Journal of cardiac surgery
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A variety of surgical techniques are used to manage a disintegrated aortic annulus in patients with endocarditis and excavating aortic root sepsis. Homograft root replacement is preferable in this setting but suitable homografts are restricted in availability and excision of the aortic root carries the risk of postoperative bleeding. As an alternative we used a stentless porcine xenograft root (Medtronic Freestyle valve) to manage this problem. ⋯ The stentless porcine aortic root implanted within the human aorta provides an additional surgical option for excavating aortic root sepsis.
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Comparative Study
Preferred method for insertion of the Toronto Stentless Porcine Valve.
The Toronto Stentless Porcine Valve has been extensively used for aortic valve replacement. A standardized, detailed description of a preferred operative technique has been absent from the literature. A method is described that stresses (a) proper position and orientation of the aortotomy, (b) debridement of the diseased native valve, (C) proper sizing of the aortic root and choice of prosthesis and (d) implantation of the valve. Using this technique, the prosthesis can be reproducibly implanted with relative ease, without valvular insufficiency or coronary obstruction.
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Reduction of surgical trauma is the aim of minimally invasive cardiac surgery. This can be achieved by reducing the size of the incision or by eliminating or changing the cardiopulmonary bypass system. However, certain cardiac surgical procedures, such as valvular surgery and complex multivessel coronary artery surgery, are not feasible without the use of cardiopulmonary bypass. Therefore endovascular cardiopulmonary bypass may allow reduction of surgical trauma for these patients. ⋯ The EndoCPB endovascular cardiopulmonary bypass system allows the application of true Port-Access minimally invasive cardiac surgery in procedures that require the use of cardiopulmonary bypass and cardioplegic arrest. Sternotomy and its potential complications can be avoided, and the surgical procedures can be performed safely on an empty, arrested heart with adequate myocardial protection.
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Left anterior descending artery grafting using the left internal mammary artery via a left anterior small thoracotomy (LAST) gained new popularity in 1994. We review our experience in 250 of 512 patients who underwent a LAST in single vessel left anterior descending artery disease from November 1994 to October 1997. ⋯ New instrumentation has made the operation easier and has contributed to its spread, along with increased experience and the end of the learning curve. At the moment we consider the LAST a more anatomical and physiological surgical approach to single vessel coronary disease.
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Comparative Study
Minimally invasive direct coronary artery bypass: technical considerations and instrumentation.
Minimally invasive coronary artery bypass is defined as any maneuver or modification of conventional coronary bypass that decreases adverse effects. These adverse effects fall into three broad categories, which are access trauma, consequences of cardiopulmonary bypass, and aortic manipulation. In the minimally invasive direct coronary artery bypass (MIDCAB) approach, coronary revascularization is performed via a limited access incision, usually a left anterior thoracotomy, through which a left internal mammary artery is anastomosed under direct vision to the left anterior descending artery on a stabilized beating heart. ⋯ Graft patency data from early series of stabilized MIDCAB procedures and published series of left internal mammary artery graft patency with conventional bypass grafting appear to be comparable. Current indications for MIDCAB include restenosis of the left anterior descending artery after catheter-based therapy and the necessity for target vessel revascularization in elderly high-risk patients with multivessel disease. Limitations of the MIDCAB procedure include mostly single vessel revascularization of the anterior aspect of the heart.