thereafter until hospital discharge. After the
first 72 hours, trained nurses performed clinical observations every 4
hours. An ECG was recorded on the basis of any clinical suspicion
of arrhythmia. In the case of documented arrhythmia,
continuous ECG monitoring was restarted.
Each episode of arrhythmias was printed out and interpreted by an independent intensive care physician. AF, atrial flutter, and atrial tachycardia were defined according to Kalman et al.2 AF was defined as nonsustained if lasting between 10 beats and 10 minutes and sustained if persisting for >10 minutes.2 For the purpose of the analysis, only a first event was recorded, provided its duration satisfied prespecified criteria.
Indications for temporary pacing were made by an independent intensive care physician, according to the ICU protocol, and included symptomatic bradycardia, unresponsive to treatment by drugs, acute conduction disturbances including second- or third-degree atrioventricular (AV) block, and bifascicular or trifascicular block. Indications for permanent pacemaker were made by an independent cardiologist and included second-degree (Mobitz type II) and third-degree AV block and long-lasting symptomatic bradycardia.
Intraoperative and postoperative data, including complications and
adverse events, were recorded. Clinical diagnostic
criteria for perioperative MI were new Q waves of
>0.04 ms and/or a reduction in R waves >25% in 2 leads.
Chest infection was defined as the presence of purulent sputum associated with fever and requiring antibiotic therapy according to positive sputum culture.
Statistical Analysis
Arrhythmias such as atrial flutter, atrial
tachycardia, or others were not considered in the same
group of AF because their mechanism differs.2 Only
sustained episodes of AF were included in the statistical
analysis. The association of preoperative, intraoperative, and
postoperative variables with postoperative AF was investigated with
univariate analysis. The following factors,
reported as predictors of AF by other investigators, were also included
in the analysis: age at operation, preoperative use of
ß-blocker, left ventricular ejection fraction, previous
MI, diabetes mellitus, surgery of the right coronary
artery/posterior descending coronary artery (RCA/PDA), number
of grafts, CPB and cardioplegic arrest, intubation time, chest
infection, inotropic requirement, and blood loss. Because continuous
data did not show a gaussian distribution, they were analyzed
by the Mann-Whitney test. Categoric data comparison was made by
2 test. Data are expressed as median with
minimum-maximal values or number (percentage) of patients.
Factors that turned out to be predictors of AF at univariate analysis were then included in a stepwise logistic multivariate regression model to ascertain their independent role. ORs and 95% CIs were calculated.
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Results |
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Preoperative and operative characteristics are shown in Tables 1
and 2,
respectively.
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The two groups were similar with respect to age, sex, and severity of coronary disease, diabetes mellitus, angina class, and surgical data, including number of distal anastomoses.
There were 2 deaths in the on-pump group, both for multiorgan failure as a consequence of low cardiac output. Four patients in the on-pump group and 1 in the off-pump group had perioperative MI as per predefined criteria.
The incidence of perioperative arrhythmias is
presented in Table 3. The overall
incidence of AF was 28% (56 patients), with 45 patients in the on-pump
group and 11 patients in the off-pump group (P=0.001). Of
these, 39 in the on-pump group and 8 in the off-pump group had
sustained episodes of AF (P=0.001), and the average of their
duration was similar between the two groups (Table 3). Atrial
flutter occurred in 2 patients in the on-pump group and 1 patient in
the off-pump group. Temporary pacing was required in 7 patients in the
on-pump group (1 transient second-degree AV block and 6 transient
symptomatic bradycardia) over the first 24 hours after
surgery. One patient was temporarily paced in the off-pump group
because of transient second-degree AV block (P=0.03, on
versus off pump). One patient in each group was affected by
third-degree AV block requiring a permanent pacemaker.
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Postoperative clinical data are reported in Table 4. The off-pump group showed reduced
inotropic usage, chest infection, blood loss and transfusion
requirement, intubation time, and length of ICU and hospital stay.
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Results from the univariate analysis for the
association of each factor with AF is reported in Table 5. The use of CPB inclusive of
cardioplegic arrest, postoperative inotropic requirement, prolonged
intubation time, chest infection, and hospital permanence were all
predictors of AF. However, stepwise multivariate
regression analysis indicated the use of CPB inclusive of
cardioplegic arrest as the only independent predictor of postoperative
AF (OR 7.4; CI 3.4 to 17.9).
