The heart surgery forum
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The heart surgery forum · Jan 2007
Controlled Clinical TrialGenetic polymorphisms contribute to acute kidney injury after coronary artery bypass grafting.
Acute kidney injury is one of the most serious complications after cardiac surgery. Genetic polymorphisms are reported to be associated with postoperative renal impairment. The aim of this study was to investigate the relationship between selected gene polymorphisms and acute kidney injury after cardiac surgery. ⋯ The present findings support the hypothesis that ACE I/D and APO E gene polymorphisms may play a role in the development of acute kidney injury after cardiac surgery. However, AGTR1 does not have a unique association with postoperative renal impairment.
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The heart surgery forum · Jan 2007
Randomized Controlled Trial Comparative StudyEffects of pretreatment with different topical vasodilators on blood flow in the internal mammary artery: a prospective randomized study.
This study was conducted to investigate how brief pretreatments with 4 different vasodilators applied topically at normal body temperature affect blood flow in the internal mammary artery. ⋯ Brief treatment of the internal mammary artery with topical vasodilators at normal body temperature significantly increases blood flow in this vessel. The data from this study are particularly valuable in relation to off-pump surgery, in which this vessel is usually anastomosed soon after it is harvested.
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The heart surgery forum · Jan 2007
Robotic totally endoscopic double-vessel bypass grafting: a further step toward closed-chest surgical treatment of multivessel coronary artery disease.
After the introduction of robotic technology into the heart surgery armamentarium the performance of totally endoscopic coronary artery bypass grafting (TECAB) has become a reality. During the first years of development, the majority of TECAB cases were restricted to single-vessel disease, and the development of multivessel procedures is desirable. We report on a preliminary series of totally endoscopic double-vessel coronary artery bypass grafting. ⋯ Totally endoscopic double-vessel coronary artery bypass grafting on the arrested heart is a reproducible procedure. This intervention offers maximal preservation of patient integrity, but the long operative times need to be investigated.
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The heart surgery forum · Jan 2007
Excellent results of contemporary coronary artery bypass grafting with systematic application of modern perioperative strategies.
The patient population referred for coronary artery bypass grafting (CABG) has become more challenging. The surgical population is aging and patients present with significant preoperative comorbidities. This worsening risk profile has led to the development of operative techniques (off-pump CABG) and perioperative measures (epi-aortic scanning, intensive insulin therapy) to preserve the quality of care following CABG. The aim of this study was to determine the outcome of contemporary CABG following the implementation of the above measures in our practice. ⋯ Despite a worsening case mix, contemporary CABG can be performed with excellent results (operative mortality < 1%). Off-pump CABG performed in very high-risk patients obtains results similar to those of the general CABG population. Diabetes and ejection fraction were not independent predictors of early outcome. In our experience, these excellent outcomes were achieved by adopting an operative approach using modern perioperative management (epi-aortic scanning, intensive insulin therapy) and surgical techniques (off-pump CABG) based on individual patients.
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The heart surgery forum · Jan 2007
ReviewTotally endoscopic coronary artery bypass grafting on the arrested heart.
In the late 1990s, totally endoscopic coronary artery bypass grafting was successfully introduced into the heart surgery armamentarium using robotic techniques. Surgeons have applied the da Vinci telemanipulation system in order to develop completely endoscopic placement of internal mammary artery bypass grafts, mainly to the left anterior descending artery system. ⋯ Another option is performing procedures on the beating heart using an endostablilizer and local coronary artery occlusion. In this review, the technique and specific aspects of the arrested heart version of totally endoscopic coronary artery bypass grafting are outlined.