Heart surgery

2018 ◽  
Author(s):  
David Taggart ◽  
Yasir Abu-Omar
Keyword(s):  
Heart Surgery ◽  
Heart Defects ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Surgical Techniques ◽  
Circulatory Support ◽  
Mortality And Morbidity ◽  
Off Pump

Cardiac surgery is still a relatively young specialty, having been developed only in the latter half of the twentieth century with the introduction of extracorporeal circulation or ‘cardiopulmonary bypass’ (CPB). This initiated the era of open heart surgery, initially allowing the repair of congenital heart defects, then valve replacements, coronary artery bypass grafting (CABG), and, finally, heart transplantation. Over the last two decades, improvements in medical, anaesthetic, and surgical management of patients, allied to refinements in extracorporeal perfusion technology, have resulted in a decreasing mortality and morbidity from heart surgery despite the advanced age and significant comorbidity of many patients. Today, heart surgery continues to improve the prognosis and quality of lives of patients around the world. Surgical techniques and technologies continue to evolve and recent years have witnessed the emergence of, amongst others, the use of long-lasting conduits for CABG procedures, beating-heart (‘off-pump’) surgery, the use of minimally invasive and robotic techniques, and long-term mechanical circulatory support.

Off-Pump Coronary Artery Bypass Surgery May Produce a Hypercoagulable Patient

2005 ◽  
Vol 6 (2) ◽  
pp. 94 ◽  
Author(s):  
Robert L. Quigley ◽  
David W. Fried ◽  
John Pym ◽  
Richard Y. Highbloom
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Anticoagulation Therapy ◽  
Maximum Amplitude ◽  
Platelet Activity ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

<P>Background: 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. </P><P>Methods: We prospectively studied 17 OPCAB and 6 on-pump patients over 4 days (hospital course) with daily thromboelastography. A coagulation index (CI) (reflecting R and K times, a angle, and maximum amplitude [MA]) was calculated for the patients, who served as their own controls. </P><P>Results: The OPCAB patients demonstrated 3 days postoperatively a 17% increase in coagulation compared with the baseline. Specifically, the CI consistently revealed an elevation in the a angle and the MA, both of which reflect increased fibrinogen and platelet activity. On the other hand, 3 days following surgery the CI of the CPB group was tightly clustered around their respective baseline CI values, which had recovered from a significant decrease immediately after surgery. </P><P>Conclusion: 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.</P>

scholarly journals Off-pump myocardial revascularization using the octopus tissue stabilizer system

2003 ◽  
Vol 56 (1-2) ◽  
pp. 80-84 ◽  
Author(s):  
Predrag Milojevic ◽  
Vojislava Neskovic ◽  
Dragos Stojanovic ◽  
Miroslav Jakovljevic ◽  
Sava Nenic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Open Heart Surgery ◽  
Myocardial Revascularization ◽  
Arterial Grafts ◽  
Off Pump ◽  
Coronary Artery Revascularization ◽  
Pump Coronary Artery Bypass

Off-pump coronary artery bypass surgery (OPCAB) has changed the approach to contemporary coronary surgery. Development of new surgical devices and techniques has reduced morbidity and mortality during off-pump surgery. From March 2000 - April 2002, a total of 136 patients underwent open heart surgery using off-pump technique and fast-track anesthesia at Dedinje Cardiovascular Institute. Octopus Medtronic coronary stabilizer was used for stabilization of targeted vessel. Arterial grafts were used 169 times and saphenous vein 69 times. Average number of anastomoses was 1,830,73 per patient. One patient (0.74%) died. Three patients (2.21%) underwent surgery revision due to postoperative bleeding and one (0.74%) because of graft dysfunction Perioperative myocardial infarction was registered 2 times (1.47%) pneumothorax 3 times (2.21%), postoperative arrhythmias 11 times (8.09%) transitory ischemic attack once (0.74%) and deep wound infection once (0.74%). Twelve patients (8.82%) required prolonged inotropic support Angiographies early revealed patent grafts in 8 patients (5.88%). OPCAB is a safe and effective alternative approach to coronary artery revascularization Use of coronary stabilizer has improved the safety and quality of OPCAB surgery.

Infants with Trisomy 18 and Complex Congenital Heart Defects Should Not Undergo Open Heart Surgery

2016 ◽  
Vol 44 (2) ◽  
pp. 286-291 ◽  
Author(s):  
Eric M. Graham
Keyword(s):  
Quality Of Life ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Heart Defects ◽  
Open Heart Surgery ◽  
Trisomy 18 ◽  
Open Heart ◽  
Significant Morbidity ◽  
Surgical Interventions

Aggressive medical and surgical interventions have not been clearly demonstrated to improve survival in neonates with trisomy 18; there are no data that demonstrates improved quality of life for these children after these interventions; and these interventions are clearly associated with significant morbidity, resource allocation, and cost.

