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Multiple arterial conduits without cardiopulmonary bypass: Early angiographic results

ANNALS OF THORACIC SURGERY 1999年第2期67卷 450-456页

作者： Calafiore, AM Teodori, G Di Giammarco, G Vitolla, G Maddestra, N Paloscia, L Zimarino, M Mazzei, V Hosp Pescara Div Cardiol Pescara Italy Univ G DAnnunzio Dept Cardiac Surg I-66100 Chieti Italy

Background, Lack of angiographic results and technical difficulty in grafting the vessels in the lateral and posterior walls have reduced interest in myocardial revascularization without cardiopulmonary bypass (CPB). We describe our experience to demonstrate the feasibility of coronary surgical intervention without CPB in multivessel disease. Methods. From May 21, 1997, through February 1998, 227 patients underwent revascularization with two or more arterial conduits as the first operation: 122 without CPB (group A) and 105 with CPB (group B). Group A included a greater number of high-risk patients. Results. Mean +/- SD anastomoses per patient were 2.5 +/- 0.6 in group A and 2.8 +/- 0.8 in group B (p = NS). No patient died in group A,whereas 1 patient (0.9%) died in group B. The postoperative complication rate was low in both groups, but, intensive care unit and in-hospital stays were shorter in group A than in group B (14.1 +/- 7.1 versus 27.3 +/- 36 hours, p < 0.001, and 4.1 +/- 1.6 versus 5.4 +/- 2.4 days, p < 0.001, respectively [group A versus group BI). Sixty-seven patients in Group A (54.9%) underwent postoperative angiography 33 +/- 35 days after operation. The patency rate was 98.9% (98.2% for the marginal branches). conclusions. Arterial revascularization of the coronary arteries without CPB is feasible, with results similar to those obtained with CPB. The two techniques;in our opinion, are complementary, not antagonistic. (C) 1999 by The Society of Thoracic Surgeons.

关键词：心肺转流术/仪器和设备冠状血管造影术冠状动脉分流术/仪器和设备冠心病/放射摄影术冠心病/外科学可行性研究医院死亡率住院时间/统计学和数值数据结果与过程评价(卫生保健) 手术后并发症/死亡率危险性评估外科器械老年人女(雌)性人类男(雄)性中年人

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Prevalence of aortocoronary graft marker use and the factors affecting this decision

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JOURNAL OF CARDIAC SURGERY 1998年第3期13卷 194-199页

作者： Eisenhauer, MD Wicks, AB Olson, JP Heric, B Brooke Army Med Ctr Serv Cardiol Ft Sam Houston TX 78234 USA

Background: Despite quantifiable evidence that aortocoronary graft marker (ACGM) insertion is associated with a beneficial impact at postoperative angiography, the choice whether or not to insert them at the time of bypass surgery remains optional. Methods: A onetime anonymous membership survey of the Society of Thoracic Surgeons was used to determine the prevalence of ACGM use and obtain demographic data regarding (1) the type of ACGM inserted, (2) reasons influencing the decision as to whether or not to use ACGMs, and (3) the occurrence of possible related complications. Results: Thirty-nine percent (1,405 of 3,558) and 37% (198 of 531) were returned from within and outside the Unites States, respectively. Sixty percent of US respondents routinely insert ACGMs in the majority of their individual cases. The most frequent reason to not insert ACGMs was a "lack of perceived benefit." Conclusions: The majority of respondents practicing within the United States routinely insert ACGMs at the time of surgery. As no complication directly attributable to the use of graft markers has been reported, further study is warranted to determine the actual complication rate, although it is expected to be low.

关键词：人工血管冠状血管造影术冠状动脉分流术/仪器和设备冠状动脉分流术/统计学和数值数据冠心病/放射摄影术冠心病/外科学决策患病率问卷调查登记/统计学和数值数据回顾性研究学会医学/统计学和数值数据美国人类

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Effect of harmonic imaging without contrast on image quality of transesophageal echocardiography

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第9期84卷 1132-+页

作者： Rocchi, G de Jong, N Galema, TW Kasprzak, JD Ten Cate, FJ Erasmus Univ Heartctr Rotterdam Netherlands

Harmonic imaging improves endocardial border delineation during transesophageal echocardiography when compared with conventional imaging (26% improvement vs 2% worsening;p < 0.001). This allows better assessment of left ventricular function during cardiac surgery, and suggests a role of harmonic imaging for transesophageal echocardiography.

