The heart surgery forum
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The heart surgery forum · Jan 2003
Comparative Study Clinical Trial Controlled Clinical TrialOff-Pump versus on-pump coronary artery bypass: can OPCAB reduce neurologic injury?
Coronary artery bypass grafting (CABG) with cardiopulmonary bypass is still the gold standard for surgical myocardial revascularization. Despite advances in techniques and technologies, documented evidence indicates that cardiopulmonary bypass remains the major source of intraoperative brain injury. This study was set up to test whether offpump coronary artery bypass (OPCAB) is superior to CABG regarding postoperative neurologic outcome or neurocognitive function. ⋯ Neurologic complications and postoperative neurocognitive dysfunction remain major concerns in coronary artery surgery. Besides the occurrence of stroke, which dramatically reduces the success of the heart operation, the importance of neurocognitive disorders for postoperative quality of life is not yet well defined. OPCAB significantly improves postoperative neurocognitive function, which may in turn improve the postoperative quality of life.
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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
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.