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History of Minimally Invasive Cardiac Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
The term minimally invasive cardiac surgery does not have a standard definition, nor does it refer to a single approach. It is an amalgamation of innovations in techniques and strategies with the aid of surgical technologies to achieve the primary aims of reducing the impact of the surgical procedure and achieving a satisfactory if not excellent therapeutic result but at the same time to allow faster recovery and quicker rehabilitation. MICS achieves basic Hippocratic principles and covers evolving patient expectations. According to one, elimination of CPB in CABG is considered minimally invasive as it reduces the morbidity associated with CPB. Other authors view the median sternotomy as a significant source of morbidity, in particular postoperative respiratory impairment, sternal wound infections, chest instability and chronic pain. As a result, alternative means of access to the heart and great vessels have been sought. This has fueled the development of alternative routes and methods of CPB for cardiac surgeries (Figure 2.29).
Cardiothoracic Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Procedure:Performed via median sternotomy. A piece of conduit (saphenous vein, left internal mammary artery, radial artery) is anastomosed to the coronary artery beyond the lesion and then to the ascending aorta.
Vascular rings
Published in Prem Puri, Newborn Surgery, 2017
Benjamin O. Bierbach, John Mark Redmond, Christopher Hart
Nowadays, children presenting with tracheal or esophageal obstructions caused by congenital vascular malformations can be treated with low morbidity and a minute mortality. Conventional surgery involving thoracotomy or median sternotomy is still the standard of treatment. Minimally invasive approaches have been developed, but further technical advances are necessary to promote a wider dissemination of these techniques.
Effects of preoperative intravenous glutamine administration on cardiac and renal functions in patients undergoing mitral valve replacement surgeries: A randomized double-blind controlled trial
Published in Egyptian Journal of Anaesthesia, 2023
Mohamed F. Mostafa, Hany Ahmad Ibrahim Elmorabaa, Mohammed Mahmoud Mostafa, Ramy Mostafa Abd El Gawad, Mohamed Ismail Seddik, Ragaa Herdan, Mostafa Hassanien Bakr, Emad Zarief Kamel
Anesthesia was maintained under isoflurane 1–2% in an oxygen-air mixture (1:1 ratio) using Datex-Ohmeda Aespire anesthesia machine (Madison WI 53707–7550 USA), infusion of fentanyl 1–2 μg/kg/h, and cisatracurium 1 μg/kg/h. Monitoring of the patient was continued as before induction and included peripheral O2 saturation (SpO2), end-tidal CO2, electrocardiogram, invasive systemic blood pressure, central venous pressure, nasopharyngeal (core) body temperature, arterial blood gases, and urine output by the Carescape B650 device (GE Healyhcare Finland Oy). Median sternotomy was performed in all patients. Intravenous heparin in a dose of 3–4 mg/kg was given after doing the piercing suture of the aorta to achieve activated clotting time more than 450 s, and protamine sulfate was used for its reversal by the end of the procedure. After confirmation of activated clotting time more than 450 s and placement of aortic and venous cannulae, the patient cardiopulmonary bypass was initiated to keep mean arterial blood pressure appropriate to the degree of hypothermia applied anesthesia was maintained during bypass period using propofol, fentanyl, and cisatracurium infusion. Custodiol HTK was delivered at 3–4°C, 20 ml/kg to a maximum of 2 L.
Chronic thromboembolic pulmonary hypertension: a review of risk factors, management and current challenges
Published in Expert Review of Cardiovascular Therapy, 2022
John E Cannon, David P Jenkins, Stephen P Hoole
The operative procedure was refined and popularized by the University of California at San Diego, and the principles remain unchanged [30]. It is performed under general anesthesia with a median sternotomy incision as for conventional cardiac surgery. Cardiopulmonary bypass is required to divert blood away from the heart and allow systemic cooling to 20C. The pulmonary arteries are opened with separate right and left arteriotomies within the pericardium and a true endarterectomy plane is developed with the vessel wall. Periods of deep hypothermic circulatory arrest, of up to 20 minutes are required to give a bloodless field for the most distal endarterectomy dissection so that all visible thrombotic material is removed up to subsegmental level. Our own research demonstrated that the circulatory arrest is well tolerated without cognitive dysfunction [31]. Any concomitant procedures can be performed during rewarming although tricuspid regurgitation is usually self-limiting and repair usually unnecessary. After systemic rewarming on bypass, patients are initially managed in intensive care for the initial 2 days after surgery.
Comparison of free arterial and saphenous vein grafting in outcomes after coronary bypass surgery
Published in Scandinavian Cardiovascular Journal, 2022
Vijoleta Abromaitiene, Jacob Greisen, Hans Henrik Kimose, Zidryne Karaliunaite, Carl-Johan Jakobsen
A median sternotomy was performed on all patients. Free artery or vein utilization was at the discretion of the surgeon. RA harvesting was performed via a full forearm incision. Skeletonized SV was harvested directly through an incision over the vein along the medial leg and in 2011 a “no-touch” SV harvesting technique was implemented in one center. The SV/RA was stored at room temperature in a storage solution consisting of 60 mL blood, 1000 IU heparin and 60 mg Papaverine. RA or SV were used for coronary artery grafting as a single or sequential graft. The mean flow (mL/min) of the grafts was measured (Transit time; Medistim, Norway) after completion of all anastomoses. Peroperative surgical graft correction due to low flow was at the discretion of the surgeon.