Innovations : technology and techniques in cardiothoracic and vascular surgery
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Innovations (Phila) · Jan 2005
Thoracic epidural anesthesia for coronary bypass surgery affects autonomic neural function and arrhythmias.
: In recent years, the invasiveness of coronary reconstruction has been markedly reduced. Awake off-pump coronary artery bypass (AOCAB), coronary bypass surgery with thoracic epidural anesthesia (TEA) without general anesthesia and cardiopulmonary bypass), has been reported in the literature. Because the details of this technique are still unclear, we evaluated its usefulness by examining the autonomic neural state and the incidence of arrhythmia. ⋯ : In AOCAB, because there is no vagal inhibition, vagal dominance can be maintained after surgery. This may be associated with the lower incidence of postoperative atrial fibrillation in group A compared with group B. Further studies are necessary to evaluate the details of AOCAB.
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Innovations (Phila) · Jan 2005
Evolution of Off-Pump Coronary Artery Bypass Grafting over 15 Years: A Single-Institution Experience of 14,030 Cases.
: Off-pump coronary artery bypass grafting for multivessel disease is an important alternative to conventional myocardial revascularization using cardiopulmonary bypass. The development of exposure and stabilization techniques has made this surgery simple, safe, and routine. Experience with the technique, its evolution, the learning curve, and the pitfalls is presented. ⋯ : As surgeons' experience matures, off-pump coronary artery bypass surgery permits total myocardial revascularization in virtually all patients with multivessel coronary artery disease. Despite a significant learning curve, evolution to routine off-pump coronary artery bypass with good patient outcomes can be achieved with careful patient selection during the "learning curve." The method is safe and reproducible, and patients benefit with shorter intensive care unit and hospital stays.
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Innovations (Phila) · Jan 2005
Routine off-pump coronary artery bypass: reasons for on-pump conversion.
: To assess the feasibility of routine off-pump coronary artery bypass (OPCAB) and investigate risk factors for on-pump conversion. ⋯ : Routine OPCAB is feasible with acceptable short-term results. Patients undergoing reoperation or in persistent cardiogenic shock are more likely to require conversion to on-pump coronary artery bypass grafting.