ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00001.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractIn this fourth part of our series of articles concerned with the surgical anatomy of ventricular septal defects (VSDs), we have analyzed the arrangements when both arterial trunks arise from the same ventricle. The essence of these anomalies is that the interventricular communication is an integral part of the circulation. Unless the surgeon constructs an alternative route of exit, closure of this defect would isolate one of the ventricles. The usual surgical approach, therefore, is to patch the hole between the ventricles into one or other of the subarterial outflow tracts. This means that all the components of the ventricular outflow tracts are of potential surgical importance. In hearts with double outlet right ventricle, the VSD can be categorized as being subaortic, subpulmonary, doubly committed, or noncommitted. It is also important to determine whether its anatomical borders, as seen from the right ventricle, are in part fibrous or exclusively muscular, so as to establish the location of the atrioventricular conduction axis. It is possible, according to the nature of these borders, to place the defects into one of three groups, perimembranous, muscular, or doubly committed and juxta‐arterial. The size of the defect is another important surgical consideration. Double outlet left ventricle is a significantly more rare malformation, but the rules for determining the disposition of the conducting tissues are the sam

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00002.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractDespite many advances in blood conservation techniques, a significant proportion of patients undergoing primary coronary revascularization still require homologous transfusions. Based on a large clinical experience with high‐risk patients during coronary artery bypass, a comprehensive strategy to diminish perioperative blood loss was developed by integrating many individual components. An integral component in this strategy is the use of lower heparinization (activated clotting time [ACT]>280 sec) in conjunction with “tip‐to‐tip” heparin‐bonded cardiopulmonary bypass (CPB) circuits (HBC). This technique was prospectively applied to a group of Jehovah's Witnesses (JW) patients who refuse blood transfusion on religious grounds (n = 9). Outcome was compared to a matched group of patients treated with full heparinization (ACT>480 sec) used with conventional, nonheparin‐bonded CPB circuits (NHBC) performed within the same academic year (n = 455). There were no complications in JW patients who had a significantly lower mediastinal and pleural tube output in the first 24 hours (323 67 mL vs 984 616 mL, p<0.01). In comparison to JW patients who received no transfusions, 68.1% of patients treated with NHBC were transfused (p 0.0001). In summary, HBC in conjunction with lower anticoagulation was effectively and safely applied to JW patients undergoing coronary artery bypass grafting. This technique should be considered for broader

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00003.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractFrom November 1989 to December 1994, we performed 2264 bypass procedures. Data were collected prospectively. The population was divided into three subgroups: group 1 = single internal mammary artery (IMA) ± veins (n = 1584); group 2 = veins only (n = 503); and group 3 = two or more arterial conduits ± veins (n = 177). Patients who received only saphenous vein conduits (group 2) were significantly older (66.7 ± 8.9 years) than either group 1 (60.3 ± 8.3 years) or group 3 (51.6 ± 9.2 years). Furthermore, this cohort group had the highest percentage of females (28.6%), urgent cases (43.5%), preoperative myocardial infarction (MI) (18.5%), and redo surgery (5.4%). In contrast, patients who received two or more arterial conduits were 94.9% male, and had the lowest incidence of urgent cases (18.1%) and redo surgery (0.5%). Mortality was 1.4% in group 1 and 3.2% in group 2; there were no deaths in group 3. Furthermore, group 2 patients had the highest incidence of perioperative MI (6.6%), low output syndrome (22.1%), intra‐aortic balloon pump (IABP) assist (6.2%), and stroke (2.7%). By multivariate logistic regression analysis (odds ratio in parentheses), redo surgery (7.92), preoperative IABP (5.53), poor LV function (4.01), renal impairment (3.94), and advanced age (2.12) were all predictors of operative mortality. When mortality and morbidity (death, infarction, low output syndrome, IABP assist) were combined, regression analysis revealed that in addition to the above variables, female gender and cold cardioplegia were also independent predictors of combined mortality and morbidity. Resource utilization was determined for the three patient groups. There was concern that the increased technical demands of multiple arterial grafting along with longer periods of aortic occlusion and pump times may lead to increased complications and prolonged hospital stay. However, we found that group 3 had the lowest ventilation time, intensive care unit stay, and hospital stay. The results no doubt were influenced by case selection. Whether or not this approach to revascularization will increase long‐term survival and freedom from reoperation will require furth