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Discussion |
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AF is the most common complication occurring after cardiac surgery.1 2 3 Despite advances in CPB, cardioplegic arrest, and surgical techniques, its incidence has paradoxically increased in recent years18 as the result of surgical patients being older and sicker and advances in ECG continuous monitoring technology.3 It is frequently not well tolerated, and patients may have symptoms including temporary hemodynamic instability, thromboembolic events, and shortness of breath or chest discomfort and has been shown to increase costs and to lengthen hospital stay.1 3
Many preoperative and postoperative factors have been suggested to increase the incidence of postoperative AF after conventional CABG such as advanced age, hypertension,3 withdrawal of ß-blocker drug,19 RCA stenosis,5 respiratory complications,6 and bleeding.7 Strategies directed toward reduction of postoperative AF have focused on several drugs, given prophylactically, such as ß-adrenoceptor antagonists,1 19 calcium antagonists,9 amiodarone, and propafenone,10 20 with conflicting results.1 However, little is known about intraoperative mechanisms through which the incidence of postoperative AF could be reduced.21
Recently, there has been a renewed interest in performing CABG on the beating heart.11 12 13 14 Several studies have reported improved myocardial and renal protection,11 22 minimal inflammatory response,2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 excellent patency rate of the grafts,13 and decreased costs.3 25 Furthermore, a reduction in postoperative AF has been reported in off-pump series,12 14 although this remains an area of controversy.15 Buffolo and coworkers12 reported a significantly lower incidence of arrhythmias in a cohort of 1274 patients undergoing off-pump surgery when compared with patients undergoing CABG on pump. Abreu et al14 have also reported a trend toward a lower incidence of postoperative AF in patients undergoing CABG without CPB. Conversely, Cohn et al,15 in a very recent retrospective age-matched study, failed to demonstrate a lower incidence of postoperative AF among patients undergoing minimally invasive direct CABG than among those undergoing conventional CABG. This led the authors to conclude that mechanisms common to both groups must be considered as determinants of postoperative AF.
Whereas the above studies,12 14 15 by comparing conventional CABG with beating coronary surgery, are appropriate in terms of control group, in none of these was a prospective randomization undertaken.
To the best of our knowledge, the present study is the first prospective, randomized study to investigate the role of intraoperative factors such as CPB and associated techniques as determinants of postoperative AF in similar cohorts of patients undergoing CABG with or without CPB through a median sternotomy.
The main finding of the present study is that CPB inclusive of cardioplegic arrest is the main independent predictor for the development of postoperative AF, the risk being 7 times higher in the on-pump compared with the off-pump group. This could be related to the period of myocardial ischemia or to the inflammatory response after CPB itself, the required atrial cannulation, and the adverse effects of cardioplegia. Inadequate atrial protection has been postulated as the trigger responsible for the development of AF in vulnerable patients.26 27 Myocardial damage has been reported to occur after cross-clamping of the aorta28 and cardioplegic arrest,1 2 with its effects influencing myocardial ischemia and arrhythmias during both reperfusion and the early postoperative periods.9 In a recent study, we have shown a significantly higher troponin I release in patients undergoing conventional CABG when compared with beating heart revascularization.11
Sympathetic activation may be important in the pathogenesis of AF after CABG,2 6 and this underlines the importance of ß-adrenoceptor blockade as prophylaxis. White and associates19 found a significant increase in the incidence of AF in patients in whom administration of ß-adrenoceptor antagonists was ceased when compared with those whose drug treatment was continued after surgery. In the present study, preoperative ß-blockers were administered until the day of surgery and restarted on the first postoperative day unless in the presence of slow heart rate or hemodynamic compromise.
In keeping with the findings of Kalman et al2 and Aranki et al,3 the univariate analysis of the present study showed that the need for postoperative inotropic requirement, ventilation time, chest infection, and hospital stay were all predictors of development of AF. However, when these factors were included in a stepwise logistic multivariate regression model, they did not appear to have an independent role.
In contrast with previous reports,1 2 3 4 5 6 7 this study failed to demonstrate advanced age as an independent predictor of postoperative AF, although overall a higher percentage of AF was observed in older patients.
The 39% incidence of sustained episodes of AF in the on-pump group is in the upper range of that previously reported when similar cardioplegia was used.29 This relatively high incidence may reflect the use of continuous monitoring during the first 3 postoperative days.
The relation between AF and postoperative bleeding reported by others7 did not quite reach statistical significance in the univariate analysis of the present study (P=0.06). However, the blood loss of the on-pump group in this study is in keeping with other recently published data.30 A significant percentage of our patients were in-hospital referrals with unstable angina who were still receiving aspirin and low-molecular heparin. Furthermore, cell-savers, tranexamic acid, or aprotinin were not used in this study.
The limitation of the present study is the absence of continuous Holter ECG monitoring31 after the first 72 hours until discharge from the hospital. Although it is possible that short episodes of asymptomatic AF might have been missed, this is unlikely for sustained episodes, given the fact that patients were assessed every 4 hours. Furthermore, if there was any clinical suspicion of arrhythmia, an ECG was promptly recorded.
Conclusions
This prospective, randomized study clearly shows CPB inclusive of
cardioplegic arrest as the main independent predictor of postoperative
AF in patients undergoing CABG. The minimal incidence of AF in the
off-pump group satisfies the modern demand of further improvements in
perioperative patient treatment, reduction of costs and
resources while maintaining quality of care, and patient
satisfaction.
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Acknowledgments |
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The Garfield Weston Trust and the British Heart Foundation supported this work.
Received February 9, 2000; revision received April 26, 2000; accepted May 2, 2000.
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References |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
1. Pfisterer ME, Kloter-Weber UCD, Huber M, et al. Prevention of supraventricular tachyarrhythmias after open heart operation by low-dose sotalol: a prospective, double-blind, randomised, placebo-controlled study. Ann Thorac Surg. 1997;64:1113–1119.
2.
Kalman JM, Munawar M, Howes LG, et al. Atrial
fibrillation after coronary artery bypass grafting is
associated with sympathetic activation. Ann Thorac
Surg. 1995;60:1709–1715.
3.
