The heart surgery forum
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The heart surgery forum · Jan 2007
How I do it: traction of ascending aorta with starfish heart positioner during proximal saphenous vein graft anastomosis using the PAS-Port system in off-pump coronary artery bypass grafting.
The PAS-Port system allows for the rapid deployment of a clampless proximal anastomosis between a saphenous vein graft and the aorta. We have developed a simple technique of establishing traction of the ascending aorta with the Starfish heart positioner during proximal saphenous vein anastomosis using the PAS-Port system in off-pump coronary artery bypass grafting.
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The heart surgery forum · Jan 2007
Review Meta AnalysisEpidural analgesia in cardiac surgery: an updated risk assessment.
The use of epidural anesthesia carries risks that have been known for 50 years. The debate about the use of locoregional technique in cardiac anesthesia continues. The objective of this report is to estimate the risks and their variability of a catheter-related epidural hematoma in cardiac surgery patients and to compare it with other anesthetic and medical procedures. ⋯ The risk of a hematoma after epidural in cardiac surgery is comparable to other nonobstetrical surgical procedures. Its routine application in a controlled setting should be encouraged.
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The heart surgery forum · Jan 2007
ReviewTotally endoscopic coronary artery bypass grafting on the arrested heart.
In the late 1990s, totally endoscopic coronary artery bypass grafting was successfully introduced into the heart surgery armamentarium using robotic techniques. Surgeons have applied the da Vinci telemanipulation system in order to develop completely endoscopic placement of internal mammary artery bypass grafts, mainly to the left anterior descending artery system. ⋯ Another option is performing procedures on the beating heart using an endostablilizer and local coronary artery occlusion. In this review, the technique and specific aspects of the arrested heart version of totally endoscopic coronary artery bypass grafting are outlined.
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The heart surgery forum · Jan 2007
Comparative StudyCardiac troponin T levels in on- and off-pump coronary artery bypass surgery.
Conventional coronary artery bypass graft surgery (CCAB) has been associated with greater myocardial injury than off-pump surgery (OPCAB). However, the extent of myocardial injury following CCAB and OPCAB has not been assessed by priority of surgery or the number of diseased vessels. We tested the hypothesis that the additional myocardial injury associated with CCAB compared with OPCAB is sustained when patients are stratified by priority and 2- or 3-vessel disease. ⋯ In summary, higher postoperative cTnT levels are associated with CCAB than with OPCAB, regardless of priority, number of diseased vessels, patient characteristics, or surgeon. OPCAB results in less myocardial injury in patients, whether they present with 2- or 3-vessel disease and whether they undergo urgent or elective cardiac surgery.
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The heart surgery forum · Jan 2007
Surgical challenges for urgent approach in penetrating heart injuries.
The aim of this clinical study is to assess the characteristics of penetrating heart injury and its surgical challenges for urgent surgical approach. ⋯ Although the most important factor affecting mortality in penetrating heart injuries is rapid transport, an urgent approach applied by a specialist team can decrease potential mortality and morbidity rates.