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00004.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractCardiomyoplasty has the potential to become an alternative therapy for congestive heart failure patients and is presently in Phase III clinical trials. In experimental studies, it is necessary to use an animal with muscle characteristics that resemble those of humans. Therefore, the purpose of this study was to compare morphological and biochemical characteristics of the latissimus dorsi muscle (LDM) of three common large mammals with those of human. Of the three mammals studied, the goat had the most overall similarities to the human when comparing mitochondrial capacity, percent fiber types, fiber areas, myofibrillar (MF)‐AT‐Pase activity, and 72‐kDa heat shock protein (HSP) content. The pig was dissimilar to the human in its fiber‐type arrangement, glycolytic capacity, percent fiber type, MF‐ATPase activity, and HSP‐72 content. The dog differed from the human in that it had high‐mitochondrial enzyme activity, a fiber‐type profile consisting of all high‐aerobic fibers, and fiber cross‐sectional areas that were nearly half those of humans. These findings show that the LDM of the goat most resemble

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00005.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractFrom April 1975 to February 1995, 305 patients (260 females and 45 males) underwent open heart surgical procedures through the thoracotomy approach. Their ages ranged from 4 months to 55 years (mean age 21.8 ± 13 years). Two hundred and ninety‐seven patients were operated through the right and eight through the left thoracotomy approach. Two hundred and sixteen patients had congenital heart disease and 89 patients had acquired heart diseases, which included ostium secundum defect (190 patients), sinus venosus defect (11 patients), partial atrioventricular (AV) canal defect (5 patients), complete AV canal (1 patient), ventricular septal defect (4 patients), Tetralogy of Fallot (3 patients), anomalous origin of left coronary artery from pulmonary artery (3 patients), mitral valve lesions (83 patients), including tricuspid valve lesions (5 patients) and coronary artery disease (2 patients). Postoperative recovery was observed to be faster (mean hospital stay 7.8 days vs mid‐sternotomy 9.6 days), infection rate lower (0.35% vs median sternotomy 2.56%), postoperative drainage lower (148.8 ± 86.2 mL vs median sternotomy 587 ± 112.6 mL), and cosmetically found to be much more acceptable in the female population. There have been seven early and one late postoperative deaths which were unrelated to the operative approach. We conclude from this experience that thoracotomy can be safely used as an access for a wide variety of open cardiac surgical operations on the atrial and (upper) ventricular septae, AV valves, right ventricular outflow tract, and coronary artery reconstruction in some situations. It is also useful in some emergency and redo operations with distinct advantages over the median sternotomy approach. We feel its use should be increased as newer subsets of patient populations are being subjected to primary and redo cardiac oper

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00006.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractRight latissimus dorsi Cardiomyoplasty has recently been shown to provide effective support for the chronic failing heart. A simplified technique to perform this procedure is described here. The use of the pericardial “suspenders” may avoid dangerous lifting of the heart out of its sac position, and allow a more appropriate adjustment of the wrapping tension with enhanced surgical management and potential benefits for postoperative outc

