The heart surgery forum
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The heart surgery forum · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialHemodilution during off-pump coronary artery bypass grafting: can we improve flow and reduce hypercoagulability?
The aim of this study was to compare intraoperative coronary graft flows performed on pump and off pump and to evaluate the effects of hemodilution on coronary graft flows in off-pump coronary artery bypass grafting (CABG) patients by using transit time flow measurements (TTFM). ⋯ Off-pump CABG patients with hemodilution had significantly higher graft flows than off-pump CABG patients without hemodilution. Although we failed to show the existence of a hypercoagulable state for patients in the offpump group, an examination of the TTFM findings suggests that hemodilution may help to improve graft patency in offpump CABG patients during the early postoperative period.
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The heart surgery forum · Jan 2003
Myocardial contractile performance, preload recruitable stroke work relationships, and histomorphometric changes following off-pump and on-pump coronary bypass grafting of the left internal thoracic artery to the left anterior descending artery.
It has been shown that coronary artery bypass grafting without cardiopulmonary bypass (off-pump or OPCABG) preserves better cerebrocognitive, pulmonary, hepatorenal, and blood cell functions compared with onpump surgery because of an attenuated inflammatory response. The degrees of ischemia/reperfusion injury, myocardial protection, and quantitative changes in myocardial contractile performance following OPCABG have not been well documented. ⋯ Compared with most commonly applied myocardial preservation techniques (cardiopulmonary bypass, hypothermic blood cardioplegic arrest), OPCABG provides at least equal myocardial protection, because there were no significant quantitative differences between off-pump and onpump CABG in myocardial contractile performance following LITA-to-LAD revascularization. The more prominent intimal thickening observed in OPCABG procedures is worrisome and deserves further investigation.
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The heart surgery forum · Jan 2003
Comparative StudyMidterm results of beating heart surgery in 1-vessel disease: minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with full sternotomy.
Off-pump cardiac surgery is becoming an established method of surgical revascularization. However, performing anastomoses on a beating heart can be challenging, especially through small incisions. We compared our midterm results in patients with 1 vessel disease using full sternotomy (OPCAB) or a left anterior minithoracotomy (MIDCAB). ⋯ Our initial experience in beating heart surgery demonstrated that MIDCAB is technically more challenging than OPCAB. MIDCAB procedures should therefore be performed by experienced surgeons on selected patients. Midterm results after OPCAB procedures tend to a lower rate of adverse cardiac events.
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The heart surgery forum · Jan 2003
Case ReportsEndoscopic computer-enhanced mediastinal mass resection using robotic technology.
Robotic technology can be used to facilitate the performance of a variety of cardiac surgical procedures, including internal mammary artery mobilization, atrial septal defect repair, mitral valve repair, and coronary artery bypass grafting. This report describes t h e use of robotic technology for resection of mediastinal masses. ⋯ Resection of a mediastinal mass ca n be performed safely and effectively using robotic technology. By minimizing surgical trauma, this approach is likely to yield a hastened postoperative recovery and improved quality of life.
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The heart surgery forum · Jan 2003
Off-pump coronary artery bypass surgery may produce a hypercoagulable patient.
The incidence of thromboembolic events following traditional open heart surgery has not been clinically significant. However, with beating heart surgery, for which cardiopulmonary bypass (CPB) is not required, the incidence of spontaneous intravascular thrombosis may be similar to that encountered after general surgeries. Compounding this risk is that many cases of off-pump coronary artery bypass (OPCAB) surgery are reserved for the elderly patient with multiple comorbidities. The few studies to date that have assessed the coagulation profile in OPCAB patients have been limited to the first 24 hours after surgery. ⋯ A state of hypercoagulability, as measured by thromboelastography, exists in the OPCAB patient beyond the first postoperative day, and this finding suggests that prophylactic postoperative anticoagulation therapy targeting fibrinogen and platelet activity may be indicated for these patients.