Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jul 2000
Review Historical ArticleMechanical cardiac assistance: historical perspectives.
Cardiac transplantation remains the therapeutic option of choice for treating patients with chronic, progressive, end-stage heart failure. However, over the past 40 years, a number of mechanical assist systems have been developed with the goal of treating and rehabilitating patients with severe circulatory compromise. Today, a wide array of devices is available to provide increasing levels of circulatory support. ⋯ Already, clinical trials are underway to test the effectiveness of left ventricular assist devices as long-term support. As smaller, more effective cardiac assist devices become available, they should benefit even more the number of patients who may need permanent circulatory support. The fact that myocardial function can improve enough with chronic ventricular unloading to allow removal of the device may further broaden the use of this technology.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2000
Comparative StudyStroke prevention as an indication for the Maze procedure in the treatment of atrial fibrillation.
The Maze procedure has proven to be extremely effective in curing medically refractory atrial fibrillation. This analysis of our surgical results with the Maze procedure indicates that the Maze procedure, with or without associated cardiac surgery, has the lowest perioperative stroke rate of any major cardiac surgical procedure. ⋯ Only 1 patient has had a stroke in the 12-year follow-up period following the Maze procedure. This is comparable to the risk of stroke in the general population and indicates that the Maze procedure essentially abolishes the risk of stroke associated with atrial fibrillation.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2000
ReviewObservations on the perioperative management of patients undergoing the Maze procedure.
In addition to the usual measures that constitute optimal perioperative care after cardiac surgery, the Maze procedure demands several other measures because of certain complications that are unique to this particular operation. These complications include preoperative conditions such as amiodarone therapy, thromboembolism, diastolic dysfunction of the left ventricle, and associated valvular heart disease, as well as intraoperative differences that include multiple atriotomies and excision of both atrial appendages. The most common postoperative complications are atrial arrhythmias, excessive fluid retention, and pulmonary complications. In this article, we outline our own approach to the perioperative care of patients undergoing the Maze procedure.
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Semin. Thorac. Cardiovasc. Surg. · Oct 1999
ReviewTreatment of postoperative atrial fibrillation: a nonsurgical perspective.
Atrial fibrillation is a common complication of cardiovascular surgery. The 2 most important risk factors for its development are advancing age and a preoperative history of atrial fibrillation. ⋯ These strategies are most effective in high-risk patients. When atrial fibrillation does occur, treatment includes control of the ventricular rate, systemic anticoagulation, and conversion back to sinus rhythm.
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Semin. Thorac. Cardiovasc. Surg. · Oct 1999
ReviewA perspective on postoperative atrial fibrillation.
Some patients develop atrial fibrillation after any type of surgery, some patients develop atrial fibrillation only after cardiac surgery, and still other patients never develop postoperative atrial fibrillation. Despite the inherent difficulty in identifying the causes of postoperative atrial fibrillation, several important observations have been made during the recent past that may play a role in treating or even preventing this common and serious postoperative problem. This communication provides a framework within which the problem of postoperative atrial fibrillation can be evaluated and treated.