The heart surgery forum
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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 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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We have developed a technique that enables robotic aortic valve replacement with port access via a small right anterior thoracotomy and minimally invasive aortic cross clamping. The procedure is performed under video guidance with all the annular sutures placed with the robot. In the case we report, the patient's postoperative course was extremely simple and pain was minimal. We believe that this is the first reported aortic valve replacement using robotic technology and that it opens a new field of application for robotic assisted surgery.
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The heart surgery forum · Jan 2004
Controlled Clinical TrialIn vivo and in vitro evaluation of the heparin management test versus the activated coagulation time for monitoring anticoagulation level in aprotinin-treated patients during cardiac surgery.
Monitoring whole blood anticoagulation therapy with the activated coagulation time (kaolin ACT) and the heparin management test (HMT) were correlated in vivo with the plasma anti-activated factor X (anti-Xa) heparin concentration in patients who received variable doses of aprotinin and in vitro in the presence of increasing concentrations of aprotinin. ⋯ The abilities of the HMT and the kaolin ACT to measure anticoagulation effects were not significantly different. Aprotinin prolonged both the kaolin ACT and the HMT time in a dose-dependent manner, but the HMT was significantly less affected by aprotinin in vivo. The HMT is a reliable alternative to measuring the ACT in cardiac operations and may offer greater accuracy in aprotinin-treated patients.
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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.