The heart surgery forum
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The heart surgery forum · Jan 2007
Excellent results of contemporary coronary artery bypass grafting with systematic application of modern perioperative strategies.
The patient population referred for coronary artery bypass grafting (CABG) has become more challenging. The surgical population is aging and patients present with significant preoperative comorbidities. This worsening risk profile has led to the development of operative techniques (off-pump CABG) and perioperative measures (epi-aortic scanning, intensive insulin therapy) to preserve the quality of care following CABG. The aim of this study was to determine the outcome of contemporary CABG following the implementation of the above measures in our practice. ⋯ Despite a worsening case mix, contemporary CABG can be performed with excellent results (operative mortality < 1%). Off-pump CABG performed in very high-risk patients obtains results similar to those of the general CABG population. Diabetes and ejection fraction were not independent predictors of early outcome. In our experience, these excellent outcomes were achieved by adopting an operative approach using modern perioperative management (epi-aortic scanning, intensive insulin therapy) and surgical techniques (off-pump CABG) based on individual patients.
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The heart surgery forum · Jan 2007
Detection of coronary arteries and evaluation of anastomoses with a commercially available 15-MHz, broadband, linear array transducer.
In coronary artery bypass surgery the detection of the target vessels can be difficult due to their intramural location, coverage by adipose tissue, calcification, or fibrous tissue formation. Their identification is especially critical during off-pump coronary artery bypass (OPCAB) and minimally invasive direct coronary artery bypass (MIDCAB) surgeries. Our objectives were to identify whether (1) the epimyocardial use of the broadband linear array transducer CL15-7 allows a clear and rapid identification of the target artery during on-pump coronary bypass (CPB), OPCAB and MIDCAB surgeries; and (2) if this transducer is helpful in investigating the anastomotic morphology with 2D and color flow Doppler. ⋯ The CL15-7 transducer gives excellent near field visibility of the LAD and RCA. This is extremely valuable for the safe dissection of these vessels, especially during off-pump coronary surgery. The anatomical morphology of the anastomoses can be identified but, due to the shape of the transducer handle, only the coronary arteries on the anterior surface of the heart can be evaluated. A flexible, rather than a rigid, hockey stick-shaped handle would eliminate this problem. Training is essential to obtain reliable results.
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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
A novel mechanical circulatory approach for patients with cardiogenic shock in the intensive care unit.
The capacity of the heart to maintain cardiac output can be acutely impaired as a result of myocardial infarction, graft failure after transplantation, or other cardiac events. Medical therapy or the use of an intra-aortic balloon pump may be insufficient to help the patient overcome acute cardiogenic shock. The set-up of mechanical assist devices such as extracorporeal membrane oxygenation or patient relocation into the operating room requires valuable time that is often not available. The aim of our study was to test whether a novel left ventricular assist device can be percutaneously implanted without fluoroscopy under echocardiographic navigation in a preclinical model. ⋯ The ability to abstain from fluoroscopy and the feasibility of inserting the afferent cannula across the interatrial septum guided by TEE allows for application of this system in intensive care units, saving precious time as well as financial and human resources.
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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.