The heart surgery forum
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The heart surgery forum · Jan 2000
Multicenter Study Comparative Study Clinical TrialThe subclavian and axillary arteries as inflow vessels for coronary artery bypass grafts--combined experience from three cardiac surgery centers.
The subclavian and axillary arteries represent reliable inflow vessels in peripheral vascular surgery. During recent years they have also been used for special situations in coronary artery bypass grafting. We report on a preliminary, triple center experience with subclavian/axillary artery to coronary artery bypass grafting. ⋯ Subclavian/axillary artery to coronary artery bypass is feasible and can be applied for complications in minimally invasive coronary artery bypass grafting, for redo operations and for management of the severely atherosclerotic ascending aorta. To reach the left anterior descending artery-system, the saphenous vein as well as the radial artery can be used. Complications concerning the infraclavicular incision seem to be no problem. Short-term patency rates are acceptable.
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There is controversy regarding the role of reparative techniques for rheumatic-mitral valve disease. We have analyzed the late results of mitral valve repair in a group of patients with rheumatic mitral valve insufficiency. ⋯ Late results obtained with mitral valve repair for rheumatic mitral valve insufficiency were satisfactory and exceeded those reported for mitral valve replacement in the same population.
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The heart surgery forum · Jan 2000
Off-pump coronary artery bypass grafting with use of the octopus 2 stabilization system.
The treatment of coronary artery disease has evolved rapidly over the last two decades. The gold standard of surgical revascularization, the on-pump coronary artery bypass graft, has been challenged by the development of percutaneous transluminal coronary angioplasty. Our experience with the alternative of the off-pump ("beating heart") coronary artery bypass (OPCAB) technique during a period of 18 months suggests that OPCAB avoids the complications of cardiopulmonary bypass and offers patients the benefit of long-term graft patency that greatly exceeds that of current endovascular technologies. ⋯ Our early results suggest that off-pump CABG with Octopus 2 (Medtronic, Inc., Minneapolis, MN) can be a good alternative in high risk patients who need multiple vessel revascularization.
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The heart surgery forum · Jan 2000
Comparative Study Clinical TrialPitfalls and results of immediate angiography after off-pump coronary artery bypass grafting.
We sought to determine the feasibility of off-pump coronary artery bypass grafting (OPCAB) in a consecutive series and prospectively assess the value of immediate post-operative coronary angiography. ⋯ There were a significant number of unexpected arterial graft occlusions. The reversal of heparin and ITA spasm appeared to be contributory. All patients with occluded grafts had no signs of trouble. Interpretation of immediate post-operative catherization is difficult because of significant native vessel and graft spasm. It reliably determines patency but it's value is suspect for determination of long-term graft adequacy.
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The heart surgery forum · Jan 1999
ReviewEndarterectomy for preventing stroke in symptomatic and asymptomatic carotid stenosis. Review of clinical trials and recommendations for surgical therapy.
Multicenter, randomized trials have demonstrated advantages for surgery over medical therapy in both symptomatic and asymptomatic carotid stenosis of greater than 70%. Controversial interpretations of these trials are debated between medical and surgical camps. The goal of this review is to summarize the current state of knowledge in carotid stenosis and the role of surgery and several advances in operative management. ⋯ Randomized trials support the safety and efficacy of carotid endarterectomy for stenosis greater than 70% (with or without symptoms). Advantages of surgery over medical therapy were found in less than three years and there is ample evidence to suggest that the differences between these groups would have been even more pronounced had longer follow-up been obtained. Thus for patients who face many years of risk after diagnosis of a carotid lesion, early surgery is the most important and effective intervention for preventing stroke. The results of these trials raised initial concern over increasing health care expenditures from rising surgical case volumes. However, studies of cost effectiveness confirmed that surgery saves health care dollars when compared to the long term care of stroke victims.