The heart surgery forum
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The heart surgery forum · Jan 2003
A feasibility study of the safety and efficacy of a combined clopidogrel and aspirin regimen following off-pump coronary artery bypass grafting.
Effective antiplatelet therapy may decrease the risk of complications following off-pump coronary artery bypass surgery (CABG). We prospectively evaluated the safety and early efficacy of a combined regimen of clopidogrel and aspirin starting immediately after off-pump CABG. ⋯ Early administration of a combined regimen of clopidogrel and aspirin following off-pump CABG is safe and is associated with a relatively low incidence of major adverse cardiac events, bleeding, PE, and DVT. Consequently, its routine administration after off-pump CABG is recommended.
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The heart surgery forum · Jan 2003
A miniature right heart support system improves cardiac output and stroke volume during beating heart posterior/lateral coronary artery bypass grafting.
Certain heart manipulations carried out to access anastomotic sites during beating heart coronary artery bypass (OPCAB) compromise hemodynamics, and these risks can affect end-organ perfusion and limit patient selection. Evidence suggests that right heart support (RHS) augments left ventricular preload and provides hemodynamic stability. This study evaluated hemodynamic measures in OPCAB with RHS with respect to individual target vessels and general target distribution groups. ⋯ Augmenting left ventricular preload with RHS improves hemodynamic measures during OPCAB for all target vessel positions and provides critical support in a large number of anastomoses.
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The heart surgery forum · Jan 2002
Randomized Controlled Trial Multicenter Study Clinical TrialA new thermoregulation system for maintaining perioperative normothermia and attenuating myocardial injury in off-pump coronary artery bypass surgery.
Most patients undergoing coronary artery bypass surgery demonstrate perioperative mild-to-moderate hypothermia (<36 degrees C). Patients undergoing off-pump coronary artery bypass (OPCAB) grafting may become even more severely hypothermic for want of cardiopulmonary bypass rewarming. One consequence is increased circulating catecholamine levels that induce an elevated systemic vascular resistance (SVR), which causes a subsequent deterioration in cardiac output. ⋯ Maintenance of perioperative normothermia (36.5 degrees C-37.5 degrees C) during OPCAB procedures can be efficiently achieved with the Allon thermoregulation system. The system was found to be superior to other routinely used methods of temperature maintenance. Benefits may include lowering afterload (as expressed by reduced SVR), an improved CI, and attenuation of myocardial injury (as assessed by cTnI levels).
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The heart surgery forum · Jan 2002
Case ReportsRepair of acute ascending aorta-arch dissection with continuous body perfusion: a case report.
An approach for the replacement of the distal ascending aorta-proximal arch and acute dissection is described. During the operation, the patient's entire body was continuously perfused, the aortic arch was excluded from the arterial circulation, and the aorta was not clamped at any time. To achieve continuous body perfusion, we independently cannulated the right axillary and the left femoral arteries. ⋯ Aggressive medical management resulted in complete patient recovery. No neurologic deficits were observed, and the patient regained full cognitive function. This report describes a simple approach to facilitate repair of the aortic arch and minimize postoperative organ failure.
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The heart surgery forum · Jan 2002
Total arterial off-pump coronary revascularization with only internal thoracic artery and composite radial artery grafts.
Total arterial off-pump coronary artery bypass (OPCAB) grafting with only internal thoracic artery (ITA) and composite radial artery (RA) grafts has been applied extensively to avoid cerebral complications and late vein graft failure. We evaluated the initial experience with this method by clinical and angiographic study. ⋯ OPCAB grafting with ITAs and composite RAs provides excellent early and intermediate clinical results and graft patency.