We investigated the use of bivalirudin as an anticoagulant therapy during cardiopulmonary bypass in 20 patients who underwent coronary artery bypass grafting. Primary end points consisted of clinical outcome data, whereas secondary end points focused on blood loss, transfusions, pharmacokinetics, and monitoring. Our data provide the first evidence of clinical feasibility of anticoagulation with bivalirudin during cardiopulmonary bypass.

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PubMed2003

Mitral valve replacement versus repair in 2003: where do we stand?

Mitral valve repair as a proportion of all mitral valve procedures continues to become more prominent in this country. As the procedures are performed more frequently and concomitantly surgeons become more comfortable performing these repairs, risks and benefits (compared with mitral valve replacement) have become better defined. The patient population and valve morphology that are most favorable for the repair approach have also been better defined, and new techniques (including minimally invasive approaches) have been reported. A prominent question remains: what to do about ischemic mitral regurgitation.

Heart Valve Prosthesis Implantation↗

PubMed2003

A porcine beating heart model for robotic coronary artery surgery.

BACKGROUND: The application of robotically assisted coronary artery surgery continues to be investigated clinically. Consequently, there is a need for a simple method to train surgeons in performing these operations. The aim of the present study was to assess a model using an excised porcine heart for the training of surgeons in creating a robotically assisted arterial anastomosis. METHODS: An ex vivo beating heart model was constructed with a porcine heart and was evaluated by 3 cardiac surgeons previously trained in robotic surgery. All anastomoses from the first half of the study were reviewed to measure anastomotic time, the number of sutures placed, and the rate of suture placement per minute and were compared to those completed in the second half of the study by means of a unpaired Student t test. RESULTS: Fifty-seven anastomoses were completed with the beating heart model, 28 in the first half of the study and 29 in the second half. The mean time to create an anastomosis in the first half of the study was 19.3 minutes (range, 10-28 minutes), compared with 15.0 minutes (range, 7-20 minutes) in the second half; the difference did not meet statistical significance. However, the number of sutures placed per minute did increase in the second half of the study with a mean of 0.77 sutures per minute (range, 0.55-1.25), compared with 0.56 sutures per minute (range, 0.40-0.80) in the first half of the study (P <.0001). The number of sutures per anastomosis also decreased in the second half of the study with a mean of 9.0 sutures (range, 8-11), compared with 10.6 sutures (range, 8-16) in the first half of the study (P =.0049). CONCLUSIONS: This preliminary experience demonstrated technical improvements in the second half of the study. Fewer sutures were placed per anastomosis with better precision, implying a learning curve that could be accelerated with our model. This porcine beating heart model represents an inexpensive training method that mimics the beating heart, complete with coronary blood flow, and may be used multiple times to train and assess a surgeon's skill in robotically assisted coronary surgery.

Animals↗

PubMed2002

Symptomatic Bochdalek hernia in an octogenarian.

We present a case of an 88-year-old man who presented with chest pain and shortness of breath. Chest radiography suggested the presence of a ruptured diaphragm, and on exploration a left Bochdalek defect with herniation of stomach and small bowel into the left pleural cavity was found. This was repaired and the patient eventually was discharged to a nursing facility. We believe this represents the oldest patient presentation of a symptomatic Bochdalek hernia.

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PubMed2002

VHI report card gets a failing grade. Virginia Health Improvement.

Explore the source record for details and available documents.

Databases, Factual↗

PubMedDate not supplied

Onlay patch for complete intercostal artery preservation during thoracic and thoracoabdominal aortic aneurysm repair.

BACKGROUND: Replacement of the thoracic aorta is associated with a potential for interruption of the blood supply to the spinal cord leading to paralysis. Techniques have been proposed to ameliorate this risk, including reimplantation of the intercostal arteries. We present a technique to simplify this approach. METHODS: In patients with extensive aneurysmal disease, a standard approach to the thoracic aorta via a left thoracotomy is performed. The patient is placed on full cardiopulmonary bypass with moderate hypothermia. The proximal anastomosis is performed unclamped with circulatory arrest. After completing the proximal and distal anastomosis separately, an onlay patch of Dacron is created and placed along the entire back wall of the aorta to cover all of the intercostal arteries. A side-to-side anastomosis between the patch and the distal graft is then performed and subsequently the anastomosis tested by retrograde flow. RESULTS: The technique allows direct inspection of all suture lines, tested to an adequate pressure, so that postoperative bleeding is minimal. CONCLUSION: Techniques to lessen the risk of paraplegia associated with aortic surgery include reimplantation of the intercostal arteries. This technique allows each suture line to be tested and easily visually inspected prior to closure of the chest.

Adult↗

PubMedDate not supplied

Developing a blood conservation program in cardiac surgery.

The beneficial effects of blood transfusions have been described and widely accepted. Multiple factors, including shortages, costs, infectious risks, immunologic risks, and the risk/benefit ratio to the patient, have made the medical community reassess the guidelines for transfusion. Cardiac surgery presents a unique subset of patients, because intervention at multiple stages in the care of these patients is possible to decrease the need for transfusion. An algorithm for a cardiac surgery program was developed and a reassessment performed. Once it was seen that no detrimental effect on patient care occurred, the program was expanded, was enhanced, and subsequently has been offered to the rest of the health care system. This program has resulted in a decrease in cost while maintaining patient outcomes. The success of the program is believed to be a result of the multidisciplinary approach taken, with a commitment from all members of the blood reduction team being the key component of this success.

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