The heart surgery forum
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The heart surgery forum · Jan 2003
Comparative StudyMidterm results of beating heart surgery in 1-vessel disease: minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with full sternotomy.
Off-pump cardiac surgery is becoming an established method of surgical revascularization. However, performing anastomoses on a beating heart can be challenging, especially through small incisions. We compared our midterm results in patients with 1 vessel disease using full sternotomy (OPCAB) or a left anterior minithoracotomy (MIDCAB). ⋯ Our initial experience in beating heart surgery demonstrated that MIDCAB is technically more challenging than OPCAB. MIDCAB procedures should therefore be performed by experienced surgeons on selected patients. Midterm results after OPCAB procedures tend to a lower rate of adverse cardiac events.
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The heart surgery forum · Jan 2003
Comparative StudyEarly and midterm results after coronary artery bypass grafting with and without cardiopulmonary bypass: which patient population benefits the most?
We present our early and midterm results with off-pump coronary artery bypass grafting (OPCAB) on the beating heart and with conventional coronary artery bypass grafting (CABG) and compare patient outcomes for both procedures. ⋯ OPCAB surgery improved postoperative recovery for the entire patient population without compromising midterm outcome. Compared with conventional CABG, high-risk patients with multimorbidity particularly profit from avoiding cardiopulmonary bypass and show significantly lower hospital mortality.
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The heart surgery forum · Jan 2003
Comparative StudyMultivessel off-pump coronary artery bypass: analysis of 4953 cases.
To avoid the harmful effects of cardiopulmonary bypass (CPB), cardiac surgeons are using off-pump coronary artery bypass (OPCAB) as an effective alternative to conventional coronary artery bypass grafting (CABG). In the present study, we analyze our results with OPCAB in patients with multivessel coronary artery disease and compare them with those achieved in patients who underwent operations on CPB. ⋯ OPCAB is a safe and effective procedure for patients with multivessel coronary artery disease and is associated with reduced morbidity and mortality. However, large randomized studies with long-term follow-up may show the real benefits of OPCAB compared with CABG on CPB.
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The heart surgery forum · Jan 2003
Less invasive cardiac anesthesia: an ultra-fast-track procedure avoiding thoracic epidural analgesia.
A new "less invasive" technique avoiding thoracic epidural analgesia has be en tested for suitability as a routine procedure for cardiac anesthesia. Early postoperative extubation is an important step in this fasttrack procedure. ⋯ Early extubation proved suitable as a routine procedure for the vast majority of patients. With a good postoperative analgetic protocol, there is no need for thoracic epidural analgesia. Such avoidance of thoracic epidural analgesia is a further step in minimizing invasiveness in cardiac surgery.
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The heart surgery forum · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialHemodilution during off-pump coronary artery bypass grafting: can we improve flow and reduce hypercoagulability?
The aim of this study was to compare intraoperative coronary graft flows performed on pump and off pump and to evaluate the effects of hemodilution on coronary graft flows in off-pump coronary artery bypass grafting (CABG) patients by using transit time flow measurements (TTFM). ⋯ Off-pump CABG patients with hemodilution had significantly higher graft flows than off-pump CABG patients without hemodilution. Although we failed to show the existence of a hypercoagulable state for patients in the offpump group, an examination of the TTFM findings suggests that hemodilution may help to improve graft patency in offpump CABG patients during the early postoperative period.