The heart surgery forum
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The heart surgery forum · Jan 2002
Randomized Controlled Trial Multicenter Study Clinical TrialA new thermoregulation system for maintaining perioperative normothermia and attenuating myocardial injury in off-pump coronary artery bypass surgery.
Most patients undergoing coronary artery bypass surgery demonstrate perioperative mild-to-moderate hypothermia (<36 degrees C). Patients undergoing off-pump coronary artery bypass (OPCAB) grafting may become even more severely hypothermic for want of cardiopulmonary bypass rewarming. One consequence is increased circulating catecholamine levels that induce an elevated systemic vascular resistance (SVR), which causes a subsequent deterioration in cardiac output. ⋯ Maintenance of perioperative normothermia (36.5 degrees C-37.5 degrees C) during OPCAB procedures can be efficiently achieved with the Allon thermoregulation system. The system was found to be superior to other routinely used methods of temperature maintenance. Benefits may include lowering afterload (as expressed by reduced SVR), an improved CI, and attenuation of myocardial injury (as assessed by cTnI levels).
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The heart surgery forum · Jan 2002
Case ReportsRepair of acute ascending aorta-arch dissection with continuous body perfusion: a case report.
An approach for the replacement of the distal ascending aorta-proximal arch and acute dissection is described. During the operation, the patient's entire body was continuously perfused, the aortic arch was excluded from the arterial circulation, and the aorta was not clamped at any time. To achieve continuous body perfusion, we independently cannulated the right axillary and the left femoral arteries. ⋯ Aggressive medical management resulted in complete patient recovery. No neurologic deficits were observed, and the patient regained full cognitive function. This report describes a simple approach to facilitate repair of the aortic arch and minimize postoperative organ failure.
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The heart surgery forum · Jan 2002
Total arterial off-pump coronary revascularization with only internal thoracic artery and composite radial artery grafts.
Total arterial off-pump coronary artery bypass (OPCAB) grafting with only internal thoracic artery (ITA) and composite radial artery (RA) grafts has been applied extensively to avoid cerebral complications and late vein graft failure. We evaluated the initial experience with this method by clinical and angiographic study. ⋯ OPCAB grafting with ITAs and composite RAs provides excellent early and intermediate clinical results and graft patency.
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The heart surgery forum · Jan 2002
Aortic and mitral valve surgery on the beating heart is lowering cardiopulmonary bypass and aortic cross clamp time.
The concept of cardiac surgery on the beating heart is acceptable rationale for the cardiac surgery in the next millenium. Beating heart (off-pump) coronary artery bypass grafting (CABG) techniques have led us to consider the possibility for performing the aortic and mitral valve surgery (mitral valve repairs and replacements - with or without CABG) on the beating heart with the technique of retrograde oxygenated coronary sinus perfusion. ⋯ We conclude that beating heart valve surgery (any combination) with or without CABG significantly lower the cardiopulmonary bypass and aortic cross clamp time. In addition, the advantages of beating-heart surgery are 1) the perfused myocardial muscle, 2) the heart is not doing any work, 3) no reperfusion injury, 4) the possibility for ablation of atrial fibrillation on the beating heart, and 5) testing of the mitral valve repair is done in real physiologic conditions in the state of left ventricle beating tonus. The procedure could be the procedure of choice for the valve operation or combined operations (valve operation and CABG) in high-risk patients with low ejection fractions. There is no doubt that at present day in cardiac surgery exist at least two major factors for mortality and morbidity after cardiac surgery, which are operation - related, namely cardiopulmonary bypass time and its duration and aortic cross clamp time (ischemic time of myocardium). In the last few years a number of different techniques emerged in the field of cardiac surgery, which were directed toward better results in the selected high risk patients or to minimize the deleterious effects of cardiopulmonary bypass (CPB) on the overall postoperative performance [Calafiore 1996, Tasdemir 1998]. Due to the fact, that the cardiac muscle should be protected at most during the cardiac arrest, retrograde blood cardioplegia was successfully introduced [Buckberg 1990], and more - the warm cardioplegia is being used recently [Kawasuji 1997]. The natural status of the human heart is the beating status, so it is reasonable to try to perform the operations on the beating heart. This has been done recently with the MID - CAB and OP - CAB (off-pump CABG) operations [Tasdemir 1998]. The retrograde warm blood cardioplegia has therefore led us to the premise, that with retrograde oxygenated blood perfusion it would be possible to achieve the operations on the beating heart even in the open heart surgery, such as aortic and/or mitral valve surgery. All will agree that the most damaging effect of the cardioplegia is the reperfusion injury [Allen 1997], and it is obvious that with the technique of retrograde continuous oxygenated blood perfusion this effect will be canceled. In this article, we would like to show the how-to technique for the operations on the beating heart in the case of operations on the aortic valve replacement (AVR) with mitral valve repair (MVR) or replacement MVR and with/without concomitant coronary artery bypass (CABG) surgery. The tricuspid valve repair (PTV) is normally done on the beating heart and there it is realized what problems or technical difficulties may arise during procedures on the mitral valve: the walls of the ventricles are not flattened and the exposure of the mitral valve is challenging task. Furthermore, the free walls of the ventricles with interventricular septum are in the state of the tonus, so every force applied to better expose the aortic or mitral valve is not acceptable
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The heart surgery forum · Jan 2002
Review Case ReportsMitral valve aneurysm associated with aortic valve endocarditis and regurgitation.
Mitral valve aneurysms are rare complications occurring most commonly in association with aortic valve infective endocarditis. [Decroly 1989, Chua 1990, Northridge 1991, Karalis 1992, Roguin 1996, Mollod 1997, Vilacosta 1997, Cai 1999, Vilacosta 1999, Teskey 1999, Chan 2000, Goh 2000, Marcos- Alberca 2000] While the mechanism of the development of this lesion is unclear, complications such as perforation can occur and lead to significant mitral regurgitation. [Decroly 1989, Karalis 1992, Teskey 1999, Vilacosta 1999]; The case of a 69-year-old male with Streptococcus Sanguis aortic valve endocarditis and associated anterior mitral leaflet aneurysm is presented. Following surgery, tissue pathology of the excised lesion revealed myxomatous degeneration and no active endocarditis or inflammatory cells. This may add support to the hypothesis that physical stress due to severe aortic insufficiency and structural weakening, without infection of the anterior mitral leaflet, can lead to the development of this lesion.