Transient cortical blindness during coronary and aortocoronary bypass graft angiography

The prevalence of cerebrovascular complications after cardiac catheterization is low. These include stroke, transient ischemic attack, and amaurosis fugax. Cortical blindness is a rare, bilateral clinical condition of largely ischemic etiology, characterized by damage to the cerebral cortex, which manifests with acute reduction of visual acuity. Usually, neuro-ophthalmic complications of cardiac catheterization are correlated with embolic phenomena or migraine. We report a case of transient cortical blindness during coronary and aortocoronary bypass graft angiography.

Revascularization using the saphenous vein as a composite graft

The saphenous vein conduit has been used as an aortocoronary bypass graft in almost all previous studies, and its use as a composite graft was reserved for patients with diffusely atherosclerotic or calcified ascending aorta to minimize ascending aorta manipulation and to reduce the risk of neurological injury.

Efficacy and Safety of Heparinase I versus Protamine in Patients Undergoing Coronary Artery Bypass Grafting with and without Cardiopulmonary Bypass

Background Hemodynamic protamine reactions with heparin reversal during cardiac surgery are common and associated with adverse outcomes. As an alternative to protamine, the authors examined heparinase I reversal of heparin after aortocoronary bypass graft surgery. Methods In a randomized, double-blind, double-dummy trial, 167 on- and off-pump aortocoronary bypass graft surgery patients received either heparinase I (maximum 35 microg/kg) or protamine (maximum 650 mg) for heparin reversal, monitored by activated clotting time values and clinical assessment. Hemodynamic parameters were recorded electronically; safety evaluation was to 30 days postoperatively. Noninferiority was predefined as 400 ml or less median 12-h chest tube drainage from intensive care unit arrival for heparinase I patients, after risk adjustment. Hemodynamic instability was defined as systemic hypotension (> or = 30 mmHg decrease) and/or pulmonary hypertension (> or = 40 mmHg with an increase > or = 10 mmHg) within 30 min of heparin reversal initiation. Results Patient enrollment was terminated on advisement of the Data Safety Monitoring Board. Although heparinase I was noninferior for 12-h chest tube drainage, protamine had a superior safety profile. Overall, heparinase I subjects had longer hospital stays (P = 0.04), were more likely to experience a serious adverse event (P = 0.01), and were less likely to avoid transfusion (P = 0.006). A composite morbidity score was not different (P = 0.24), and similar rates of hemodynamic instability were observed between groups. Findings were consistent in analyses stratified by on- and off-pump surgery. Conclusions Heparinase I reverses heparin anticoagulation after aortocoronary bypass graft surgery but is not equivalent to protamine because of its inferior safety profile.