Coronary Artery Bypass Surgery in a Patient with a Functional Single Lung

2005 ◽  
Vol 13 (4) ◽  
pp. 377-379 ◽  
Author(s):  
Levent Yazicioglu ◽  
Atilla Aral ◽  
Ozge Uymaz ◽  
Hakki Akalin
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Heart Surgery ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Postoperative Management ◽  
Open Heart ◽  
Mortality And Morbidity

Destructed lung and pneumonectomy are associated with anatomic and physiologic changes that may interfere with the conduct of subsequent open heart surgery. Here we report a case of an autopneumonectomized patient who required open heart surgery. The preoperative, intraoperative and postoperative management of this patient was unique. Open heart procedures on patients with a single lung can be performed with acceptable operative mortality and morbidity.

scholarly journals Off pump coronary artery bypass surgery in octogenarians: long term results and quality of life

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P911-P911
Author(s):  
A. Graffigna ◽  
A. Motta ◽  
R. Bonmassari ◽  
S. Branzoli ◽  
S. Sinelli ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Long Term Results ◽  
Off Pump ◽  
Pump Coronary Artery Bypass ◽  
Surgery In Octogenarians

Long-term Neuromotor Outcome at School Entry of Infants with Congenital Heart Defects Requiring Open-heart Surgery

2006 ◽  
Vol 148 (1) ◽  
pp. 72-77 ◽  
Author(s):  
Annette Majnemer ◽  
Catherine Limperopoulos ◽  
Michael Shevell ◽  
Bernard Rosenblatt ◽  
Charles Rohlicek ◽  
...  
Keyword(s):  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Heart Defects ◽  
Open Heart Surgery ◽  
School Entry ◽  
Open Heart

scholarly journals HEART TRANSPLANTATION IN PATIENTS WITH PREVIOUS OPEN HEART SURGERY

2016 ◽  
Vol 18 (3) ◽  
pp. 116-127
Author(s):  
R. Sh. Saitgareev ◽  
V. N. Poptsov ◽  
V. M. Zakharevich ◽  
A. R. Zakiryanov
Keyword(s):  
Heart Transplantation ◽  
Mechanical Circulatory Support ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Perioperative Period ◽  
Clinical Situation ◽  
The Other ◽  
Circulatory Support ◽  
Open Heart

Heart Transplantation (HTx) to date remains the most effective and radical method of treatment of patients with end-stage heart failure. The defi cit of donor hearts is forcing to resort increasingly to the use of different longterm mechanical circulatory support systems, including as a «bridge» to the follow-up HTx. According to the ISHLT Registry the number of recipients underwent cardiopulmonary bypass surgery increased from 40% in the period from 2004 to 2008 to 49.6% for the period from 2009 to 2015. HTx performed in repeated patients, on the one hand, involves considerable technical diffi culties and high risks; on the other hand, there is often no alternative medical intervention to HTx, and if not dictated by absolute contradictions the denial of the surgery is equivalent to 100% mortality. This review summarizes the results of a number of published studies aimed at understanding the immediate and late results of HTx in patients, previously underwent open heart surgery. The effect of resternotomy during HTx and that of the specifi c features associated with its implementation in recipients previously operated on open heart, and its effects on the immediate and long-term survival were considered in this review. Results of studies analyzing the risk factors for perioperative complications in repeated recipients were also demonstrated. Separately, HTx risks after implantation of prolonged mechanical circulatory support systems were examined. The literature does not allow to clearly defi ning the impact factor of earlier performed open heart surgery on the course of perioperative period and on the prognosis of survival in recipients who underwent HTx. On the other hand, subject to the regular fl ow of HTx and the perioperative period the risks in this clinical situation are justifi ed as a long-term prognosis of recipients previously conducted open heart surgery and are comparable to those of patients who underwent primary HTx. Studies cited in the review may have important clinical applications, because they outline the range of problems and possible solutions in the performance of the HTx in recipients previously operated on open heart. This knowledge can facilitate the decision making process with regard to the opportunities and risks of the implementation of HTx. Given the uniqueness of each of the recipient and the donor, it is required to make a personalized approach to the question of the possible risks and to the preventive measures to reduce those risks in any given clinical situation. 

scholarly journals Comparison between OPCABG and CABG Surgical Revascularization Using Transit Time Flow Measurement (TTFM)

2021 ◽  
Vol 24 (6) ◽  
pp. E963-E967
Author(s):  
Marko Kusurin ◽  
Mateja Majnaric ◽  
Daniel Unic ◽  
Davor Baric ◽  
Robert Blazekovic ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Transit Time ◽  
Flow Measurement ◽  
Artery Bypass ◽  
Surgical Techniques ◽  
Surgical Revascularization ◽  
Circumflex Artery ◽  
Off Pump ◽  
Time Flow

Objective: To compare the intraoperative quality of coronary anastomoses performed with or without cardiopulmonary bypass using transit time flow measurement (TTFM) parameters. Methods: We collected data from 588 consecutive patients who underwent surgical revascularization. We retrospectively reviewed data from two groups: 411 with cardiopulmonary bypass (CABG group) and 177 off-pump (OPCABG group). Transit time flow measurement parameters: mean graft flow (MGF), pulsatile index (PI), and diastolic filing (DF) were measured for each graft and patient. Results: Patients in the OPCABG group had higher EuroSCORE compared with the CABG group (3.53 ± 2.32 versus 2.84 ± 2.15, P = .002). Overall comparison of TTFM parameters showed no statistical difference between the two surgical techniques except for PI in circumflex artery territory, which was higher in the OPCABG group for all types of grafts 3.0 ± 4.9 versus 2.4 ± 2.0 in, P = .026. Conclusion: The comparison between OPCABG and CABG in this study showed comparable results with both surgical techniques. PI was higher in the OPCABG group in harder-to-reach vessel territories. Measurement of transit time may improve the quality, safety, and efficacy of coronary artery bypass grafting and should be considered as a routine procedure.

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