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
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
Case ReportsSuperior vena cava rupture during balloon angioplasty and stent placement to relieve superior vena cava syndrome: a case report.
Percutaneous stenting of the superior vena cava (SVC) has been an accepted therapy for SVC syndrome for more than a decade. Complications are uncommon and usually of minor consequence. ⋯ We report a fourth case of SVC rupture during angioplasty and stenting that required immediate pericardiocentesis followed by open surgical repair via sternotomy for direct control and repair. An algorithm for rapid recognition and prompt intervention is described.
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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
Good recovery after nontransthoracic cardiopulmonary bypass in rats.
Cardiopulmonary bypass (CPB) has been shown to be associated with systemic inflammatory response leading to postoperative organ dysfunction. Unwanted side effects of CPB are well known but poorly understood due to the absence of a stable recovery animal model that is easy to handle and reduces experiment cost and time. The purpose of this study was to establish a good recoverable rat model of CPB to study the pathophysiology of these potential complications. ⋯ The rat model of CPB can in principle simulate the clinical setting of human CPB. The non-transthoracic model is easy to establish and is associated with excellent recovery. This reproducible model may open the field for various studies on the pathophysiological process of CPB and systemic ischemia-reperfusion injury in vivo.