Biomedical subjects

Edda Tschernko

Publications and source records attributed to Edda Tschernko.

3 recordsLinked to original sources

PubMed2005

Total endoscopic CABG using robotics on beating heart.

BACKGROUND: The implementation of a total endoscopic coronary surgery on the beating heart with the aid of the Da Vinci surgical system (Intuitive, Sunnyvale, CA) requires a stepwise learning process. After cadaveric training and clinical start of the program in November 2002, we gained experience with arrested heart procedures starting in May 2003. In November 2003, we moved to beating heart surgery. METHODS: From November 2003 to January 2005, 14 patients with coronary artery disease (mean age of 62 +/- 5 years, female to male ratio 2:12) were operated with the intention to perform a beating heart TECAB (totally endoscopic coronary artery bypass grafting) procedure. RESULTS: Total conversion rate was 35% (5/14), due to pleural adhesions in 2 patients, injury of the lung during port placement, inability to occlude the LAD with saddle loops, atherosclerotic diseased mammary artery in 1 patient each. Mean operating time was 298 +/- 110 minutes with a steady decline throughout the study period (first 5 patients: 342 +/- 61 minutes, patients 6 to 9: 337 +/- 87 minutes, last 4 patients: 290 +/- 53 minutes), resulting in a 60 minute shorter operating time. Mean ICU stay was 1.3 days and hospital stay lasted on average 8.4 +/- 2.8 days. CONCLUSION: Total endoscopic bypass surgery on the beating heart with the Da Vinci surgical system can be safely implemented in clinical use. The learning curve results in a constantly decreasing procedure time due to a more effective table team-console surgeon-robotic system interaction and a moderate conversion rate.

Coronary Artery Bypass, Off-Pump↗

PubMed2004

Complicated acute aortic dissection type B caused by femoral cannulation for endoscopic coronary artery bypass surgery.

PURPOSE: To report endovascular treatment of a patient with complicated acute aortic type B dissection caused by cannulation of the femoral artery for endoscopic coronary artery bypass (CAB) surgery. CASE REPORT: A 63-year-old man underwent single-vessel CAB surgery facilitated by the Da Vinci surgical system. After the procedure, acute lower limb ischemia led to the discovery of a type B dissection from the left subclavian artery to the iliac arteries. The subclavian artery was also dissected, with only minimal flow in the left mammary artery. The visceral and renal vessels originated from the false lumen and were not perfused. Emergent stent-graft placement was undertaken to close the entry tear and re-establish perfusion of the lower extremity as well as visceral and renal organs. Additional stent-grafts were placed in the dissected left subclavian artery to perfuse the left internal mammary bypass and in the inferior mesenteric artery, which arose from the false lumen. Six months after operation, the patient is well. CONCLUSIONS: Acute iatrogenic aortic dissection secondary to endoscopic CAB surgery can be treated emergently to restore distal perfusion to vital organs.

Aneurysm↗

PubMed2003

High-dose remifentanil does not impair cerebrovascular carbon dioxide reactivity in healthy male volunteers.

BACKGROUND: Cerebrovascular carbon dioxide reactivity during high-dose remifentanil infusion was investigated in volunteers by measurement of regional cerebral blood flow (rCBF) and mean CBF velocity (CBFv). METHODS: Ten healthy male volunteers with a laryngeal mask for artificial ventilation received remifentanil at an infusion rate of 2 and 4 microg x kg-1 x min-1 under normocapnia, hypocapnia, and hypercapnia. Stable xenon-enhanced computed tomography and transcranial Doppler ultrasonography of the left middle cerebral artery were used to assess rCBF and mean CBFv, respectively. If required, blood pressure was maintained within baseline values with intravenous phenylephrine to avoid confounding effects of altered hemodynamics. RESULTS: Hemodynamic parameters were maintained constant over time. Remifentanil infusion at 2 and 4 microg x kg-1 x min-1 significantly decreased rCBF and mean CBFv. Both rCBF and mean CBFv increased as the arterial carbon dioxide tension increased from hypocapnia to hypercapnia, indicating that cerebrovascular reactivity remained intact. The average slopes of rCBF reactivity were 0.56 +/- 0.27 and 0.49 +/- 0.28 ml. 100 g-1 x min-1 x mmHg-1 for 2 and 4 microg x kg-1 x min-1 remifentanil, respectively (relative change in percent/mmHg: 1.9 +/- 0.8 and 1.6 +/- 0.5, respectively). The average slopes for mean CBFv reactivity were 1.61 +/- 0.95 and 1.54 +/- 0.83 cm x s-1 x mmHg-1 for 2 and 4 microg x kg-1 x min-1 remifentanil, respectively (relative change in percent/mmHg: 1.86 +/- 0.59 and 1.79 +/- 0.59, respectively). Preanesthesia and postanesthesia values of rCBF and mean CBFv did not differ. CONCLUSION: High-dose remifentanil decreases rCBF and mean CBFv without impairing cerebrovascular carbon dioxide reactivity. This, together with its known short duration of action, makes remifentanil a useful agent in the intensive care unit when sedation that can be titrated rapidly is required.

Adult↗