The heart surgery forum
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The heart surgery forum · Jan 2003
Off-pump coronary artery bypass surgery may produce a hypercoagulable patient.
The incidence of thromboembolic events following traditional open heart surgery has not been clinically significant. However, with beating heart surgery, for which cardiopulmonary bypass (CPB) is not required, the incidence of spontaneous intravascular thrombosis may be similar to that encountered after general surgeries. Compounding this risk is that many cases of off-pump coronary artery bypass (OPCAB) surgery are reserved for the elderly patient with multiple comorbidities. The few studies to date that have assessed the coagulation profile in OPCAB patients have been limited to the first 24 hours after surgery. ⋯ A state of hypercoagulability, as measured by thromboelastography, exists in the OPCAB patient beyond the first postoperative day, and this finding suggests that prophylactic postoperative anticoagulation therapy targeting fibrinogen and platelet activity may be indicated for these patients.
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The heart surgery forum · Jan 2003
Midterm results of routine bilateral internal thoracic artery grafting.
Skeletonized dissection of the internal thoracic artery (ITA) decreases the occurrence of sternal devascularization, thus decreasing the risk of postoperative sternal complications in patients undergoing bilateral ITA grafting. ⋯ Bilateral skeletonized ITA grafting is associated with satisfactory early and midterm results. We do not recommend the use of this surgical technique in patients with chronic obstructive pulmonary disease.
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The heart surgery forum · Jan 2003
Off-pump coronary artery bypass grafting attenuates postoperative bleeding associated with preoperative clopidogrel administration.
Clopidogrel is being increasingly administered as primary therapy for acute coronary syndromes and prior to planned percutaneous coronary intervention (PCI). In these settings, surgical revascularization results in signifi- cantly increased postoperative bleeding, transfusion, and reexploration. Off-pump coronary artery bypass grafting (OPCAB) may decrease the extent of postoperative bleeding in patients exposed to clopidogrel. ⋯ Among these 15 OPCAB patients with immediately preoperative administration of clopidogrel and aspirin, outcome was improved compared with published results for on-pump coronary bypass patients and was equivalent to results among OPCAB patients not exposed to clopidogrel. Published, recommended approaches to clopidogrel administration, such as avoidance of pre-PCI clopidogrel, delay of surgery, and platelet transfusion do not appear to be necessary with OPCAB.
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The heart surgery forum · Jan 2003
Primary OPCAB as a strategy for acute coronary syndrome and acute myocardial infarction.
Conventional coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass (CPB) carries higher mortality and morbidity for patients undergoing surgery during acute coronary syndrome (ACS). The aim of this retrospective study was to evaluate potential benefits of avoiding CPB by instead performing off-pump CAB (OPCAB) during surgery on patients in ACS. ⋯ OPCAB is a valuable treatment strategy in ACS patients; however, it carries significant mortality and morbidity. Careful preselection and timing of intervention are required in order for patients to fully benefit from the OPCAB strategy.
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The heart surgery forum · Jan 2003
Case ReportsPatent foramen ovale causing refractory hypoxemia after off-pump coronary artery bypass: a case report.
Patent foramen ovale (PFO) is not uncommon in the adult population undergoing cardiac surgery. Although usually innocent, PFO can cause severe hypoxemia, which can be reversed only by surgical or interventional interruption of the interatrial right-to-left shunt. Such a case is presented, and the diagnosis and pathophysiology are discussed.