The heart surgery forum
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The heart surgery forum · Apr 2004
Multicenter StudyIs off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency?
Renal dysfunction is a well-recognized complication following coronary artery bypass grafting (CABG). Coronary revascularization without cardiopulmonary bypass (CPB) has been shown to minimize renal injury in patients with normal preoperative renal function who undergo elective procedures. The purpose of this study was to define the effect of an off-pump revascularization strategy on the incidence of postoperative renal failure and survival of patients with preexisting renal dysfunction. ⋯ The results of this study suggested that patients with preoperative non-dialysis-dependent renal insufficiency have more favorable outcome when revascularization is done off pump. Avoidance of CPB results in (1) a reduction in the incidence of postoperative renal failure; (2) a reduction in the need for new dialysis; and (3) improved in-hospital and midterm survival.
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The heart surgery forum · Jan 2004
Randomized Controlled Trial Clinical TrialSpinal (subarachnoid) morphine for off-pump coronary artery bypass surgery.
To study the effects of 8 microg/kg preoperatively administered intrathecal morphine sulfate on extubation time, postoperative pulmonary function, and postoperative analgesia after off-pump coronary artery bypass grafting (OPCAB). ⋯ Intrathecal morphine provided superior quality of analgesia that translated into better maintenance of postoperative lung volume determined by spirometry. This analgesic method also facilitated earlier tracheal extubation without any major respiratory or neurologic complications.
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The heart surgery forum · Jan 2004
Comparative StudyMitral valve operations through standard and smaller incisions.
Evaluate the operative results of mitral valve repair (MVV) and mitral valve replacement (MVR) performed through standard and smaller incisions. ⋯ The mortality rate for MV operations is concentrated among a few diagnoses. In some patients surgery may be approached safely through smaller incisions without introducing new elements of operative risk.
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The heart surgery forum · Jan 2004
Immediate Extubation after Aortic Valve Surgery Using High Thoracic Epidural Anesthesia.
Abstract Purpose: Fast-track anesthesia has gained widespread use in cardiac centers around the world. No study has focused on immediate extubation after aortic valve surgery. This study examines the feasibility and hemodynamic stability of immediate extubation after simple or combined aortic valve surgery using thoracic epidural anesthesia. ⋯ There were no complications related to TEA. Conclusions: Immediate extubation is feasible after aortic valve surgery with high thoracic epidural analgesia and maintenance of hemodynamic stability throughout surgery. Immediate extubation after aortic valve surgery is a promising new path in cardiac anesthesia.
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The heart surgery forum · Jan 2004
Controlled Clinical TrialExperience on the way to totally endoscopic atrial septal defect repair.
Remote-access perfusion and robotics have enabled totally endoscopic closure of atrial septal defect (ASD) and patent foramen ovale (PFO). We report on a stepwise approach to a totally endoscopic procedure. ⋯ The implementation of robotic totally endoscopic closure of ASD or PFO in a heart surgery program seems to be safe. An intermediate step of performing the operations through minithoracotomy, adapting to remote access perfusion systems, and gaining experience in other robotic cardiac surgical procedures seems worthwhile. Learning curves are apparent, and adequate defect closure does not seem to be compromised by the totally endoscopic approach.