1306 Recommendations for the Use of Simulators in Cardiothoracic Surgical Training

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Whittaker ◽  
Y Salmasi ◽  
G Asimakopoulos ◽  
T Athanasiou
Keyword(s):  
Literature Search ◽  
Basic Skills ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cardiothoracic Surgery ◽  
Circulatory Support ◽  
Mesh Terms ◽  
Analysis Of Results ◽  
Early Training ◽  
Selection Of

Abstract Aim To systematically review the simulators that are currently available for cardiothoracic surgical procedures and the validation evidence supporting them. Additionally, to recommend several simulators for training based on analysis of results. Method A systematic literature search of the MEDLINE® (1946 to December 2019) and EMBASE® (1947 to December 2019) databases was performed to identify simulators for basic skills and procedures in cardiothoracic surgery. A selection of keywords and MeSH terms were used to execute the literature search. After identification of relevant articles, data were extracted and analysed. Results Ninety simulators were found in eighty-one articles. Simulators for basic skills (n=24) and coronary artery bypass graft (n=22) were the most commonly described, followed by miscellaneous (n=14), valve surgery (n=13), thoracic lobectomy (n=10), and mechanical circulatory support (n=7). The majority of models were either benchtop (n=42) or hybrid (n=33) modalities. Evidence of validity was demonstrated in 38 (42.2%) simulators. Five (5.6%) simulators had three or more elements of validity established and only one (1.1%) accomplished full validation. Conclusions Five simulators were recommended for supplemental training in cardiothoracic surgery. Low-fidelity models can provide a broad foundation for surgical skills development and high-fidelity simulators can be used for immersive training scenarios and appraisals. These should be utilised in early training, at which point the learning curve of trainees is steepest.

Urgent coronary artery bypass graft surgery supported by veno-arterial extracorporeal membrane oxygenation: a report of two cases

Perfusion ◽  
2021 ◽  
pp. 026765912110081
Author(s):  
Tamer Abdalghafoor ◽  
Bassam Shoman ◽  
Amr Salah Omar ◽  
Yasser Shouman ◽  
Abdulwahid Almulla
Keyword(s):  
Coronary Artery ◽  
Extracorporeal Membrane Oxygenation ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Circulatory Support ◽  
Membrane Oxygenation ◽  
Cardiac Procedures ◽  
Risk Patients ◽  
Va Ecmo

Mechanical circulatory support (MCS) devices, especially veno-arterial extracorporeal membrane oxygenation (VA-ECMO) devices, are increasingly used to shore complex cardiac procedures in high-risk patients. We are reporting two cases where patients underwent coronary artery bypass grafting (CABG) under support of VA-ECMO in the setting of cardiogenic shock complicating acute myocardial infarction. The patients had different courses, but both survived the initial insult and were weaned successively from VA-ECMO. Our report indicates that VA-ECMO can be used instead of the cardiopulmonary bypass machine (CPB) to support the circulation during CABG surgery in patients with complex coronary anatomy and unstable haemodynamics. Future studies focusing on the long-term outcomes of such patients will probably help to establish the optimal management of this type of patients.

The National Practice Patterns of Venous Thromboembolism Prophylaxis Post-Cardiothoracic Surgery

2016 ◽  
Vol 30 (4) ◽  
pp. 394-399 ◽  
Author(s):  
Sheena E. Mathew ◽  
Craig J. Beavers ◽  
Elizabeth McNeely
Keyword(s):  
Venous Thromboembolism ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The United States ◽  
Cardiothoracic Surgery ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Multicenter Survey ◽  
Pharmacologic Prophylaxis ◽  
Chemical Prophylaxis

Background: The rates of venous thromboembolism (VTE) post-cardiothoracic surgery are not well understood. The american college of chest physicians (CHEST) guidelines report weak recommendations for starting VTE prophylaxis post-cardiothoracic surgery. It is suspected that due to the increase in bleed risk, postsurgery initiation of pharmacologic VTE prophylaxis is limited. Objective: The study sought to investigate the use of VTE prevention in US hospitals performing cardiac surgery and the use of mechanical/chemical prophylaxis postoperatively. Methods: This is a multicenter survey distributed to cardiac hospitals in the United States. The survey was distributed through 3 separate listservs. Data were analyzed utilizing descriptive statistics. Results: The majority of the hospitals were academic and/or community and completed coronary artery bypass graft (CABG), valve replacement (mitral/aortic/tricuspid), and aortic repair. It was common for hospitals to start mechanical and pharmacologic prophylaxis post-cardiothoracic surgery on postoperative day (POD) 1 to 2. The anticoagulation most commonly used consisted of unfractionated heparin. Conclusions: The majority of the institutions are initiating therapy POD 1 to 2 with both mechanical and chemical prophylaxis. The full impact of early initiation of VTE prophylaxis is unknown, and more studies are needed to assess the true risks/benefits of these practices.