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00007.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground and Aims: Recent evidence suggests that the incidence of stroke during cardiac surgery may be reduced by using intraoperative epiaortic ultrasound (IEU) to detect ascending aortic atherosclerosis (AAA). To better define the role of this modality, IEU was performed in 89 patients during elective cardiac procedures.Methods: The ascending aorta and proximal arch were divided into four segments that were graded (0 to 2) on the extent of disease both by palpation and IEU. A patient score (range 0 to 8) was determined for each modality by summing the segmental scores. Operative plan was determined in part by IEU findings. Preoperative variables were evaluated for associated risk of AAA. Palpation and IEU scores were compared for their ability to identify AAA.Results: Operative technique was modified to avoid AAA in ten (11.2%) patients (mean age 68.3 ± 2.2 years; mean IEU score = 4.40 ± 0.40). Stroke occurred in two patients (2.2%), one whose operation was modified to avoid severe AAA and another who had minimal AAA. Mean IEU scores were significantly higher for patients ± 65 years compared with younger patients (1.35 ± 0.26 vs 0.66 ± 0.21; p<0.05) and for smokers compared with nonsmokers (1.15 ± 0.19 vs 0 ± 0; p<0.05). Mean patient IEU score was greater than mean palpation score (1.06 ± 0.18 vs 0.74 ± 0.16; p<0.05). Sensitivity of palpation (based on 356 segments) was 0.46; however, specificity was 0.96, predictive power of a negative palpation exam was 0.88, and overall accuracy of palpation was 0.86. Thirty of the 38 false negatives resulted from failure to detect 1+ disease. None of the 63 (71%) patients with a palpation score of zero required a technical modification or had a stroke.Conclusions: These data suggest that AAA may be more severe in older patients and smokers. Aortic palpation may not identify mild AAA. IEU can confirm and clearly define both the extent and distribution of suspected AAA and is useful for determining optimal operative strategy in patients with aortic

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00008.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractThe incidence of diffuse disease requiring multiple endarterectomies is high among the Oriental population. The technique of LAD endarterectomy and reconstruction is difficult, and often it is a challenging problem. From June 1987 to September 1994, 2376 patients from seven countries underwent coronary artery bypass graft surgery, among whom 610 patients had endarterectomy. One hundred thirty‐six patients underwent LAD endarterectomy, and among them, 69 had extensive endarterectomy. The LAD was reconstructed with IMA onlay patch in 41 patients and with saphenous vein onlay patch in 28 patients. Three patients had evidence of postoperative myocardial infarction and seven patients died in the postoperative period. Twelve patients were postoperatively restudied and in all of them, the graft to LAD was patent. Use of internal mammary artery onlay patch after endarterectomy is advantageous since it may be associated with higher long‐term patency and low incidence of reoperation. To our knowledge, this has not been reported anywh

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00009.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractAim of Study: To evaluate the necessity and efficacy of quinidine fumarate, verapimil, or amiodarone prophylaxis for sinus rhythm maintenance in patients who experienced atrial fibrillation after coronary artery bypass surgery.Methods: Between 1992 and 1995, this prospective, randomized, placebo‐controlled study examined 120 patients in whom atrial fibrillation occurred and was restored to sinus rhythm by pharmacological therapy or direct current cardioversion in the immediately postoperative period after coronary artery bypass surgery. There were no significant differences in perioperative characteristics among the patients, who were randomly separated into four groups in the course of discharge. In group 1 (n = 30), patients did not receive antiarrhythmic drugs. Quinidine fumarate was given in group 2 (n = 30), verapimil in group 3 (n = 30), and amiodarone in group 4 (n = 30). Patients were monitored six times over a 90‐day postoperative period by 24‐hour Holter monitoring and routine examination.Results: The recurrent atrial fibrillation usually developed within 15 days of discharge. Atrial fibrillation occurred in one patient (3.33%) in group 1, and two each (6.66%) in groups 2, 3, and 4. Atrial fibrillation was asymptomatic and occurred with slow ventricular response in groups 3 and 4. Side effects occurred in 5 patients (16.6%) given quinidine, 1 patient given amiodarone, but in no patient given verapimil.Conclusions: There were no significant differences in the maintenance of sinus rhythm among the four groups, so we suggest that long‐term prevention of atrial fibrillation in patients with coronary artery bypass grafting was not necessary at the postdischarge

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00010.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY