The Annals of thoracic surgery
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With increasing use of beating heart techniques for bypass of the left anterior descending coronary artery with the left internal mammary artery (LIMA), appropriate concerns have been raised of whether graft patency by these techniques compares favorably with conventional, arrested heart techniques. ⋯ Meaningful comparison of LIMA graft patency between arrested heart, conventional coronary artery bypass grafting, and minimally invasive direct coronary artery bypass grafting is difficult; however, early graft patency by both techniques can confidently be stated as being 90% or greater.
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Randomized Controlled Trial Clinical Trial
Fibrinolysis-adjusted perioperative low-dose aprotinin reduces blood loss in bypass operations.
Postoperative bleeding still remains a serious problem in bypass surgery. This study evaluated fibrinolysis and perioperative low-dose antifibrinolytic regimens adjusted to the time course of fibrinolysis. ⋯ This low-dose aprotinin regimen adjusted to perioperative fibrinolysis reduces blood loss significantly in coronary bypass grafting. For further progress in this subject, clinical investigations of individual fibrinolysis-adjusted antifibrinolytic treatment seems warranted.
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Case Reports
Extracardiac Fontan operation with tube fenestration allowing transcatheter coil occlusion.
A fenestration may improve the immediate postoperative course after a Fontan procedure by preserving the cardiac output. We describe a simple and safe technique of fenestration amenable to coil occlusion, which can be carried out in most cardiac catheterization laboratories.
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Clinical Trial
A dual-vent left heart deairing technique markedly reduces carotid artery microemboli.
Cerebral embolization, mainly bubbles, follows aortic declamping in left heart valve operations. Embolization is not prevented by conventional left heart deairing methods. We have validated a "dual-vent" deairing technique, which uses high-flow left ventricular and aortic venting from the working heart into the cardiopulmonary bypass venous line before aortic declamping. ⋯ Cerebral embolization after aortic declamping in left heart valve operations was significantly reduced by this dual-vent deairing technique.
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To achieve complete myocardial revascularization in patients with diffuse coronary artery disease and patients at high risk if they undergo cardiopulmonary bypass such as severe systemic disease or diffuse arteriosclerosis of the aorta, we have adopted the technique of combining direct coronary artery bypass grafting without cardiopulmonary bypass with transmyocardial laser revascularization. ⋯ Transmyocardial laser revascularization is an excellent adjunct to minimally invasive coronary artery bypass grafting to achieve complete myocardial revascularization in patients with graftable vessels in the anterior wall and ungraftable vessels in the posterior and inferior wall. This achieves complete myocardial revascularization without compromising safety in patients who are at high risk if they undergo cardiopulmonary bypass. Minimal morbidity and mortality in the present series revealed that this procedure is safe, and postoperative follow-up of these patients showed significant functional improvement as well as an improvement in myocardial perfusion scan.