The heart surgery forum
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The heart surgery forum · Jan 2001
Correction of congenital heart defects and mitral valve operations using limited anterolateral thoracotomy.
Median sternotomy, which generally is used as a standard access for atrial septal defect (ASD) and mitral valve operations, has a significant risk of postoperative instability/osteomyelitis of the sternum. Moreover, especially in young women, the resulting large scar is a poor cosmetic result that may have adverse psychological consequences. Our presentation suggests that these difficulties may be avoided by the use of a less invasive approach consisting of a limited anterolateral thoracotomy with standard cannulation. ⋯ Atrial septal defect operations, including partial anomalous pulmonary venous connection, left atrial myxoma and mitral valve operations, can be performed safely and effectively using a limited anterolateral thoracotomy and standard cannulation technique with excellent cosmetic results.
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The heart surgery forum · Jan 2001
Evaluation of a novel synthetic sealant for inhibition of cardiac adhesions and clinical experience in cardiac surgery procedures.
Pericardial adhesions subject patients requiring reoperation to potential injuries to the heart, great vessels, and cardiac grafts during the re-sternotomy. These adhesions can severely complicate re-operations by making re-entry hazardous, impeding orientation and visibility, increasing the amount of blood loss, and prolonging the operation time. The efficacy of an in situ-forming polyethylene glycol (PEG) material, CoSeal surgical sealant (CoSeal), for inhibiting cardiac adhesions in an animal model is reported. It is currently estimated that 10-20% of patients undergoing aortic valve replacement and coronary artery bypass grafting (CABG) will require a second operation later in their lives. Successful clinical experience using CoSeal for sealing suture lines of the aorta and CABGs with the data reported here suggest that CoSeal may have multiple applications in cardiac surgery. ⋯ In the rabbit cardiac adhesion model, CoSeal significantly reduced the formation of adhesions as compared to surgical control and Tissucol, and demonstrated good biocompatibility. In CoSeal treated patients undergoing cardiopulmonary bypass or vessel repair, sealing was achieved comparable to previous cases using Tissucol fibrin sealant. CoSeal effectively sealed the suture lines of the aorta and coronary artery bypass grafts.
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The heart surgery forum · Jan 2001
A review of 140 Octopus off-pump bypass patients over the age of seventy: procedure of choice?
Many studies have demonstrated that patients of advanced age are at increased risk for morbidity and mortality following coronary artery bypass graft (CABG) surgery. When compared to younger age groups, the risks of adverse neurological outcome or mortality have been demonstrated to be higher in septuagenarians and octogenarians. It has been suggested that off-pump coronary artery bypass (OPCAB) surgery, by avoiding the adverse effects of cardiopulmonary bypass (CPB), may improve the risks of morbidity and mortality, particularly in these higher risk elderly patients. Despite the increased rates of adverse events in patients of advanced age, various authors have described these risks to be in the acceptable range, justifying continued recommendations for operative revascularization in properly selected elderly patients. OPCAB theoretically may provide improvements in early outcomes for these patients by avoiding the unwanted sequelae of CPB. ⋯ OPCAB has been demonstrated to be safe and effective, with surgeons from many centers worldwide reporting low rates of morbidity and mortality. Early patency rates appear to be equal to or perhaps even better than CABG with CPB. This report adds to a growing body of literature supporting the use of OPCAB in elderly patients requiring surgical revascularization. If further investigations continue to demonstrate improved outcomes, OPCAB may become the procedure of choice for patients of advanced age.
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The heart surgery forum · Jan 2001
ReviewStress and inflammatory response after beating heart surgery versus conventional bypass surgery: the role of thoracic epidural anesthesia.
Cardiac surgery elicits a cascade of stress responses mediated by the release of various cytokines and stress hormones [Roth-Isigkeit 1998]. Apart from the stress induced by the surgical process, cardiopulmonary bypass (CPB) has been documented to play a major role in the perioperative stress response seen following cardiac surgery [Butler 1993, McBride 1995, Hall 1997]. The imbalance in pro- and anti-inflammatory responses may affect outcome in cardiac surgery patients [Casey 1993, McBride 1995, Menasch 1995]. ⋯ Beating heart surgery done without the aid of CPB significantly attenuates cytokine and stress response [Brasil 1998, Fransen 1998, Gu 1998, Wan 1999b, Ganapathy 1999a, Ganapathy 2000a]. There is reduced renal dysfunction following beating heart surgery [Ascione 1999], which may be related to reduced proinflammatory cytokine surge. Thoracic epidural analgesia inhibits intraoperative cortisol as well as catecholamine surge but does not add further to the reduction in cytokine response [Ganapathy 1999b].
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The heart surgery forum · Jan 2001
ReviewEffect of aprotinin (trasylol) on the inflammatory and thrombotic complications of conventional cardiopulmonary bypass surgery.
Before the discovery of its hemostatic properties, aprotinin was thought of as a potential anti-inflammatory agent. Its clinical introduction in 1987 to prevent blood loss during cardiac surgery [Royston 1987, van Oeveren 1987] led to its anti-inflammatory benefits being largely overlooked in favor of a vigorous debate centering on whether aprotinin may be pro-thrombotic when given to patients. In this article, we summarize evidence for the anti-inflammatory activity of aprotinin and discuss our recent contributions in this area. We also summarize the state of the thrombosis debate and discuss our recent evidence from purified platelets which shows that aprotinin is simultaneously hemostatic yet anti-thrombotic.