The heart surgery forum
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The heart surgery forum · Jan 2002
Multiple off-pump coronary revascularization with "aorta no-touch " technique using composite and sequential methods.
Although off-pump coronary artery bypass grafting (OPCAB) has been widely applied in patients who are considered high risk for cardiopulmonary bypass (CPB), there is still a risk of stroke during the operation because of the ascending aortic partial clamp for proximal anastomosis. In the present study, we report the initial results of an "aorta no-touch " technique using an in-situ graft and composite and sequential grafting methods. ⋯ OPCAB performed with the aorta no-touch technique using an in-situ graft and composite and sequential grafting methods provides excellent early clinical results and graft patency.
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The heart surgery forum · Jan 2002
Cardiac surgery in patients with heparin-induced thrombocytopenia using preoperatively determined dosages of iloprost.
Patients with preoperatively diagnosed type II heparin-induced thrombocytopenia (HIT) scheduled for cardiopulmonary bypass (CPB) present a challenge in their intraoperative anticoagulation management because re-exposure to heparin may result in profound thrombocytopenia, intravascular thromboses, bleeding, and even death. Iloprost, a prostacyclin analogue that reversibly inhibits platelet aggregation, has been suggested as a management approach in such cases. The purpose of this study was to assess and confirm the efficacy of a perioperative intravenous iloprost infusion in preventing thromboembolic complications in patients with type II HIT undergoing cardiac surgery and requiring the use of heparin and CPB. ⋯ Although a number of alternative anticoagulation methods, such as the use of another anticoagulant (danaparoid sodium and recombinant hirudin) or the preoperative use of a defibrinogenating agent (ancorod), have been suggested for patients with type II HIT requiring anticoagulation during CPB, the use of heparin associated with a potent platelet inhibitor such as the prostacyclin analog iloprost is, as this study confirmed, the only to-date safe and effective choice.
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The heart surgery forum · Jan 2002
ReviewMulti-modality neurophysiologic monitoring for cardiac surgery.
A high percentage of patients who undergo cardiac surgery experience persistent cognitive decline. The costs to insurers from brain injury associated with cardiac surgery is enormous. Furthermore, the same processes that injure the brain also appear to cause dysfunction of other vital organs. Therefore, there are great clinical and economic incentives to improve brain protection during cardiac surgery. This article discusses the methods of monitoring neurophysiologic function during heart surgery, including electroencephalography (EEG), near-infrared spectroscopy (NIRS), transcranial doppler (TCD) ultrasound, and cerebral oximetry, and analyzes the effectiveness of multi-modality neuromonitoring. ⋯ This study provides the clearest evidence to date that multi-modality neuromonitoring for cardiac surgery is safe, clinically beneficial, and cost-effective. Although neuromonitoring involves negligible risk and modest costs, it's benefits for patient outcome and cost control are substantial.