Aranki SF, Shaw DP, Adams DH, et al. Predictors of
atrial fibrillation after coronary artery surgery: current
trends and impact on hospital resources. Circulation. 1996;94:390–397.
4. Crosby LH, Pifalo WB, Woll KR, et al. Risk factors for atrial fibrillation after coronary artery bypass grafting. Am J Cardiol. 1990;66:1520–1522.[Medline] [Order article via Infotrieve]
5. Mendes LA, Connelly GP, McKenney PA, et al. Right coronary artery stenosis: an independent predictor of atrial fibrillation after coronary artery bypass surgery. J Am Coll Cardiol. 1995;25:198–202.[Abstract]
6. Almassi GH, Schowalter T, Nicolosi AC, et al. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg.. 1997;226:501–511.[Medline] [Order article via Infotrieve]
7.
Moulton MJ, Creswell LL, Machery ME, et al.
Reexploration for bleeding is a risk factor for adverse outcomes after
cardiac operations. J Thorac Cardiovasc Surg. 1996;111:1037–1046.
8.
Daoud EG, Strickberger SA, Man KC, et al. Preoperative
amiodarone as prophylaxis against atrial fibrillation after
heart surgery. N Engl J Med. 1997;337:1785–1791.
9.
Seitelberger R, Hannes W, Gleichauf M, et al. Effects
of diltiazem on perioperative ischemia,
arrhythmias, and myocardial function in patients undergoing
elective coronary bypass grafting. J Thorac
Cardiovasc Surg. 1994;107:811–821.
10. Rousou JA, Meeran MK, Engelman RH, et al. Does the type of venous drainage or cardioplegia affect postoperative conduction and atrial arrhythmias? Circulation. 1985;72(suppl II):II-259-II-263.
11.
Ascione R, Lloyd CT, Gomes WJ, et al. Beating versus
arrested heart revascularization: evaluation of
myocardial function in a prospective randomised study. Eur J
Cardiothorac Surg. 1999;15:685–690.
12.
Buffolo E, de Andrade CS, Branco JN, et al.
Coronary artery bypass grafting without cardiopulmonary
bypass. Ann Thorac Surg. 1996;61:63–66.
13.
Poirier NC, Carrier M, Lesperance J, et al.
Quantitative angiographic assessment of coronary anastomoses
performed without cardiopulmonary bypass. J Thorac
Cardiovasc Surg. 1999;117:292–297.
14. Abreu JE, Reilly J, Salzano RP, et al. Comparison of frequencies of atrial fibrillation after coronary artery bypass grafting with and without the use of cardiopulmonary bypass. Am J Cardiol. 1999;83:775–776.[Medline] [Order article via Infotrieve]
15.
Cohn WE, Sirois CA, Johnson RG. Atrial fibrillation
after minimally invasive coronary artery bypass grafting: a
retrospective, matched study. J Thorac Cardiovasc Surg. 1999;117:298–301.
16.
Caputo M, Dihmis W, Bryan AJ, et al. The effect of
magnesium on myocardial metabolism during ischemia
and reperfusion, in patients undergoing coronary artery surgery
using intermittent antegrade warm blood cardioplegia. Eur J
Cardiothorac Surg. 1998;14:596–601.
17.
Lucchetti V, Angelini GD. An inexpensive method of
heart stabilisation during coronary artery operation without
cardiopulmonary bypass. Ann Thorac Surg. 1998;65:1477–1478.
18. Creswell LL, Schuessler RB, Rosenbloom M, et al. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg. 1993;56:539–549.[Abstract]
19.
White HD, Antman EM, Glynn MA, et al. Efficacy and
safety of timolol for prevention of supraventricular
tachyarrhythmias after coronary artery bypass
surgery. Circulation. 1984;70:479–484.
20. Larbuisson R, Venneman I, Stiels B. The efficacy and safety of intravenous propafenone versus intravenous amiodarone in the conversion of atrial fibrillation or flutter after cardiac surgery. J Cardiothorac Vasc Anesth. 1996;10:229–234.[Medline] [Order article via Infotrieve]
21. Mulay A, Kirk AJ, Angelini GD, et al. Posterior pericardiotomy reduces the incidence of supraventricular arrhythmias following coronary artery bypass surgery. Eur J Cardiothorac Surg. 1995;9:150–152.[Abstract]
22.
Ascione R, Lloyd CT, Underwood MJ, et al. On pump
versus off pump coronary revascularization:
evaluation of renal function. Ann Thorac Surg. 1999;68:493–498.
23.
Brasil LA, Gomes WJ, Salomao R, et al. Inflammatory
response after myocardial revascularization with or
without cardiopulmonary bypass. Ann Thorac Surg. 1998;66:56–59.
24.
Ascione R, Lloyd CT, Underwood MJ, et al. Inflammatory
response after coronary revascularization
with or without cardiopulmonary bypass: a prospective
randomised study. Ann Thorac Surg.. 2000;69:1198–1204.
25.
Ascione R, Lloyd CT, Underwood MJ, et al. Economic
outcome of off pump coronary artery bypass surgery: a
prospective randomised study. Ann Thorac Surg. 1999;68:2237–2242.
