The heart surgery forum
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The heart surgery forum · Jan 2003
Comparative StudyEarly and midterm results after coronary artery bypass grafting with and without cardiopulmonary bypass: which patient population benefits the most?
We present our early and midterm results with off-pump coronary artery bypass grafting (OPCAB) on the beating heart and with conventional coronary artery bypass grafting (CABG) and compare patient outcomes for both procedures. ⋯ OPCAB surgery improved postoperative recovery for the entire patient population without compromising midterm outcome. Compared with conventional CABG, high-risk patients with multimorbidity particularly profit from avoiding cardiopulmonary bypass and show significantly lower hospital mortality.
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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.
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The heart surgery forum · Jan 2003
Comparative StudyMultivessel off-pump coronary artery bypass: analysis of 4953 cases.
To avoid the harmful effects of cardiopulmonary bypass (CPB), cardiac surgeons are using off-pump coronary artery bypass (OPCAB) as an effective alternative to conventional coronary artery bypass grafting (CABG). In the present study, we analyze our results with OPCAB in patients with multivessel coronary artery disease and compare them with those achieved in patients who underwent operations on CPB. ⋯ OPCAB is a safe and effective procedure for patients with multivessel coronary artery disease and is associated with reduced morbidity and mortality. However, large randomized studies with long-term follow-up may show the real benefits of OPCAB compared with CABG on CPB.
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The heart surgery forum · Jan 2003
Less invasive cardiac anesthesia: an ultra-fast-track procedure avoiding thoracic epidural analgesia.
A new "less invasive" technique avoiding thoracic epidural analgesia has be en tested for suitability as a routine procedure for cardiac anesthesia. Early postoperative extubation is an important step in this fasttrack procedure. ⋯ Early extubation proved suitable as a routine procedure for the vast majority of patients. With a good postoperative analgetic protocol, there is no need for thoracic epidural analgesia. Such avoidance of thoracic epidural analgesia is a further step in minimizing invasiveness in cardiac surgery.