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Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
The right internal mammary may rarely be used or the radial artery from the arm. A detailed examination of the operative notes should tell you which grafts were used. Operations in which cardiopulmonary bypass is not used (the so-called ‘closed’ procedures) are generally performed through a lateral thoracotomy. As with median sternotomy, drains are inserted after lateral thoracotomy. The latter is approached through the bed of the third to the fifth rib and the rib is excised to allow closure of the wound. Operations performed through a left thoracotomy include closed mitral valvotomy (now obsolete in the West as a first operation for mitral stenosis – except as an emergency procedure during pregnancy – but still commonly performed in the Middle East and India), resection of coarctation of the aorta (irrespective of the technique employed), closure of patent ductus arteriosus, pericardiectomy, and many of the ‘shunt’ operations to increase circulation to the lungs in congenital cardiac malformations causing cyanosis. The thoracotomy is always drained, leaving additional small scars marking the respective positions of the drains.
Minimally Invasive Atrial Ablation Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
The advancement of minimally invasive approaches, with and without the use of cardiopulmonary bypass, has reduced the trauma of the surgical procedure, thereby expanding the number of patients experiencing this therapy. Some minimally invasive approaches replicate the maze procedure better than others, with some compromising procedural completeness for less invasive techniques. However, the guiding principles of a surgical therapy for AF remain the same: complete isolation of the four pulmonary veins, electrical isolation of the posterior left atrium, management of the left atrial appendage and appropriate ablation of the right atrium (Figure 13.2).
Cardiac Surgery in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Risk of fetal demise related to cardiac surgery has been reported as between 14% and 33% [3–6]. The risk appears to be higher if there are additional maternal risk factors for fetal loss, or if the surgery occurs in an emergent setting or at an early gestational age [5]. Most of this risk is related to cardiopulmonary bypass, and not the anesthesia itself [5].
Current evidence for pharmacologic therapy following stage 1 palliation for single ventricle congenital heart disease
Published in Expert Review of Cardiovascular Therapy, 2022
Meredith C. G. Broberg, Ira M Cheifetz, Sarah T Plummer
In addition to advances in surgical technique and cardiopulmonary bypass, improved medical care of patients in the perioperative period and at home have significantly impacted survival. Through the aid of large registries and national quality improvement initiatives, care in the interstage period, which has historically been highly variable between centers, is becoming more standardized and evidence-based [10–12]. The National Pediatric Cardiology Improvement Collaborative (NPC-QIC) is an example of a network of pediatric cardiology care centers in the United States, Canada, and the United Kingdom, which partners with a parent organization, Sisters by Heart and through quality improvement initiatives and research aims to improve mortality and quality of life for those infants in the interstage period [13]. Initiatives including optimizing nutrition and weight gain and daily at home monitoring programs have improved patient outcomes [14]. Despite standardization of some care practices, there continues to be variation in the management of these patients with medications within the interstage period, likely due, in part, to a paucity of research dedicated to this area [10]. Thus, we sought to review the current literature regarding medication usage in the interstage period.
Combined liver transplantation and off-pump coronary artery bypass grafting: a report of two cases
Published in Acta Chirurgica Belgica, 2022
Tumay Uludag Yanaral, Gokhan Ertugrul, Mustafa Ozer Ulukan, Pelin Karaaslan, Ibrahim Oguz Karaca, Murat Dayangac
OPCAB has been associated with better clinical outcome in high-risk patients when compared to on-pump CABG [8]. The potential benefits of avoiding a cardiopulmonary bypass include reduced inflammatory response, coagulation disorders, hemorrhage, arrhythmia, renal dysfunction, hypothermia, and neurocognitive injury [9]. Puskas et al. [10] emphasized that OPCAB provided less volume shifts, myocardial stunning, and improved vital organ perfusion compared to on-pump CABG. Moreover, OPCAB improves myocardial function and can also increase the chance of short and mid-term success in the high-risk LT group. Therefore, OPCAB is expected to reduce early mortality, neurological events, and length of hospital stay [10]. However, due to the limited data available, it is not possible to make a comparison between the conventional and off-pump techniques in patients undergoing combined CABG and LT. Nevertheless, there is a growing tendency to perform OPCAB among cardiac surgeons, and because of the aforementioned advantages, OPCAB may be the preferred technique in LT recipients.
Retrograde ascending aortic dissection in the midterm period after thoracic endovascular aortic repair: a case report and literature review
Published in Acta Chirurgica Belgica, 2022
Sinan Erkul, Gulen Sezer Alptekin Erkul
The patient was taken for emergent open surgical repair with median sternotomy incision. There was dissection and haematoma on the ascending aorta. Cardiopulmonary bypass was established. The dissection was proximally limited to the tubular portion of the ascending aorta and was not extending to the aortic root. The cardioplegia was given from ostial cannula, and proximal anastomosis with a 28 mm tubular Dacron graft (Maquet®, Germany) was performed during the cooling period. Following hypothermic circulatory arrest at 18 °C, antegrade cerebral perfusion was performed via the right axillary cannula. The aorta lumen was explored. The proximal bare springs of the stent graft were penetrating the intima of the lesser curvature of arcus aorta where the dissection was likely to arise and extended to the ascending aorta (Figure 1(d)). Bare springs were cut with the wire scissors. The proximal coated part of the TEVAR graft was stabilized with teflon felt-supported 5/0 prolene sutures inside the lumen of the aortic arch wall to avoid migration of the stent graft. Ascending aorta and hemiarch replacement was performed in a beveled fashion 2 cm proximally to the TEVAR graft with an anastomosis to the native aortic tissue with teflon felt-supported 4/0 prolene sutures (Figure 2(a–b)).