The heart surgery forum
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This study was designed to evaluate the feasibility of beating heart coronary bypass operations on the anterior vessels of the heart through very limited sternotomy (VLS). ⋯ Coronary bypass grafting on the LAD, the RCA, and their tributaries can be safely performed through VLS. Early and midterm results are comparable with those of classic methods of myocardial revascularization. Conversion to full sternotomy is quite easy and safe, should the necessity arise.
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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.
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The heart surgery forum · Jan 2003
Improving hemodynamics by atrial pacing during off-pump bypass surgery.
To avoid hemodynamic deterioration during tilting of the heart in off-pump surgery, we perform atrial pacing. We describe hemodynamic evaluation of this simple maneuver. ⋯ Atrial pacing increases intraoperative RRs, RRm, CO, and CI and decreases SV and LAP significantly, thus offering stable hemodynamics during off-pump surgery. In the last 400 consecutive off-pump coronary artery bypass grafting procedures, there was only 1 (0.25%) conversion to cardiopulmonary bypass.
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The heart surgery forum · Jan 2003
Clinical Trial Controlled Clinical TrialMarkers of myocardial ischemia in the evaluation of the effect of left anterior descending coronary artery lesion and collateral circulation on myocardial injury in 1-vessel off-pump coronary bypass surgery.
The purpose of this study was to use serum markers for myocardial tissue damage to evaluate the effect of the severity of left anterior descending artery (LAD) lesions after 1-vessel off-pump coronary artery bypass grafting. ⋯ One-vessel off-pump coronary artery bypass grafting can be performed safely in patients with serious LAD stenosis and borderline antegrade blood flow without the need for any coronary collateral circulation support. A short anastomosis time prevents myocardial injury during off-pump coronary surgery.
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A "fast track" approach to cardiac surgery can be defined as a perioperative process involving rapid progress from preoperative preparation through surgery and discharge from the hospital. Although highly individualized among the various heart surgery centers, the fast-track process is a team activity. ⋯ The necessary elements of the fast-track program are choice and the titration of short-acting anesthetic drugs, standardized surgical procedures, early extubation, rewarming and sustained postoperative normothermia, postoperative pain control, early ambulation, alimentation and discharge, and follow-up after discharge. We review the current approaches to some of these aspects of patient care.