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Cardiac diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Saravanan Kuppuswamy, Sudarshan Balla
With the advances in knowledge and technology, the maternal and fetal outcome has improved significantly. Numerous pregnant patients with mitral stenosis have undergone valve replacement for both aortic and mitral valve diseases (92,117,118). Although this procedure has been shown to be relatively safe and effective, it carries a high fetal mortality and should be reserved for patients refractory to medical management. In selected patients, closed mitral valvotomy offers excellent results, comparable with those of nonsurgical treatments (119). Other successful intracardiac procedures during pregnancy include pulmonary valvuloplasty, ASD and VSD repair, excision of left atrial myxomas, and, as an emergency, repair of an aortic dissection. In addition, there have been several successful coronary artery bypass graft procedures carried out during pregnancy (92,117). The chief concerns in the optimal management of pregnant patients who are undergoing cardiopulmonary bypass (CPB) are the control of temperature, perfusion pressure, and the nature of the bypass flow. Current evidence favors maintaining normothermic CPB instead of the hypothermic CPB. The role of off pump coronary artery bypass grafting is a safe and accepted technique for coronary revascularization; however, its role in pregnancy needs further evaluation.
Anaortic, Off-Pump, Total-Arterial Coronary Artery Bypass Grafting Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Michael Seco, J James B Edelman, Fabio Ramponi, Michael K Wilson, Michael P Vallely
The debate of on-pump versus off-pump coronary artery bypass grafting (CABG) has been continuing as long as surgical revascularization has been performed. This has been fueled by a number of randomized controlled trials that have seen no improvement and even harm associated with an off-pump technique, but a multitude of observational studies demonstrating significant benefit. Whilst the most common CABG technique used today remains cardiopulmonary bypass with an arrested heart, many centers pursue off-pump CABG (OPCAB) and continue to refine the surgical technique.
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
CABG without the use of CPB is a well-established and increasingly popular method that may be combined with a minimally invasive approach or carried out through a conventional sternotomy. It offers the advantages that it avoids the physiological stress associated with CPB and, to some extent, the aortic manipulation that can lead to neurological injury through atherosclerotic embolisation. Since the introduction of cardiac stabilising devices such as the Octopus®(Figure54.8), off-pump coronary artery bypass (OPCAB) grafting has become widespread. One of the concerns, however, is related to the quality of anastomosis carried out on a beating heart and bloody field that can limit the surgeon’s vision. The advantages of off-pump surgery over on-pump has recently been questioned, especially with the development of mini-bypass pumps, which offer a closed circuit and minimal unphysiological surface area. This reduces proinflammatory activation but at the same time allows the surgeon to operate on a still, bloodless heart. However, there is still no evidence to support the superiority of any of the above mentioned techniques and the final decision is usually based on the surgeon’s skills and the required operation.
Off-pump Coronary Artery Bypass through Ministernotomy in Patients with Diabetes Mellitus
Published in Structural Heart, 2020
Khusan Khalikulov, Abrol Mansurov, Saidorifhon Murtazaev
Methods: We have performed 40 operations off-pump coronary artery bypass. All operations were performed through ministernotomy using myocardial stabilizer. The age of patients varies from 32 to 60 years old. All patients were male. Unstable angina was diagnosed in 15 (37.5%) patients, and the rest of 25 (62.5%) patients had different class of stable angina. Arterial hypertension was present in 38 patients, coronary insufficiency in 11 patients. 34 patients had myocardial infarction in the anamnesis. ECG data revealed ischemia in 25 patients. Echo: left ventricle ejection fraction under 40% in patients, under 50% in 22 patients and the rest of patients had 55%. Blood glucose level was varied from 8 to 15 mmol/L and average mean composed of 11.2 mmol/L. Angiography data revealed single-vessel disease in 25 cases and the other 15 patients had double-vessel disease.
Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery
Published in Disability and Rehabilitation, 2019
Isadora Salvador Rocco, Marcela Viceconte, Hayanne Osiro Pauletti, Bruna Caroline Matos-Garcia, Natasha Oliveira Marcondi, Caroline Bublitz, Douglas William Bolzan, Rita Simone Lopes Moreira, Michel Silva Reis, Nelson Américo Hossne, Walter José Gomes, Ross Arena, Solange Guizilini
Anaesthetic procedures were conducted in a routine fashion with midazolam, maintained with sufentanil and isoflurane (0.5–1%). Off-pump coronary artery bypass grafting was accomplished through a median sternotomy, using the left internal thoracic artery complemented with additional saphenous vein grafts. The left internal thoracic artery was harvested by the skeletonised technique, with meticulous caution routinely taken to preserve pleura integrity in order to preserve respiratory system compliance and resistance. Off-pump coronary artery bypass grafting follows our standardised protocol [3]. In all cases, an Octopus 3 (Medtronic, Inc., Minneapolis, MN) suction stabiliser was utilised, and to maintain normothermia, a heated water mattress was used throughout the operation.