Biomedical subjects

Michael Danzmayr

Publications and source records attributed to Michael Danzmayr.

3 recordsLinked to original sources

PubMed2005

Hybrid coronary artery revascularization: logistics and program development.

Planning hybrid coronary artery revascularization--a combination of cardiac surgery with percutaneous procedures--requires, at first sight, a very complex logistical setup. Technical and equipment related details should be defined as early as possible in order to have time for training of all OR personnel involved. The most challenging aspect in OR-located hybrid coronary revascularization remains a very close cooperation of cardiac surgeons and interventional cardiologists. This teamwork does include indication findings and subsequent referral of multivessel coronary artery disease patients to hybrid procedures, as well as high individual flexibility of interventionalists and surgeons. The major prerequisite for this cooperation is a mutual acceptance of different revascularization approaches and the intent to combine their most striking advantages. Intraoperative graft angiography during coronary artery bypass grafting (CABG) procedures is one important step toward simultaneous hybrid coronary revascularization procedures. We describe our experience with on table angiography using a mobile C-arm for intraoperative imaging. This fluoroscopy system can in selected cases be used for simultaneous hybrid procedures.

Adult↗

PubMed2003

Modification of surgical technique for ascending aortic atherosclerosis: impact on stroke reduction in coronary artery bypass grafting.

OBJECTIVE: Use of epiaortic scanning in coronary surgery is still a matter of debate. It is unclear whether the findings obtained by epiaortic scanning lead to effective changes in surgical technique that may reduce stroke rates. METHODS: Epiaortic scanning was performed in 352 patients undergoing primary coronary artery bypass grafting before opening the pericardium using a 7.5-MHz ultrasonic probe. In the presence of moderate atherosclerosis (maximum aortic wall thickness of 3 to 5 mm), primarily single aortic crossclamping was carried out. In cases of severe sclerosis (maximum aortic wall thickness > 5 mm), aortic no-touch techniques on the beating heart were used. RESULTS: The degree of ascending aortic atherosclerosis was normal or mild in 151 patients (42.9%), moderate in 167 patients (47.5%), and severe in 34 patients (9.6%). The operative technique was modified in 31.1% of patients with moderate aortic sclerosis and in 91.2% of patients with severe aortic sclerosis. Perioperative mortality was 0.0% for mild disease, 3.0% for moderate disease, and 8.8% for severe disease (P =.005). Corresponding stroke rates reached 2.0%, 2.4%, and 2.9% (P =.935). Logistic regression adjusting for EuroSCORE showed that ascending aortic atherosclerosis was an independent predictor of perioperative mortality (P =.013, odds ratio 1.67, confidence interval 1.11-2.50). The influence of aortic disease on the stroke prevalence was probably due to chance (P =.935), demonstrating a potentially positive effect of operative modifications concerning stroke caused by aortic manipulation. CONCLUSIONS: We conclude that intraoperative screening of coronary artery bypass grafting patients by epiaortic scanning can reveal useful information about the operative risk and with an aortic no-touch concept, perioperative stroke rates in high-risk patients may be lower than predicted.

Age Factors↗

PubMed2003

Intraoperative angiography for quality control in MIDCAB and OPCAB.

We present our initial experience with intraoperative angiographic evaluation of coronary artery bypass grafts placed on the beating heart. Thirty-three grafts were investigated in 23 patients. Transfemoral angiography was performed using an OEC 9800 mobile C-arm. Spasm of the graft and/or target vessel was present in 11 grafts, two grafts were severely stenosed requiring surgical revision. In a third case an additional bypass graft was placed due to angiography findings. There was no hospital mortality and no significant perioperative myocardial ischemic event. All patients were free of angina 6 months postoperatively. Intraoperative angiography seems to reveal valuable information in beating heart coronary surgery.

Adult↗