26. Tchervenkov CI, Wynands JE, Symas JF, et al. Electrical behavior of the heart following high-potassium cardioplegia. Ann Thorac Surg. 1983;36:314–319.[Abstract]
27. Smith PK, Buhrman WC, Levett JM, et al. Supraventricular conduction abnormalities following cardiac operations: a complication of inadequate atrial preservation. J Thorac Cardiovasc Surg. 1983;85:105–115.[Medline] [Order article via Infotrieve]
28.
Buckberg GD. Update on current techniques of myocardial
protection. Ann Thorac Surg. 1995;60:805–814.
29. Fuller JA, Adams GG, Buxton B. Atrial fibrillation after coronary artery bypass grafting: is it a disorder of the elderly? J Thorac Cardiovasc Surg.. 1989;97:821–825.[Abstract]
30.
Lemmer JH, Dilling EW, Morton JR, et al. Aprotinin for
primary coronary artery bypass grafting: a multicenter trial of
three dose regimens. Ann Thorac Surg. 1996;62:1659–1668.
31.
Bollmann A, Sonne K, Esperer HD, et al. Non invasive
assessment of fibrillary activity in patients with paroxysmal and
persistent atrial fibrillation using the Holter ECG. Cardiovasc
Res. 1999;44:60–66.
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C. G. Koch, L. Li, D. R. Van Wagoner, A. I. Duncan, A. M. Gillinov, and E. H. Blackstone Red Cell Transfusion is Associated With an Increased Risk for Postoperative Atrial Fibrillation Ann. Thorac. Surg., November 1, 2006; 82(5): 1747 - 1756. [Abstract] [Full Text] [PDF]
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 A. Sedrakyan, A. W. Wu, A. Parashar, E. B. Bass, and T. Treasure Off-Pump Surgery Is Associated With Reduced Occurrence of Stroke and Other Morbidity as Compared With Traditional Coronary Artery Bypass Grafting: A Meta-Analysis of Systematically Reviewed Trials * Supplemental Appendix I Stroke, November 1, 2006; 37(11): 2759 - 2769. [Full Text] [PDF]
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C. Rajakaruna, C. A. Rogers, C. Suranimala, G. D. Angelini, and R. Ascione The effect of diabetes mellitus on patients undergoing coronary surgery: A risk-adjusted analysis J. Thorac. Cardiovasc. Surg., October 1, 2006; 132(4): 802 - 810. [Abstract] [Full Text] [PDF]
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J. R. Edgerton, M. A. Herbert, S. L. Prince, J. L. Horswell, L. Michelson, M. J. Magee, T. M. Dewey, Z. J. Edgerton, and M. J. Mack Reduced Atrial Fibrillation in Patients Immediately Extubated After Off-Pump Coronary Artery Bypass Grafting Ann. Thorac. Surg., June 1, 2006; 81(6): 2121 - 2127. [Abstract] [Full Text] [PDF]
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G. Mariscalco, K. G. Engstrom, S. Ferrarese, G. Cozzi, V. D. Bruno, F. Sessa, and A. Sala Relationship between atrial histopathology and atrial fibrillation after coronary bypass surgery J. Thorac. Cardiovasc. Surg., June 1, 2006; 131(6): 1364 - 1372. [Abstract] [Full Text] [PDF]
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 H. Vernhet-Kovacsik, P. Battistella, R. Demaria, J. L. Pasquie, C. Bousquet, G. Dogas, F. Leclercq, B. Albat, and J. P. Senac Early Postoperative Assessment of Coronary Artery Bypass Graft Patency and Anatomy: Value of Contrast-Enhanced 16-MDCT with Retrospectively ECG-Gated Reconstructions Am. J. Roentgenol., June 1, 2006; 186(6_Supplement_2): S395 - S400. [Abstract] [Full Text] [PDF]
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C. A. Rogers, G. D. Angelini, L. A. Culliford, R. Capoun, and R. Ascione Coronary surgery in patients with preexisting chronic atrial fibrillation: early and midterm clinical outcome. Ann. Thorac. Surg., May 1, 2006; 81(5): 1676 - 1682. [Abstract] [Full Text] [PDF]
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R. Ascione, S. Talpahewa, C. Rajakaruna, B. C. Reeves, A. T. Lovell, A. Cohen, and G. D. Angelini Splanchnic Organ Injury During Coronary Surgery With or Without Cardiopulmonary Bypass: A Randomized, Controlled Trial Ann. Thorac. Surg., January 1, 2006; 81(1): 97 - 103. [Abstract] [Full Text] [PDF]
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R. Ascione, A. Ghosh, B. C. Reeves, J. Arnold, M. Potts, A. Shah, and G. D. Angelini Retinal and Cerebral Microembolization During Coronary Artery Bypass Surgery: A Randomized, Controlled Trial Circulation, December 20, 2005; 112(25): 3833 - 3838. [Abstract] [Full Text] [PDF]
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M. Caputo, B. C. Reeves, C. Rajkaruna, H. Awair, and G. D. Angelini Incomplete Revascularization During OPCAB Surgery is Associated With Reduced Mid-Term Event-Free Survival Ann. Thorac. Surg., December 1, 2005; 80(6): 2141 - 2147. [Abstract] [Full Text] [PDF]
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C. Rajakaruna, C.A. Rogers, G.D. Angelini, and R. Ascione Risk factors for and economic implications of prolonged ventilation after cardiac surgery J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1270 - 1277. [Abstract] [Full Text] [PDF]
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 L. L. Creswell, J. C. Alexander Jr., T. B. Ferguson Jr., A. Lisbon, and L. A. Fleisher Intraoperative Interventions: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 28S - 35S. [Abstract] [Full Text] [PDF]