scholarly journals Sevoflurane-medicated the pathway of chemokine receptors bind chemokines in patients undergoing CABG

2017 ◽  
Vol 12 (1) ◽  
pp. 443-451
Author(s):  
Bing Kong ◽  
Yu-Wu Ma ◽  
De-Xue Li ◽  
Xi-Jiang Liu ◽  
Yong-Guang Xu
Keyword(s):  
Chemokine Receptors ◽  
Molecular Mechanisms ◽  
Permutation Test ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Random Permutation ◽  
Snowball Sampling ◽  
Differential Modules ◽  
Pathway Analyses ◽  
Selection Of

AbstractBackgroundWe aim to identify sevoflurane-induced modules and pathways in patients following coronary artery bypass graft (CABG) surgery, and to further elucidate the molecular mechanisms of the cardioprotective effects of sevoflurane.MethodsDifferential co-expression network (DCN) was constructed. Candidate modules were identified via three steps: selection of seed genes, search of modules using snowball sampling, and refinement of modules. Afterwards, the significance of the candidate modules was assessed. Ultimately, pathway analyses for genes in differential modules were implemented to illuminate the biological processes.ResultsOverall, 122 genes were identified to serve as seed genes. From every seed gene, we extracted 122 modules and the mean node size in a module was 3. By setting the classification accuracy cutoff at 0.9 and the number of nodes in a module at 5, 7 candidate modules were identified, including module 80, 82, 82, 84, 85, 86 and 89. Based on the random permutation test, we found that these 7 candidate modules were all differential ones. Moreover, pathway analysis showed that genes in the differential modules 80, 82, and 85 were all enriched in the pathway of chemokine receptors bind chemokines.ConclusionSevoflurane might exert cardioprotective functions in patients following CABG, partially through regulating the pathway of chemokine receptors bind chemokines.

The enabler right ventricular circulatory support system for beating heart coronary artery bypass graft surgery

1999 ◽  
Vol 68 (4) ◽  
pp. 1558-1561 ◽  
Author(s):  
Gijs G Geskes ◽  
André L Dekker ◽  
Frederik H van der Veen ◽  
Audrey A Cramers ◽  
Jos G Maessen ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Right Ventricular ◽  
Coronary Artery Bypass ◽  
Support System ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Beating Heart ◽  
Circulatory Support ◽  
Artery Bypass Graft

scholarly journals Coronary artery bypass grafting under sole Impella 5.0 support for patients with severely depressed left ventricular function

2021 ◽  
Author(s):  
Shintaro Katahira ◽  
Yukiharu Sugimura ◽  
Arash Mehdiani ◽  
Alexander Assmann ◽  
Philipp Rellecke ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Percutaneous Coronary ◽  
Heart Lung Machine ◽  
Lung Machine ◽  
Selection Of

AbstractSelection of the ideal surgical procedure for coronary revascularization in patients with severe cardiac dysfunction at times may represent a challenge. In recent years, with the advent of surgical large microaxial pumps, e.g., Impella 5.0 (Abiomed Inc., Boston, USA), specific support and effective unloading of the left ventricle has become available. In the interventional field, good results have been achieved with smaller microaxial pumps in the setting of so-called protected percutaneous coronary intervention. In this study, we would like to share our early experience with surgical coronary revascularization under the sole support of Impella 5.0, omitting the use of heart–lung machine in three cases of severe cardiac dysfunction due to complex ischemic heart disease. Effective circulatory support intraoperatively and postoperatively speaks in favor of this technique in selected patients.

Routes and Sources ofStaphylococcus aureusTransmitted to the Surgical Wound During Cardiothoracic Surgery Possibility of Preventing Wound Contamination by Use of Special Scrub Suits

2001 ◽  
Vol 22 (6) ◽  
pp. 338-346 ◽  
Author(s):  
Ann Tammelin ◽  
Anna Hambræus ◽  
Elisabeth Ståhle
Keyword(s):  
Operating Room ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cardiothoracic Surgery ◽  
Surgical Wound ◽  
Skin Preparation ◽  
Air Samples ◽  
Wound Contamination ◽  
Surgical Wounds ◽  
Airborne Contamination

