Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Aug 2009
How to replace an extracorporeal life support without interruption of the cardiopulmonary assistance.
The extracorporeal life support (ECLS) allows a maximum of a few weeks of cardio-respiratory assistance. Using standard ECLS, the circuit must be replaced after a few days or sometimes more frequently, in case of dysfunction. Classically, the replacement needs the interruption of the support inducing a temporarily hemodynamic instability. ⋯ We describe the original modification, the complete procedure and our results. This method has been used in 34 ECLS replacements in 14 patients without any incident or thrombo-embolic events. This simple technique is safe, reliable, and avoids the hemodynamic instability induced by classical replacements.
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Interact Cardiovasc Thorac Surg · Aug 2009
Prognosis of patients undergoing cardiac surgery and treated with intra-aortic balloon pump counterpulsation prior to surgery: a long-term follow-up study.
The aim of this study was to evaluate short- and long-term outcome in patients undergoing coronary artery bypass grafting (CABG), who received an intra-aortic balloon pump (IABP) prior to surgery. Between January 1990 and June 2004, all patients (n=154) who received an IABP prior to on-pump CABG in our center were included. Patients received the IABP for vital indications (i.e. either unstable angina refractory to medical therapy or cardiogenic shock; group 1: n=99) or for prophylactic reasons (group 2: n=55). ⋯ A decrease in 30-day mortality occurred in group 2 (median predicted mortality was 7.2% and observed was 0%). Cumulative 1-, 5-, and 6-year survival was 82.8+/-3.8%, 70.1+/-4.9%, and 67.3+/-5.1% for group 1 vs. 98.2+/-1.8%, 84.0+/-5.6% and 84.0+/-5.6% for group 2 (Log-rank: P=0.02). Logistic EuroSCORE (HR 1.03 [1.01-1.05], P=0.007) was an independent predictor of long-term all-cause mortality.
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Interact Cardiovasc Thorac Surg · Aug 2009
Multicenter Study Clinical TrialThe role of thoracoscopy for the diagnosis of hidden diaphragmatic injuries in penetrating thoracoabdominal trauma.
Patients with a thoracoabdominal stab wound may have hidden diaphragmatic injuries that could finally lead to chronic diaphragmatic hernia. In this study, we analyzed 30 patients with penetrating thoracoabdominal injuries that were stable hemodynamically and did not need emergency exploration. They underwent thoracoscopy in order to find a probable diaphragmatic injury from March 2005 to October 2007. ⋯ We performed thoracoabdominal CT-scan 6 months later and chronic diagrammatic hernias were not reported. Diagnostic accuracy of thoracoscopy was 100%. Owing to the high diagnostic accuracy rate, minimal invasiveness and therapeutic potency of thoracoscopy we recommend it to be performed in all clinically stable patients with penetrating thoracoabdominal penetrating injury especially in the 8th intercostal space.
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Interact Cardiovasc Thorac Surg · Aug 2009
Does obesity affect operative times and perioperative outcome of patients undergoing totally endoscopic coronary artery bypass surgery?
More and more patients undergoing coronary artery bypass grafting (CABG) are overweight. This patient group suffers from wound healing problems more often than normal-weight patients. Therefore, avoiding sternotomy in obese patients by using an endoscopic technique could be a promising approach. ⋯ There was no correlation between BMI (1) left internal mammary artery (LIMA) takedown-time [Spearman-rank correlation coefficient (R)=0.02; P=n.s.], (2) lipectomy and pericardiotomy-time (R=0.042, P=n.s.), (3) total operative-time (R=-0.083: P=n.s.), (4) cardiopulmonary-bypass-time (R=-0.012; P=n.s.), (5) aortic-endoocclusion-time (R=-0.055; P=n.s.), (6) mechanical-ventilation-time (R=0.001, P=n.s.), (7) length of ICU-stay (R=0.04; P=n.s.), (8) length of hospital-stay (R=-0.103; P=n.s.) or (9) occurrence of intra- and/or postoperative adverse events. In overweight, obese but also morbidly obese patients the TECAB procedure did not increase operative times or the rate of intra- or postoperative complications. This patient group, therefore, benefits from this less traumatic version of coronary surgery.
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Interact Cardiovasc Thorac Surg · Aug 2009
Comparative StudyPreliminary experience for the evaluation of the intraoperative graft patency with real color charge-coupled device camera system: an advanced device for simultaneous capturing of color and near-infrared images during coronary artery bypass graft.
We developed a new color charge-coupled device (CCD) camera for the intraoperative indocyanine green (ICG) angiography. This device consists of a combination of custom-made optical filters and an ultra-high sensitive CCD image sensor, which can detect simultaneously color and near-infrared (NIR) rays from 380 to 1200 nm. We showed a comparison between our system and other devices for the preliminary experience. ⋯ When the CCD camera suspected a graft failure, CCD camera and angiography showed a comparable graft failure. The unique device that visualized ICG-enhanced structures against a background of natural myocardial color improved the visibility of abnormality in flow and perfusion. Our findings show that this device may become a standard intraoperative graft and perfusion assessment tool in coronary artery bypass graft (CABG).