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 E. L. Gillespie, K. A. Gryskiewicz, C. M. White, J. Kluger, C. Humphrey, S. Horowitz, and C. I. Coleman Effect of aprotinin on the frequency of postoperative atrial fibrillation or flutter Am. J. Health Syst. Pharm., July 1, 2005; 62(13): 1370 - 1374. [Abstract] [Full Text] [PDF]
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 M. L. Fontes, J. P. Mathew, H. M. Rinder, D. Zelterman, B. R. Smith, C. S. Rinder, and the Multicenter Study of Perioperative Ischemia (M Atrial Fibrillation After Cardiac Surgery/Cardiopulmonary Bypass Is Associated with Monocyte Activation Anesth. Analg., July 1, 2005; 101(1): 17 - 23. [Abstract] [Full Text] [PDF]
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Y. Ishii, R. B. Schuessler, S. L. Gaynor, K. Yamada, A. S. Fu, J. P. Boineau, and R. J. Damiano Jr Inflammation of Atrium After Cardiac Surgery Is Associated With Inhomogeneity of Atrial Conduction and Atrial Fibrillation Circulation, June 7, 2005; 111(22): 2881 - 2888. [Abstract] [Full Text] [PDF]
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J. Auer, G. Lamm, T. Weber, K. Mandal, M. Jahangiri, M. Mukhin, J. Poloniecki, A. J. Camm, and Q. Xu Letter Regarding Article by Mandal et al, "Association of Anti-Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation" * Response Circulation, May 24, 2005; 111(20): e306 - e306. [Full Text] [PDF]
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G. Bisleri, T. Bottio, J. A. Morgan, and C. Muneretto Preservation of the anterior fat pad and incidence of postoperative atrial fibrillation following coronary surgery J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1308 - 1308. [Full Text] [PDF]
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R. Ascione, A. Ghosh, C. A. Rogers, A. Cohen, C. Monk, and G. D. Angelini In-Hospital Patients Exposed to Clopidogrel Before Coronary Artery Bypass Graft Surgery: A Word of Caution Ann. Thorac. Surg., April 1, 2005; 79(4): 1210 - 1216. [Abstract] [Full Text] [PDF]
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 D. Bainbridge, J. Martin, and D. Cheng Off Pump Coronary Artery Bypass Graft Surgery Versus Conventional Coronary Artery Bypass Graft Surgery: A Systematic Review of the Literature Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 105 - 111. [Abstract] [PDF]
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K. Mandal, E. Torsney, J. Poloniecki, A. J. Camm, Q. Xu, and M. Jahangiri Association of High Intracellular, But Not Serum, Heat Shock Protein 70 With Postoperative Atrial Fibrillation Ann. Thorac. Surg., March 1, 2005; 79(3): 865 - 871. [Abstract] [Full Text] [PDF]
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M. L. Brackbill and L. Moberg Magnesium sulfate for prevention of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting Am. J. Health Syst. Pharm., February 15, 2005; 62(4): 397 - 399. [Abstract] [Full Text] [PDF]
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 J.-F. Legare, K. J. Buth, and G. M. Hirsch Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial Eur. J. Cardiothorac. Surg., February 1, 2005; 27(2): 296 - 301. [Abstract] [Full Text] [PDF]
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 Z. Yang, S. M. Harrison, and D. S. Steele ATP-dependent effects of halothane on SR Ca2+ regulation in permeabilized atrial myocytes Cardiovasc Res, January 1, 2005; 65(1): 167 - 176. [Abstract] [Full Text] [PDF]
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 S. G. Raja, A. A. Behranwala, and J. Dunning Does off-pump coronary artery surgery reduce the incidence of postoperative atrial fibrillation? Interactive CardioVascular and Thoracic Surgery, December 1, 2004; 3(4): 647 - 652. [Abstract] [Full Text] [PDF]
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G. J Murphy, R. Ascione, and G. D Angelini Coronary artery bypass grafting on the beating heart: surgical revascularization for the next decade? Eur. Heart J., December 1, 2004; 25(23): 2077 - 2085. [Abstract] [Full Text] [PDF]
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M. Caputo, B. C. Reeves, C. A. Rogers, R. Ascione, and G. D. Angelini Monitoring the performance of residents during training in off-pump coronary surgery J. Thorac. Cardiovasc. Surg., December 1, 2004; 128(6): 907 - 915. [Abstract] [Full Text] [PDF]
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E. A Black, S. Ghosh, K. Sin, T. Spyt, and R. Pillai Off-Pump Coronary Artery Bypass Surgery Asian Cardiovasc Thorac Ann, December 1, 2004; 12(4): 379 - 386. [Abstract] [Full Text] [PDF]
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K. Mandal, M. Jahangiri, M. Mukhin, J. Poloniecki, A. J. Camm, and Q. Xu Association of Anti-Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation Circulation, October 26, 2004; 110(17): 2588 - 2590. [Abstract] [Full Text] [PDF]
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C. A. Palin, R. Kailasam, and C. W. Hogue Jr Atrial Fibrillation After Cardiac Surgery: Pathophysiology and Treatment Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 175 - 183. [Abstract] [PDF]