AbstractObjectives:To trace the routes of transmission and sources ofStaphylococcus aureusfound in the surgical wound during cardiothoracic surgery and to investigate the possibility of reducing wound contamination, with regard to total counts of bacteria andS aureus, by wearing special scrub suits.Methods:A total of 65 elective operations for coronary artery bypass graft with or without concomitant valve replacement were investigated. All staff present in the operating room wore conventional scrub suits during 33 operations and special scrub suits during 32 operations. Bacteriological samples were taken from the hands of the scrubbed team after surgical scrub but before putting on sterile gowns and gloves and from the patients' skin (incisional area of sternum and vein harvesting area of legs) after preoperative skin preparation with chlorhexidine gluconate. Air samples were taken during operations. Bacteriological samples also were taken from the subcutaneous walls of the surgical wound just before closing the wound. Total counts of bacteria on sternal skin and wound walls (colony-forming units [CFUs//cm2) were calculated, as well as total counts of bacteria in the air (CFUs/m3). Strains ofS aureusrecovered from the different sampling sites were compared by pulsed-field gel electrophoresis (PFGE).Results:Special scrub suits significantly reduced total counts of bacteria in air compared to conventional scrub suits (P=.002). The number of air samples in whichS aureuswas found was significantly reduced by special scrub suits compared with conventional scrub suits (P=.016; relative risk, 4.4; 95% confidence interval [CI95], 1.3-14.9]). By use of PFGE, it was possible to identify two cases of possible airborne transmission ofS aureuswhen wearing conventional scrub suits, whereas no case was found when wearing special scrub suits. When exposed to airborneS aureus, the concomitant sternal carriage ofS aureuswas a risk factor for havingS aureusin the wound.Conclusions:Use of tightly woven special scrub suits reduces the dispersal of total counts of bacteria and ofS aureusfrom staff in the operating room, thus possibly reducing the risk of airborne contamination of surgical wounds. The importance of careful preoperative disinfection of the patient's skin should be stressed.

scholarly journals Subclavian-coronary bypass graft re-operation according to the MICS technique in a patient with angina relapse

2019 ◽  
pp. 94-96
Author(s):  
I. Yu. Sigaev ◽  
M. A. Keren ◽  
A. V. Kazaryan ◽  
I. V. Pilipenko ◽  
G. G. Getsadze
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Median Sternotomy ◽  
Coronary Bypass ◽  
Patient Comfort ◽  
Successful Implementation ◽  
Coronary Bypass Graft ◽  
Selection Of

Coronary artery bypass graft (CABG) using short-scar incision (without median sternotomy) allows minimizing the invasiveness of the intervention, reducing the risks of postoperative complications, and also ensuring patient comfort and quick social and physical rehabilitation. The successful implementation of such operations is due not only to surgical skills and the integration of technological achievements into practice, but also to the appropriate selection of patients. The article presents a clinical case of successful re-operation of the subclavian-coronary artery bypass grafting on a beating heart using antero-lateral thoracotomy approach in a patient with angina relapse after CABG.

Cardiothoracic surgery

2021 ◽  
pp. 745-774
Keyword(s):  
Lung Cancer ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cardiothoracic Surgery ◽  
Artery Bypass Graft ◽  
Mediastinal Disease ◽  
Artery Disease ◽  
Preoperative Work Up ◽  
Work Up

This chapter focuses on cardiothoracic surgery. It begins by outlining the principles of cardiac surgery. The majority of procedures are coronary artery bypass graft (CABG) operations, followed by aortic valve replacements, mitral valve (MV) repair and replacements, and aortic surgeries. Meticulous preoperative work-up is essential. All investigations must be checked; sometimes, even small abnormalities can have significant harmful consequences to the patient outcomes. Many patients are elderly with multiple comorbidities, but most of the patients should be out of ICU within a day or two, and ready to go home in a week. The chapter then looks at coronary artery disease, valvular heart disease, lung cancer, pleural effusion, pneumothorax, and mediastinal disease. It also considers the cardiothoracic ICU.

scholarly journals Radial artery in myocardial revascularization

2009 ◽  
Vol 62 (5-6) ◽  
pp. 241-247 ◽  
Author(s):  
Aleksandar Redzek ◽  
Zivojin Jonjev
Keyword(s):  
Radial Artery ◽  
Personal Experience ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Coronary Bypass ◽  
Current Status ◽  
Vessel Stenosis ◽  
Harvest Techniques ◽  
Selection Of

In the past decade, the use of the radial artery as a coronary artery bypass graft has been revitalized. However, there has been controversy regarding harvest techniques, antispasm protocols, and selection of target vessels. It is widely accepted that the patency of radial-artery grafts depends on the severity of native-vessel stenosis. Thus, radial artery grafts should be preferentially used for target vessels with high-grade (>75% stenosis) lesions. In this review article, we analyzed the current status of radial artery grafts as a coronary bypass conduit based on our personal experience and recently published literature data.

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