The heart surgery forum
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The heart surgery forum · Jan 2005
Outcomes for off-pump coronary artery bypass grafting in high-risk groups: a historical perspective.
The outcomes of off-pump coronary artery bypass (OPCAB) and conventional coronary artery bypass grafting with cardiopulmonary bypass (cCABG) have been compared in detail. Similarly, several reports have examined outcomes of high-risk subsets of patients in OPCAB as a selection strategy for reducing morbidity and mortality compared to cCABG. We undertook a retrospective study comparing outcomes from the early years in our experience of beating-heart surgery in high-risk patients selected for OPCAB compared to low-risk patients having OPCAB. This study was premised on strict selection criteria in an era prior to stabilizing devices and cardiac positioners. ⋯ In this retrospective and historical review, OPCAB was found to be equally safe in carefully selected high- and low-risk patients. These results provided for the enthusiasm and innovation to expand the usage of OPCAB in patients with coronary artery disease.
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The heart surgery forum · Jan 2005
Time and risk analysis for acute type A aortic dissection surgery performed by hypothermic circulatory arrest, cerebral perfusion, and open distal aortic anastomosis.
Hypothermic total circulatory arrest, retrograde or antegrade cerebral perfusion, and open distal anastomosis are important stages of surgical management and cerebral protection for acute type A dissections. Among the factors that influence survival are the transfer time to hospital from the onset of symptoms, in-hospital transfer time to operation, organ malperfusion, preoperative risk factors, and intraoperative variables. The aim of this study was to analyze time and risk factors during surgical management. ⋯ Total circulatory arrest, cerebral perfusion, and open distal anastomosis are reliable options in the surgical management of acute type A aortic dissections. With open distal anastomosis aortic arcus can be evaluated, distal anastomosis can be performed more easily, and postoperative neurological recovery is hastened. In the present study, although statistical significance could not be reached due to limited sample size, the time to admission, durations of total circulatory arrest, cross-clamp, and cardiopulmonary bypass, and the amount of postoperative chest output seem to influence postoperative survival.
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Fast-track recovery protocols result in shorter hospital stays and decreased costs in coronary artery bypass grafting (CABG) surgery. However, data based on an objective scoring system are lacking for the impact of these protocols on patients undergoing cardiac surgery other than isolated CABG. ⋯ This study confirms the safety and efficacy of the fast-track recovery protocol in patients undergoing open cardiac surgery other than isolated CABG.
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The heart surgery forum · Jan 2005
Clinical TrialIncisional administration of local anesthetic provides satisfactory analgesia following port access heart surgery.
To evaluate the new method of postoperative pain relief following port access (PA) heart surgery. ⋯ The incisional administration of local anesthetic provides satisfactory pain control after PA heart surgery.
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The heart surgery forum · Jul 2004
Clinical TrialCalculated reduction aortoplasty for dilatation of the ascending aorta associated with aortic valve replacement.
Previous studies have advocated reduction aortoplasty to normalize the diameter of a moderately dilated ascending aorta associated with aortic valve disease. One of the reported techniques is the shawl lapel aortoplasty, which we have adopted and modified by setting a simple set of calculations. We present our midterm results. ⋯ The shawl lapel technique based on simple calculations, used as a diameter-reduction strategy for ascending aortic dilatation encountered during aortic valve replacement, is an efficacious method with excellent medium-term results.