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R. Ascione, B. C. Reeves, M. Pano, and G. D. Angelini Trainees operating on high-risk patients without cardiopulmonary bypass: a high-risk strategy? Ann. Thorac. Surg., July 1, 2004; 78(1): 26 - 33. [Abstract] [Full Text] [PDF]
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G. J.M.G. van der Heijden, H. M. Nathoe, E. W.L. Jansen, and D. E. Grobbee Meta-analysis on the effect of off-pump coronary bypass surgery Eur. J. Cardiothorac. Surg., July 1, 2004; 26(1): 81 - 84. [Abstract] [Full Text] [PDF]
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H. K. Shinn, Y. J. Oh, S. H. Kim, J. H. Lee, C. S. Lee, and Y. L. Kwak Evaluation of serial haemodynamic changes during coronary artery anastomoses in patients undergoing off-pump coronary artery bypass graft surgery: initial experiences using two deep pericardial stay sutures and octopus tissue stabilizer Eur. J. Cardiothorac. Surg., June 1, 2004; 25(6): 978 - 984. [Abstract] [Full Text] [PDF]
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K. Alwan, P.-E. Falcoz, J. Alwan, W. Mouawad, G. Oujaimi, S. Chocron, and J.-P. Etievent Beating versus arrested heart coronary revascularization: evaluation by cardiac troponin I release Ann. Thorac. Surg., June 1, 2004; 77(6): 2051 - 2055. [Abstract] [Full Text] [PDF]
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R. Ascione, B. C. Reeves, K. Santo, N. Khan, and G. D. Angelini Predictors of new malignant ventricular arrhythmias after coronary surgery: A case-control study J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1630 - 1638. [Abstract] [Full Text] [PDF]
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R. Ascione, B. C. Reeves, F. C. Taylor, H. K. Seehra, and G. D. Angelini Beating heart against cardioplegic arrest studies (BHACAS 1 and 2): quality of life at mid-term follow-up in two randomised controlled trials Eur. Heart J., May 1, 2004; 25(9): 765 - 770. [Abstract] [Full Text] [PDF]
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J. S. Kalus, C. M. White, M. F. Caron, C. I. Coleman, H. Takata, and J. Kluger Indicators of atrial fibrillation risk in cardiac surgery patients on prophylactic amiodarone Ann. Thorac. Surg., April 1, 2004; 77(4): 1288 - 1292. [Abstract] [Full Text] [PDF]
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A. N. Patel, B. L. Hamman, A. N. Patel, R. F. Hebeler, R. E. Wood, C. A. Cockerham, B. A. Willey, and H. C. Urschel Jr Epicardial atrial defibrillation: successful treatment of postoperative atrial fibrillation Ann. Thorac. Surg., March 1, 2004; 77(3): 831 - 837. [Abstract] [Full Text] [PDF]
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R. Sanjuan, M. Blasco, N. Carbonell, A. Jorda, J. Nunez, J. Martinez-Leon, and E. Otero Preoperative use of sotalol versus atenolol for atrial fibrillation after cardiac surgery Ann. Thorac. Surg., March 1, 2004; 77(3): 838 - 843. [Abstract] [Full Text] [PDF]
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T. Hakala, O. Pitkanen, and J. Hartikainen Cardioplegic arrest does not increase the risk of atrial fibrillation after coronary artery bypass surgery Eur. J. Cardiothorac. Surg., March 1, 2004; 25(3): 415 - 418. [Abstract] [Full Text] [PDF]
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J.-F. Legare, K. J. Buth, S. King, J. Wood, J. A. Sullivan, C. H. Friesen, J. Lee, K. Stewart, and G. M. Hirsch Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump Circulation, February 24, 2004; 109(7): 887 - 892. [Abstract] [Full Text] [PDF]
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M. J. Racz, E. L. Hannan, O. W. Isom, V. A. Subramanian, R. H. Jones, J. P. Gold, T. J. Ryan, A. Hartman, A. T. Culliford, E. Bennett, et al. A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy J. Am. Coll. Cardiol., February 18, 2004; 43(4): 557 - 564. [Abstract] [Full Text] [PDF]
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 A. H Olivencia-Yurvati, N. Wallace, S. Ford, and R. T Mallet Leukocyte filtration and aprotinin: synergistic anti-inflammatory protection Perfusion, January 1, 2004; 19(1_suppl): S13 - S19. [Abstract] [PDF]
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J. T. Reston, S. J. Tregear, and C. M. Turkelson Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting Ann. Thorac. Surg., November 1, 2003; 76(5): 1510 - 1515. [Abstract] [Full Text] [PDF]
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S. P. Talpahewa, R. Ascione, G. D. Angelini, and A. T. Lovell Cerebral cortical oxygenation changes during OPCAB surgery Ann. Thorac. Surg., November 1, 2003; 76(5): 1516 - 1522. [Abstract] [Full Text] [PDF]
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A. G. Cerillo, S. Bevilacqua, S. Storti, M. Mariani, E. Kallushi, A. Ripoli, A. Clerico, and M. Glauber Free triiodothyronine: a novel predictor of postoperative atrial fibrillation Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 487 - 492. [Abstract] [Full Text] [PDF]
