The heart surgery forum
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The heart surgery forum · Jun 2009
Case ReportsComminuted sternal fracture -- a sternotomy wire fixation: report of 2 cases.
Various techniques of sternal stabilization via either metal plates or wires have been described. We describe an alternative technique of simple median sternotomy followed by reduction and wire fixation of the sternal fracture. The 2 patients described in this report had traumatic comminuted and displaced sternal fractures. Even though wire repair was deemed to be tedious and achieved poor approximation of the bone, we performed median sternotomy and achieved simple wire fixation with an excellent result.
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The heart surgery forum · Jun 2009
Case ReportsA rare combination of left main coronary artery fistula to main pulmonary artery with severe left main coronary artery disease in a 69-year-old man.
A 69-year-old man was referred to our hospital with a diagnosis of non-ST elevation myocardial infarction. A selective left coronary angiography revealed a fistula connecting the left main coronary artery with the pulmonary artery in addition to severe left main coronary artery disease. The patient subsequently underwent ligation of fistulae and coronary bypass grafting. The combination of a fistula and severe artery disease seen in this patient is unusual because fistulas originating from the left main coronary artery drain into the pulmonary artery in patients with severe left main coronary artery disease.
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The heart surgery forum · Jun 2009
Planning a cardiovascular hybrid operating room: the technical point of view.
The integration of interventional techniques into cardiovascular surgery requires angiographic imaging capabilities in the operating room. A deep understanding of the technology and its implication for the surgical workflow is scarce. ⋯ With the growing trend toward endovascular procedures during surgery, the hybrid operating room will become an integral part of every cardiovascular center. This new operating room concept enables new cardiac surgery therapies and will play a vital role for minimally invasive surgery. Careful planning and professional expertise is a key factor for every hybrid room project.
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The heart surgery forum · Jun 2009
Clinical TrialRepeat surgery for coronary artery bypass grafting: the role of the left thoracotomy approach.
Repeat coronary artery bypass surgery has increased risks compared with the first operation, including low cardiac output and injury to patent grafts. The left thoracotomy approach has been advocated specifically in patients with intact grafts of the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) needing lateral wall grafting. We have evaluated this technique in conjunction with an off-pump procedure in all patients. ⋯ The procedure is safe, especially in patients with intact LIMA-to-LAD grafts needing lateral and inferior wall revascularization. Multislice computed tomography scanning allows better preoperative planning, especially regarding the site of implantation of the proximal graft, allowing a less invasive incision. The off-pump technique preserves cardiac and pulmonary function. The in-hospital death rate (1.8%) compares very well with the EuroSCORE-predicted mortality (14.2%).
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The heart surgery forum · Jun 2009
Case ReportsPoor left ventricular function is not a contraindication for robotic totally endoscopic coronary artery bypass grafting.
Robotic technology has enabled performance of totally endoscopic coronary artery bypass grafting (TECABG). Published series on TECABG were primarily performed in low-risk patients, and little is known about the outcome after totally endoscopic coronary surgery in patients with severely impaired left ventricular function. We report successful endoscopic placement of a left internal mammary artery bypass graft to the left anterior descending artery using the daVinci robotic system in a patient with a severely reduced left ventricular ejection fraction.