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The Coronaries
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
László Göbölös, Johannes Bonatti
After this step, cardioplegia is administered. Rapid cardioplegic induction is facilitated with adenosine administration (6 mg/20 mL of normal saline). If sufficient balloon occlusion is proven, systemic cooling to 34°C is commenced and cardioplegia repeated every 20 minutes.
Cardiothoracic Surgery
Published in Elizabeth Combeer, The Final FRCA Short Answer Questions, 2019
Cardioplegia is an important basic tool in cardiothoracic anaesthesia, although it is not used invariably in current surgical procedures. It was evident from the answers which candidates had undertaken an attachment in this area of practice or had read an appropriate textbook. The importance of considering the mandatory units of training in preparation for the Final FRCA examination has been emphasised previously.
Cardiac surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Aortic valve replacement (AVR) is performed through a median sternotomy on CPB. The aorta is cross-clamped and opened proximally to reveal the diseased valve. Cardioplegic solution is infused into the coronary arteries to arrest the heart in diastole. The valve is then excised leaving the annulus in situ but removing as much calcific debris as possible. The annulus is sized and the mechanical or biological valve is then sutured into position at the level of the native annulus and the aortotomy is closed.
Pathophysiology and management of saphenous vein graft disease
Published in Expert Review of Cardiovascular Therapy, 2023
Elizabeth C. Ghandakly, Aaron E. Tipton, Faisal G. Bakaeen
Redo CABG after SVG failure is an option, though with some risks. Many of the risks are associated with increased age and a number of comorbidities of the patient population, as well as general risks of redo sternotomy, though retrospective observational studies have shown long-term mortality of these patients undergoing PCI versus redo CABG is similar [69,70]. In all, where feasible, current practice favors redo CABG over PCI for patients with fewer functioning grafts, occluded LITA to LAD, lower systolic function, higher risks, and more chronic total occlusions [62]. With experience and skill the risk-adjusted outcomes of redo CABG approach those of primary CABG [71]. Care should be given to minimize manipulation of diseased vein grafts to avoid atheroembolism and perioperative MI. Retrograde cardioplegia is important in ensuring adequate myocardial protection [72].
TREM-1 as a Marker of Multiple Organ Failure in Cardiac Surgery
Published in Immunological Investigations, 2023
Maria V. Khutornaya, Maxim Yu Sinitsky, Anna V. Sinitskaya, Maxim А. Asanov, Anastasia V. Ponasenko, Evgeny V. Grigoriev
The study included 592 Caucasian patients (mean age 59 years) with confirmed coronary artery disease (CAD) or chronic heart failure who have been admitted to the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo, Russia). CAD was confirmed according to the respective guidelines of the Russian Society of Cardiology (2008). On-pump CABG was performed in patients with >70% coronary artery stenosis determined by coronary angiography. Average duration of cardiopulmonary bypass and aortic clamping was 96 [95% CI: 79−115] and 61 [95% CI: 50−75] minutes, respectively. On average, cardioplegia has been applied 3 [95% CI: 2 − 4] times. Mean number of arteries affected by CABG surgery was 3 [95% CI: 2−3]. Evaluation of MOF severity was performed using the SOFA (Sepsis-Related Organ Failure Assessment) scale (Scott 2017; Vincent et al. 1996).
Propofol versus insulin cardioplegia in valvular heart surgeries assessed by myocardial histopathology and troponin I
Published in Egyptian Journal of Anaesthesia, 2022
Omyma Shehata Mohamed, Shady Eid Al-Elwany, Mina Maher Raouf, Heba Mohamed Tawfik, Ibrahim Abbas Youssef
Although the usefulness of cardioplegia solution to arrest the heart during cardiac surgery with cardiopulmonary bypass (CPB), different degrees of myocardial damage and dysfunction can occur as a result of ischemia and disruption of metabolic and ionic homeostasis [1]. During ischemia, anaerobic metabolism leads to formation and accumulation of lactic acid (intracellular acidosis), which consequently elevate the concentration of intracellular sodium. The later can cause osmotic swelling and damage of sarcolemma of the cells. Moreover, prolonged ischemia can also lead to uncontrolled cellular calcium mobilization and formation of reactive oxygen species (ROS). Persistent elevation of intracellular calcium and the generation of ROS can destruct the integrity of mitochondrial cell membrane [2], disturb the electrical properties and contractility and eventually mitochondrial disruption with death of cardiomyocyte [3].