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D. L. Ngaage Off-pump coronary artery bypass grafting: the myth, the logic and the science Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 557 - 570. [Abstract] [Full Text] [PDF]
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 R A Archbold and N P Curzen Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation Heart, October 1, 2003; 89(10): 1134 - 1137. [Abstract] [Full Text] [PDF]
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M. Gaudino, F. Andreotti, R. Zamparelli, A. Di Castelnuovo, G. Nasso, F. Burzotta, L. Iacoviello, M. B. Donati, R. Schiavello, A. Maseri, et al. The -174G/C Interleukin-6 Polymorphism Influences Postoperative Interleukin-6 Levels and Postoperative Atrial Fibrillation. Is Atrial Fibrillation an Inflammatory Complication? Circulation, September 9, 2003; 108(90101): II-195 - 199. [Abstract] [Full Text] [PDF]
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R. Ascione, P. Narayan, C. A. Rogers, K. H. H. Lim, R. Capoun, and G. D. Angelini Early and midterm clinical outcome in patients with severe left ventricular dysfunction undergoing coronary artery surgery Ann. Thorac. Surg., September 1, 2003; 76(3): 793 - 799. [Abstract] [Full Text] [PDF]
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F C Taylor, R Ascione, K Rees, P Narayan, and G D Angelini Socioeconomic deprivation is a predictor of poor postoperative cardiovascular outcomes in patients undergoing coronary artery bypass grafting Heart, September 1, 2003; 89(9): 1062 - 1066. [Abstract] [Full Text] [PDF]
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B. C. Reeves, R. Ascione, M. H. Chamberlain, and G. D. Angelini Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery J. Am. Coll. Cardiol., August 20, 2003; 42(4): 668 - 676. [Abstract] [Full Text] [PDF]
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A. Parolari, F. Alamanni, A. Cannata, M. Naliato, L. Bonati, P. Rubini, F. Veglia, E. Tremoli, and P. Biglioli Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials Ann. Thorac. Surg., July 1, 2003; 76(1): 37 - 40. [Abstract] [Full Text] [PDF]
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D. J. Goldstein, R. B. Beauford, B. Luk, R. Karanam, T. Prendergast, F. Sardari, P. Burns, and C. Saunders Multivessel off-pump revascularization in patients with severe left ventricular dysfunction Eur. J. Cardiothorac. Surg., July 1, 2003; 24(1): 72 - 80. [Abstract] [Full Text] [PDF]
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M. Caputo, B. Reeves, G. Marchetto, B. Mahesh, K. Lim, and G. D. Angelini Radial versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 39 - 47. [Abstract] [Full Text] [PDF]
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R. Ascione and G. D. Angelini Off-pump coronary artery bypass surgery: The implications of the evidence J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 779 - 781. [Full Text] [PDF]
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L. L. Creswell and R. J. Damiano Jr Postoperative atrial fibrillation: An old problem crying for new solutions J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(90030): S20 - 23. [Full Text] [PDF]
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R. Ascione, M. Caputo, and G. D. Angelini Off-pump coronary artery bypass grafting: not a flash in the pan Ann. Thorac. Surg., January 1, 2003; 75(1): 306 - 313. [Abstract] [Full Text] [PDF]
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C. S. Hollenbeak, D. L. Morris, and M. C. Sinclair Is Off-pump Coronary Artery Bypass Graft Surgery Cost-Saving? Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2002; 6(4): 325 - 329. [Abstract] [PDF]
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M. Caputo, M. Yeatman, P. Narayan, G. Marchetto, R. Ascione, B. C. Reeves, and G. D. Angelini Effect of off-pump coronary surgery with right ventricular assist device on organ function and inflammatory response: a randomized controlled trial Ann. Thorac. Surg., December 1, 2002; 74(6): 2088 - 2095. [Abstract] [Full Text] [PDF]
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K.-B. Kim, C. H. Kang, W.-I. Chang, C. Lim, J. H. Kim, B. M. Ham, and Y. L. Kim Off-pump coronary artery bypass with complete avoidance of aortic manipulation Ann. Thorac. Surg., October 1, 2002; 74(4): S1377 - 1382. [Abstract] [Full Text] [PDF]
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M. Caputo, A. J. Bryan, R. Capoun, B. Mahesh, F. Ciulli, J. Hutter, and G. D. Angelini The evolution of training in Off-Pump coronary surgery in a single institution Ann. Thorac. Surg., October 1, 2002; 74(4): S1403 - 1407. [Abstract] [Full Text] [PDF]
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R. Ascione, B. C. Reeves, K. Rees, and G. D. Angelini Effectiveness of Coronary Artery Bypass Grafting With or Without Cardiopulmonary Bypass in Overweight Patients Circulation, October 1, 2002; 106(14): 1764 - 1770. [Abstract] [Full Text] [PDF]
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S. C. Stamou, K. A. Jablonski, A. J. Pfister, P. C. Hill, M. K.C. Dullum, A. S. Bafi, S. W. Boyce, K. R. Petro, and P. J. Corso Stroke after conventional versus minimally invasive coronary artery bypass Ann. Thorac. Surg., August 1, 2002; 74(2): 394 - 399. [Abstract] [Full Text] [PDF]
