The heart surgery forum
-
The heart surgery forum · Jan 2003
Improving hemodynamics by atrial pacing during off-pump bypass surgery.
To avoid hemodynamic deterioration during tilting of the heart in off-pump surgery, we perform atrial pacing. We describe hemodynamic evaluation of this simple maneuver. ⋯ Atrial pacing increases intraoperative RRs, RRm, CO, and CI and decreases SV and LAP significantly, thus offering stable hemodynamics during off-pump surgery. In the last 400 consecutive off-pump coronary artery bypass grafting procedures, there was only 1 (0.25%) conversion to cardiopulmonary bypass.
-
The heart surgery forum · Jan 2003
Myocardial contractile performance, preload recruitable stroke work relationships, and histomorphometric changes following off-pump and on-pump coronary bypass grafting of the left internal thoracic artery to the left anterior descending artery.
It has been shown that coronary artery bypass grafting without cardiopulmonary bypass (off-pump or OPCABG) preserves better cerebrocognitive, pulmonary, hepatorenal, and blood cell functions compared with onpump surgery because of an attenuated inflammatory response. The degrees of ischemia/reperfusion injury, myocardial protection, and quantitative changes in myocardial contractile performance following OPCABG have not been well documented. ⋯ Compared with most commonly applied myocardial preservation techniques (cardiopulmonary bypass, hypothermic blood cardioplegic arrest), OPCABG provides at least equal myocardial protection, because there were no significant quantitative differences between off-pump and onpump CABG in myocardial contractile performance following LITA-to-LAD revascularization. The more prominent intimal thickening observed in OPCABG procedures is worrisome and deserves further investigation.
-
The heart surgery forum · Jan 2002
Randomized Controlled Trial Clinical TrialEffects of phospholipid-coated extracorporeal circuits on clinical outcome parameters and systemic inflammatory response in coronary artery bypass graft patients.
The use of extracorporeal circulation (ECC) during coronary artery bypass graft (CABG) surgery is associated with a systemic inflammatory response due to the contact of blood with artificial surfaces. The clinical relevance of ECC-related systemic inflammation varies with the patient, and such inflammation may be accompanied by intermittent organ dysfunction and an increased catecholamine requirement. We investigated the effects of a new phospholipid coating system of ECC on systemic inflammatory response and clinical outcome following CABG. ⋯ Phospholipid coating significantly reduces the systemic increase in proinflammatory and anti-inflammatory cytokines and P-selectin. Despite the comparable clinical outcomes in this study, the observed significant reduction in systemic inflammatory parameter values suggests an improved biocompatibility of ECC materials when they are coated with phospholipids.
-
The heart surgery forum · Jan 2002
Review Case ReportsMitral valve aneurysm associated with aortic valve endocarditis and regurgitation.
Mitral valve aneurysms are rare complications occurring most commonly in association with aortic valve infective endocarditis. [Decroly 1989, Chua 1990, Northridge 1991, Karalis 1992, Roguin 1996, Mollod 1997, Vilacosta 1997, Cai 1999, Vilacosta 1999, Teskey 1999, Chan 2000, Goh 2000, Marcos- Alberca 2000] While the mechanism of the development of this lesion is unclear, complications such as perforation can occur and lead to significant mitral regurgitation. [Decroly 1989, Karalis 1992, Teskey 1999, Vilacosta 1999]; The case of a 69-year-old male with Streptococcus Sanguis aortic valve endocarditis and associated anterior mitral leaflet aneurysm is presented. Following surgery, tissue pathology of the excised lesion revealed myxomatous degeneration and no active endocarditis or inflammatory cells. This may add support to the hypothesis that physical stress due to severe aortic insufficiency and structural weakening, without infection of the anterior mitral leaflet, can lead to the development of this lesion.
-
The heart surgery forum · Jan 2002
Thoracic epidural anesthesia for cardiac surgery via left anterior thoracotomy in the conscious patient.
Cardiac surgery is perceived to be maximally invasive and fraught with complications. In response to this perception, cardiothoracic surgeons have been refining traditional techniques to minimize their invasive nature. Epidural anesthesia has been used safely and effectively for numerous surgical procedures to reduce morbidity associated with general anesthesia. In hopes of achieving a similar result, we set out to determine the feasibility of using thoracic epidural anesthesia for limited cardiac surgery through a left anterior thoracotomy for patients who were awake and spontaneously breathing. ⋯ Thoracic epidural anesthesia for limited cardiac surgical procedures by means of a left anterior thoracotomy is feasible, even in patients with diminished pulmonary function. Furthermore, this method offered no significant technical hurdles. Nevertheless, the applicability of this technique to other procedures remains unclear. We believe that these results warrant controlled comparison of regional versus general anesthesia for limited cardiac surgery.