European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Nov 1999
Comparative StudyMinimally invasive aortic valve replacement (AVR) compared to standard AVR.
Minimally invasive cardiac surgery has been developed to offer patients the benefits of open heart operations with decreased pain and limited skin incision. A limited superior median sternotomy has been shown to provide a good exposure for aortic valve replacement (AVR) and good results. In this study we report the results of minimally invasive AVR compared to standard sternotomy AVR performed in the same period. ⋯ The limited superior median sternotomy provides good exposure to the left ventricular outflow tract, aortic valve, ascending aorta, and even to the mitral valve through the roof of the left atrium. Therefore it seems to be suitable for all kinds of aortic valve operations. Besides less pain, shorter skin incision, shorter respiratory support time and lower blood loss, it has more advantages as opening and closure of the sternum is faster; decreasing infection and disruption of the sternum, and finally decreasing the time required for hospitalization and recovery.
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Eur J Cardiothorac Surg · Nov 1999
Review Comparative StudyInterventional cardiology versus minimally invasive cardiac surgery.
Comparing interventional cardiology with minimally invasive cardiac surgery 1998 goes back to the early 80s when cardiologists treated coronary artery disease patients with balloon angioplasty under a permanent observation of cardiac surgeons who could offer to the patient the well established Conventional CABG, which already had proven to be safe, effective, durable, reproducible, and complete. At that time some critics predicted PTCA would remain the hobby of some cardiologists. During the last two decades, however, an explosive proliferation in the number of PTCA procedures has occurred, which soon exceed the number of CABG procedures. ⋯ Within the last 5 years the minimally invasive cardiac surgery has progressed, which allows the performance of even complex cardiac surgery through small incisions with (port-access technique) or without (MIDCAB technique) cardiopulmonary bypass. The rationale of enthusiastic users of these new techniques leads to improved cosmetic results, less surgical trauma, decreased length of hospital stay, reduced cost, and comparable long-term results with respect to conventional CABG. Similar to the prediction about PTCA two decades ago, some critics say that minimally invasive cardiac surgery would remain the hobby of some cardiac surgeons.
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Eur J Cardiothorac Surg · Nov 1999
Randomized Controlled Trial Comparative Study Clinical TrialThe effects of cardiopulmonary bypass temperature on inflammatory response following cardiopulmonary bypass.
The inflammatory response to cardiopulmonary bypass is believed to play an important role in end organ dysfunction after open heart surgery and may be more profound after normothermic systemic perfusion. The aim of the present study was to investigate the effects of cardiopulmonary bypass temperature on the production of markers of inflammatory activity after coronary artery surgery. ⋯ Normothermic systemic perfusion was not shown to produce a more profound inflammatory response compared to hypothermic and moderately hypothermic cardiopulmonary bypass.
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Eur J Cardiothorac Surg · Nov 1999
Randomized Controlled Trial Comparative Study Clinical TrialInfluence of median sternotomy on the psychosomatic outcome in coronary artery single-vessel bypass grafting.
New less invasive surgical techniques for the treatment of coronary artery single-vessel disease have been developed by either avoiding median sternotomy or cardiopulmonary bypass or both, however, until now no prospective randomized trial has been carried out to compare these techniques to the conventional approach with special respect to the psychosomatical effects. ⋯ Even if surgery is successful in all procedures, operative time is longer in lateral minithoracotomy procedures without compromising intensive care unit stay and hospital stay. More pain with multiple post-traumatic stress disorders is related to median sternotomy, and post-operative convalescence is superior for lateral minithoracotomy procedures.
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Eur J Cardiothorac Surg · Nov 1999
Comparative Study Clinical TrialA contrastive analysis of release patterns of biochemical markers of brain damage after coronary artery bypass grafting and valve replacement and their association with the neurobehavioral outcome after cardiac surgery.
The present study aimed at a comparative analysis of neurobiochemical markers of brain damage and the neurobehavioral outcome in patients undergoing either valve replacement (VR) or isolated coronary artery bypass surgery (CABG). In order to control for well known risk factors both samples were strictly matched according to age, sex and preoperative neuropsychological performance. ⋯ Our data indicate that--apart from patients' age and preoperative neuropsychological performance--type of surgery remains a risk factor for postoperative neurobehavioral disorders. The different vulnerability of neurobehavioral disorders might be mirrored in different postoperative release patterns of NSE. We assume that both, NSE release and neurobehavioral disorders might be caused by a higher amount of intraoperative cerebral embolic events in VR patients.