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R. Ascione, B. C. Reeves, M. H. Chamberlain, A. K. Ghosh, K. H.H. Lim, and G. D. Angelini Predictors of stroke in the modern era of coronary artery bypass grafting: a case control study Ann. Thorac. Surg., August 1, 2002; 74(2): 474 - 480. [Abstract] [Full Text] [PDF]
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R. Ascione, K. Rees, K. Santo, M.H. Chamberlain, G. Marchetto, F. Taylor, and G.D. Angelini Coronary artery bypass grafting in patients over 70 years old: the influence of age and surgical technique on early and mid-term clinical outcomes Eur. J. Cardiothorac. Surg., July 1, 2002; 22(1): 124 - 128. [Abstract] [Full Text] [PDF]
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E. Villa, A. Moneta, and F. Donatelli Optimizing neurologic outcome in coronary bypass surgery J. Thorac. Cardiovasc. Surg., July 1, 2002; 124(1): 210 - 211. [Full Text] [PDF]
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R. Ascione, S. Al-Ruzzeh, K. Amer, and G. D Angelini Subsystem organ function during coronary surgery Perfusion, July 1, 2002; 17(4): 295 - 303. [Abstract] [PDF]
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M. H. Chamberlain, R. Ascione, B. C. Reeves, and G. D. Angelini Evaluation of the effectiveness of off-pump coronary artery bypass grafting in high-risk patients: an observational study Ann. Thorac. Surg., June 1, 2002; 73(6): 1866 - 1873. [Abstract] [Full Text] [PDF]
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E. W. Jansen Invited Commentary Asian Cardiovasc Thorac Ann, June 1, 2002; 10(2): 158 - 159. [Full Text] [PDF]
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M. Yeatman, M. Caputo, P. Narayan, A. Kumar Ghosh, R. Ascione, I. Ryder, and G. D. Angelini Intracoronary shunts reduce transient intraoperative myocardial dysfunction during off-pump coronary operations Ann. Thorac. Surg., May 1, 2002; 73(5): 1411 - 1417. [Abstract] [Full Text] [PDF]
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R. Ascione, G. Nason, S. Al-Ruzzeh, C. Ko, F. Ciulli, and G. D. Angelini Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency Ann. Thorac. Surg., December 1, 2001; 72(6): 2020 - 2025. [Abstract] [Full Text] [PDF]
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M. Yacoub Off-Pump Coronary Bypass Surgery: In Search of an Identity Circulation, October 9, 2001; 104(15): 1743 - 1745. [Full Text] [PDF]
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D. van Dijk, A. P. Nierich, E. W.L. Jansen, H. M. Nathoe, W. J.L. Suyker, J. C. Diephuis, W.-J. van Boven, C. Borst, E. Buskens, D. E. Grobbee, et al. Early Outcome After Off-Pump Versus On-Pump Coronary Bypass Surgery: Results From a Randomized Study Circulation, October 9, 2001; 104(15): 1761 - 1766. [Abstract] [Full Text] [PDF]
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F. Toraman, E. H. Karabulut, H. C. Alhan, S. Dagdelen, and S. Tarcan Magnesium infusion dramatically decreases the incidence of atrial fibrillation after coronary artery bypass grafting Ann. Thorac. Surg., October 1, 2001; 72(4): 1256 - 1262. [Abstract] [Full Text] [PDF]
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R. Ascione, G. Iannelli, K. H.H. Lim, H. Imura, and N. Spampinato One-stage coronary and abdominal aortic operation with or without cardiopulmonary bypass: early and midterm follow-up Ann. Thorac. Surg., September 1, 2001; 72(3): 768 - 774. [Abstract] [Full Text] [PDF]
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M. Galinanes, M. Loubani, M. Caputo, R. Ascione, G. Calori, C. T. Lloyd, M. J. Underwood, and G. D. Angelini Is Cardiopulmonary Bypass Really the Cause of Postoperative Atrial Fibrillation? Response Circulation, August 14, 2001; 104 (7): e36 - e36. [Full Text] [PDF]
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D. H. Spodick, R. Ascione, M. Oberhoff, M. Caputo, G. Marchetto, C. T. Lloyd, M. J. Underwood, G. D. Angelini, and G. Calori Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery Response Circulation, June 26, 2001; 103 (25): e130 - e130. [Full Text] [PDF]
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L. L. Creswell and R. J. Damiano Jr Postoperative atrial fibrillation: An old problem crying for new solutions J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 638 - 641. [Full Text] [PDF]
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M. Caputo, M. H. Chamberlain, F. Ozalp, M. J. Underwood, F. Ciulli, and G. D. Angelini Off-pump coronary operations can be safely taught to cardiothoracic trainees Ann. Thorac. Surg., April 1, 2001; 71(4): 1215 - 1219. [Abstract] [Full Text] [PDF]
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M. Yeatman, M. Caputo, R. Ascione, F. Ciulli, and G. D. Angelini Off-pump coronary artery bypass surgery for critical left main stem disease: safety, efficacy and outcome Eur. J. Cardiothorac. Surg., March 1, 2001; 19(3): 239 - 244. [Abstract] [Full Text] [PDF]
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