The heart surgery forum
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The heart surgery forum · Jan 2004
Comparative StudyOptimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients.
A recent study demonstrated that almost 75% of strokes after coronary artery revascularization surgery occur in patients classified preoperatively as low to medium risk. Thus, despite the use of risk classification, most strokes can occur when not expected. We hypothesized that optimization of cerebral oxygen delivery variables by using noninvasive cerebral oximetry could reduce the incidence of stroke. ⋯ The treatment group, which underwent all cardiac surgeries with optimized cerebral oxygen delivery using cerebral oximetry monitoring, demonstrated a significantly lower incidence of permanent stroke. Because our study is retrospective, a prospective randomized trial is warranted.
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The heart surgery forum · Jan 2004
Case ReportsMinimally invasive aortic valve replacement under thoracic epidural anesthesia in a conscious patient: case report.
Cardiopulmonary bypass and full median sternotomy have been recognized as major morbidity factors in cardiac surgery. Additional morbidity factors are general anesthesia and endotracheal intubation. Over the past several years high-thoracic epidural anesthesia (hTEA) has emerged as a potentially beneficial supplement to general anesthesia in the care of patients undergoing cardiac surgery. ⋯ There were no complications within 30 days after surgery. This case demonstrates that thoracic epidural anesthesia without endotracheal intubation used for aortic valve replacement performed through ministernotomy is feasible. Further experience is necessary to determine the safety of this method and the effect on outcome.
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The heart surgery forum · Jan 2004
Controlled Clinical TrialExperience on the way to totally endoscopic atrial septal defect repair.
Remote-access perfusion and robotics have enabled totally endoscopic closure of atrial septal defect (ASD) and patent foramen ovale (PFO). We report on a stepwise approach to a totally endoscopic procedure. ⋯ The implementation of robotic totally endoscopic closure of ASD or PFO in a heart surgery program seems to be safe. An intermediate step of performing the operations through minithoracotomy, adapting to remote access perfusion systems, and gaining experience in other robotic cardiac surgical procedures seems worthwhile. Learning curves are apparent, and adequate defect closure does not seem to be compromised by the totally endoscopic approach.
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The heart surgery forum · Jan 2004
Comparative StudyMitral valve operations through standard and smaller incisions.
Evaluate the operative results of mitral valve repair (MVV) and mitral valve replacement (MVR) performed through standard and smaller incisions. ⋯ The mortality rate for MV operations is concentrated among a few diagnoses. In some patients surgery may be approached safely through smaller incisions without introducing new elements of operative risk.
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The heart surgery forum · Jan 2004
Controlled Clinical TrialLactic acidosis after cardiac surgery is associated with adverse outcome.
The accurate identification of patients who have the potential to further deteriorate after cardiac surgery is difficult. Elevated serum lactate level after cardiac surgery is an indicator of systemic hypoperfusion and tissue hypoxia. The aim of this study was to investigate the effect of increased serum lactate on outcome after on-pump coronary artery bypass grafting. ⋯ This study has demonstrated that elevated blood lactate level is associated with adverse outcome, and monitoring the blood lactate level during and after cardiac surgery is a valuable tool in identifying the patients who have the potential to deteriorate.