European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 1997
Predictors of early and overall outcome in coronary artery bypass without cardiopulmonary bypass.
Cardiopulmonary bypass in coronary artery bypass graft operations may adversely affect the outcome especially in high-risk patients. The purpose of this study is to evaluate results of coronary artery bypass performed without cardiopulmonary bypass, in a relatively high-risk cohort, and to identify predictors of unfavorable outcome. ⋯ Coronary artery bypass grafting without cardiopulmonary bypass can be performed with relatively low operative mortality in certain high-risk subgroups of patients; however, an increased risk of graft occlusion is a potential disadvantage. This procedure should therefore be considered only for patients with suitable coronary anatomy, in whom cardiopulmonary bypass poses a high risk. Although the risk of stroke is relatively low, the procedure is still hazardous for patients aged 70 years and over.
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We wanted to evaluate the role of surgical and conservative therapy in the treatment of post-intubation tracheal rupture. ⋯ Early surgical repair is the preferred treatment for most patients with post-intubation tracheal ruptures. Conservative treatment may be a viable alternative for patients with small rents, in the absence of gross air leak, or for those judged unsuitable for surgery. The role of tracheostomy is limited by its potential for late sequelae.
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To assess the impact of the bidirectional cavopulmonary shunt, total cavopulmonary connection, and baffle fenestration on outcome of the Fontan operation in our unit. ⋯ The bidirectional cavopulmonary shunt is a suboptimal stimulus for pulmonary artery enlargement, but may reduce the risk of Fontan operation in selected children. Fenestrated lateral tunnel operations have reduced the duration of postoperative pleural effusions.
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Eur J Cardiothorac Surg · Jul 1997
Minimally invasive thoracoscopically assisted coronary artery bypass surgery.
Minimally invasive techniques have been widely used in other surgical fields including video-assisted thoracic surgery (VATS) in thoracic surgery. These concepts are now being applied to cardiac surgery. The opportunities to make cardiac surgery less invasive include elimination of the median sternotomy incision, elimination of cardiopulmonary bypass and no manipulation of the aorta. ⋯ The ability to perform an endoscopic anastomosis still remains the rate limiting step for totally endoscopic coronary artery bypass surgery. The present MIDCAB (minimally invasive direct coronary artery bypass grafting) procedure is a significant advance in cardiac surgery, but still has limitations that make performance of an exact anastomosis still somewhat difficult and applicable only to single-vessel disease. Present efforts are directed toward extending the MIDCAB procedure by various immobilization and circulatory support devices and combining the MIDCAB procedure with catheter techniques for treating more advanced disease.