The Annals of thoracic surgery
-
In off-pump coronary bypass grafting (CABG), invasiveness is reduced but technically perfect anastomosis is jeopardized by cardiac motion and the need to hurry to reduce the time of ischemia. Also, a major cause of postoperative morbidity and mortality is ungrafted circumflex coronary artery disease. We have devised a means of overcoming these shortcomings and performing multivessel CABG. The objective of this study was to assess the safety and efficacy of our technique. ⋯ These results suggest that off-pump CABG with our techniques is effective and safe. Early clinical outcome and excellent patency rates suggest its more widespread use in selected cases.
-
Acute lung injury (ALI) is associated with pulmonary hypertension, intrapulmonary shunting, and increased microvascular permeability, leading to altered oxygenation capacity. Oleic acid (OA) creates a significant ALI that physiologically mimics human adult respiratory distress syndrome (ARDS). It has been hypothesized that pulmonary vasodilatation may improve ALI. Studies in our laboratory using this model and nitric oxide (NO) have shown that NO inhalation is detrimental and worsens the effects of OA. We studied the effect of pretreatment with a potent vasodilator, sodium nitroprusside (SNP), on ALI induced by OA in an isolated lung model. We hypothesized that pretreatment with SNP will worsen pulmonary hypertension and oxygenation in OA-induced ALI, similar to the effects seen with inhaled NO in this model. ⋯ Contrary to our hypothesis, pretreatment with SNP eliminates the decrease in oxygenation and increase in lung weight, and ameliorates pulmonary hypertension in our isolated lung model of OA-induced ALI.
-
Contemporary residency training in the cardiac component of cardiothoracic operation is focused mainly on attaining technical proficiency in coronary artery revascularization. Most trainees in cardiothoracic operation are required to perform 35 cases of coronary revascularization in order to fulfill the minimum requirements for certification by the American Board of Thoracic Surgery. Although experience in minimally invasive coronary revascularization is not required for board certification in cardiothoracic operation, it is recognized by both trainees and program directors as an important component of contemporary training in less-invasive surgical approaches (LISA) for coronary artery disease. The objective of this study was to describe the training of residents in off-pump coronary revascularization in an accredited training program. ⋯ Technical innovations and evolution of techniques to better stabilize the heart for off-pump coronary revascularization have made the procedure both effective and safe. Our experience has shown that cardiothoracic residents can be taught the skills necessary to perform coronary revascularization off cardiopulmonary bypass. There are currently no standards for the training of cardiothoracic residents in off-pump coronary artery operation. We propose that at least 50 cases be performed under supervision by a trained surgeon to obtain adequate credentials in minimally invasive coronary revascularization.
-
Health care reform, public disclosure of hospital and surgeon-specific results, plus changes in reimbursement patterns have raised the specter of volume-based credentialing. ⋯ Excellent results can be obtained for patients undergoing coronary artery bypass grafting in the presence of both low surgeon and low hospital case volume.