The Coronaries
Theo Kofidis in Minimally Invasive Cardiac Surgery, 2021
With the constant development of surgical techniques and improving software and hardware support, a further broad application spectrum of robotic-facilitated CAB is likely. Special demand for surgeon and team training in the field will probably focus these procedures in specific centers. Simulation sessions are undoubtedly key components of surgical team education. Complex procedures are already performed on a regular basis, and a significant proportion of standard operations via sternotomy is expected to be replaced step by step by minimally invasive robotic procedures in the near future. Hybrid methods are increasingly incorporated into the robotic armamentarium, and recent developments of procedure-specific robotic instruments will optimize exposure of the cardiac back wall (Figure 12.2.36). Single-port access is under further expansion in endoscopic surgical fields, and will soon offer new prospect in TECAB techniques. Automatic anastomotic devices offer another novel future pathway, although further clinical tests have to commence to warrant safe daily application [39].
Short-term rehabilitation after an acute coronary event
K Sarat Chandra, AJ Swamy in Acute Coronary Syndromes, 2020
The AHA has published a scientific statement regarding sexual activity in patients with cardiovascular diseases [37]. It makes the following recommendations for resumption of sexual activity following ACS: Sexual activity is reasonable 1 or more weeks after uncomplicated MI if the patient is without cardiac symptoms during mild to moderate physical activity (class IIa, level of evidence C).Sexual activity is reasonable for patients who have undergone complete coronary revascularisation (class IIa, level of evidence B) and may be resumed (a) several days after PCI if the vascular access site is without complications (class IIa, level of evidence C) or (b) 6 to 8 weeks after standard coronary artery bypass graft surgery, provided the sternotomy is well healed (class IIa, level of evidence B).For patients with incomplete coronary revascularisation, exercise stress testing can be considered to assess the extent and severity of residual ischaemia (class IIb, level of evidence C).Sexual activity should be deferred for patients with unstable or refractory angina until their condition is stabilised and optimally managed (class III, level of evidence C).
Repair of Extensive Aortic Aneurysms: A Single-Center Experience Using the Elephant Trunk Technique over 20 Years
Juan Carlos Jimenez, Samuel Eric Wilson in 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
In 1983, Hans Borst1 and colleagues described the “elephant trunk” technique. This is a staged procedure in which the ascending aorta and aortic arch are repaired through a sternotomy and a portion of aortic graft is left extending unanchored into the proximal descending aorta, to be retrieved via a subsequent thoracotomy/thoracoabdominal incision and sutured end-to-end to a second graft used to repair the remaining distal aortic segment. The staged nature of this procedure allows for a period of recovery between the operative encounters that reduces the burden on the patient and improves the tractability of the procedure for the care team. When feasible, performing the sternotomy first can result in a shorter time interval between the proximal and distal operations, since recovery time following sternotomy is generally shorter and less painful than recovery for thoracotomy. A downside of staging the procedure—especially for large-diameter aneurysms or those in high-risk patients, such as those with Marfan syndrome—is that risk of rupture in the untreated segment remains until the entirety of the disease has been addressed.
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.
Epicardial transplantation of autologous atrial appendage micrografts: evaluation of safety and feasibility in pigs after coronary artery occlusion
Published in Scandinavian Cardiovascular Journal, 2022
Annu Nummi, Tommi Pätilä, Severi Mulari, Milla Lampinen, Tuomo Nieminen, Mikko I. Mäyränpää, Antti Vento, Ari Harjula, Esko Kankuri
A standard anterior sternotomy was performed under anesthesia. Before any cardiac interventions, echocardiography (echo) was carried out to assess baseline cardiac function. Then the right atrial appendage (RAA) was ligated using a purse string suture. The RAA was removed from all animals in both groups. The standardized size of the RAA tissue used for AAMs patch was 10 mm × 5 mm. For the animals in the AAMs patch group, the harvested RAA was processed mechanically on-site in the operating room using a tissue homogenizer (Rigenera-system, HBW s.r.l., Turin, Italy) [25]. This system utilizes a sterile, single-use tissue mechanical homogenizer surface to generate the micrografts and yields ∼ 5–10 millions of viable cells per gram of RAA tissue [25]. The isolated AAMs were applied in standard cardioplegia suspension, and to seal the micrografts and the suspension to the patch fibrin sealant (TisseelTM, Baxter Healthcare Corp. Westlake Village, CA, USA) was added into the suspension. We used an ECM sheet (Cormatrix® ECMTM Technology, Cormatrix Cardiovascular Inc., Atlanta, GA, USA) as the patch material. The AAMs suspension was placed onto the sheet and the patch was ready to be placed with the AAMs facing the epimyocardium.
Learning Curve of Totally Endoscopic Non Rib-spreading Mitral Valve Surgery
Published in Structural Heart, 2019
Giacomo Bianchi, Rafik Margaryan, Marco Solinas
Methods: From July 2015 to April 2018, 177 patents underwent totally endoscopic mitral valve surgery. The procedure was adopted for “all-comers” patients with either isolated mitral and/or tricuspid valve disease. Euroscore II was used to the risk against which the surgical failure was compared to construct the CUSUM curve. Surgical failure was defned as: 1) perioperative death; 2)intraoperative conversion to sternotomy; 3) perioperative myocardial infarction (new Q- waves >0.04 ms and/or reduction in R-waves >25% in at least two contiguous leads on electrocardiogram); 4) perioperative aortc dissection; 5) stroke (defined as Rankin Modified scale score >= 6) in-hospital reoperation for any cause. Also we considered surgical procedure end-points of failure as the occurrence of one or more of the following: 1) cardiopulmonary bypass (CPB) time exceeding 95% of our “conventional MIMVS” CPB tme; 2) cross-clamp (X-clamp) time exceeding 95% of our conventional approach; 3) preparation time exceeding 95% of our current MIMVS setup.
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