关键词：冠状动脉分流术/仪器和设备超声心动描记术经食管/仪器和设备图像增强/仪器和设备监测手术中/仪器和设备手术后并发症/超声检查敏感性与特异性换能器心室功能左/生理学老年人女(雌)性人类男(雄)性中年人

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SIMPLIFIED CIRCULAR AORTOTOMY IN AORTOCORONARY BYPASS OPERATIONS

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ANNALS OF THORACIC SURGERY 1975年第4期19卷 478-479页

作者： SURMAK, AJ KANTROWITZ, A SINAI HOSP DEPT CARDIOVASC & THORAC SURGDETROITMI SINAI HOSP DEPT SURG6767 W OUTER DRDETROITMI 48235

Adaptation of a rongeur technique facilitates aortotomy in aortocoronary bypass operations. A single motion with a double-action duckbilled rongeur produces a smooth-walled, symmetrical aortotomy which varies in shape... 详细信息

关键词：主动脉/外科学冠状动脉分流术/仪器和设备冠状动脉分流术/方法外科器械移植自体静脉/移植人类

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Assessment of patented coronary end-to-side anastomotic devices using micromechanical bonding

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ANNALS OF THORACIC SURGERY 2000年第1期70卷 218-221页

作者： Scheltes, JS Heikens, M Pistecky, PV van Andel, CJ Borst, C Univ Utrecht Med Ctr Heart Lung Inst Dept Cardiol NL-3508 GA Utrecht Netherlands Delft Univ Technol Dept Design Engn & Prod Man Machine Syst Grp Delft Netherlands

Background. Despite multiple patented ideas for vascular end-to-side anastomotic devices, and the growing need for them in minimally invasive coronary bypass procedures, no device has been evaluated clinically yet. This study assessed patents of micromechanical end-to-side anastomotic devices with respect to application in coronary artery bypass grafting. Methods. Patents were categorized with respect to their micromechanical bonding principle. Calculated values for the wall strain during the construction of an anastomosis were compared with the allowable strain for human coronary arteries. Results. From 51 patents describing vascular anastomotic devices, 11 ideas, categorized into four groups (staples, clips, mounting systems, and intraluminal stent structures), are serious candidates for coronary end-to-side anastomoses. Most ideas use an anvil for proper application of the bonding elements. For small (1.5 mm) coronary arteries, the calculated wall strain was 0.87, exceeding the breaking strain (0.45) in 60- to 79-year-old patients. Conclusions. In a coronary anastomotic device, the concept of using an anvil for the application of micromechanical bonding elements is not attractive, because excessive wall strain is likely to occur. (Ann Thorac Surg 2000;70:218-21) (C) 2000 by The Society of Thoracic Surgeons.

关键词：吻合术外科/仪器和设备人工血管冠状动脉分流术/仪器和设备冠状血管评价研究专利假体设计

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Minimally invasive vein harvest: New techniques with old tools

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ANNALS OF THORACIC SURGERY 1999年第2期67卷 571-572页

作者： Newman, RV Lammle, WG MeritCare Med Ctr Dept Cardiothorac Surg Fargo ND 58123 USA

Greater saphenous vein harvest has been the focus of increasing applications of endoscopic techniques aimed at reducing wound complication, increasing patient comfort, and providing more acceptable cosmetic results. A retired, reusable, lighted retractor used for breast surgery was adapted using minimally invasive and bridge techniques resulting in decreased incisions, gentle vein handling, decreased harvest to closure time, and better wound healing compared with open techniques. (C) 1999 by The Society of Thoracic Surgeons.

关键词：冠状动脉分流术/仪器和设备设备设计外科器械外科手术微创性/仪器和设备静脉/移植人类

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Videoscopic harvest of the inferior epigastric artery

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ANNALS OF THORACIC SURGERY 1999年第2期67卷 565-566页

作者： Hoenig, SJ Hodin, RA Novak, G Cohn, WE Beth Israel Hosp Div Cardiothorac Surg Boston MA 02215 USA

The inferior epigastric artery has been found to be a useful conduit for performing arterial coronary revascularization. The present report describes a minimally invasive port access technique for harvesting the infer... 详细信息

关键词：冠状动脉分流术/仪器和设备内窥镜腹壁动脉/移植设备设计外科手术微创性/仪器和设备录像/仪器和设备人类男(雄)性

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USE OF A FOGARTY BILIARY CATHETER TO CREATE A BLOODLESS FIELD FOR SAPHENOUS VEIN CORONARY ARTERY ANASTOMOSIS

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JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1975年第1期69卷 105-106页

作者： GROW, JB BRANTIGAN, CO ST LUKES HOSP DEPT SURGDENVERCO

A technique is described in which biliary Fogarty catheters are used to create a bloodless field for saphenous vein-coronary artery anastomosis.

关键词：动脉/外科学冠状动脉分流术/仪器和设备冠状动脉分流术/方法冠状血管/外科学心脏导管插入术/仪器和设备隐静脉/移植移植自体人类

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Coronary artery bypass grafting on the beating heart: A simple technique for subluxating the heart

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ANNALS OF THORACIC SURGERY 1999年第3期67卷 870-871页

作者： Shennib, H Bastawisy, A McGill Univ Dept Cardiothorac Surg Montreal PQ Canada

Coronary artery bypass grafting on the beating heart is becoming a widely applied procedure. It necessitates proper cardiac stabilization without impairment of hemodynamics. We describe a simple and effective technique to bring the anterolateral coronary arteries to a midline position for the purpose of performing a coronary artery bypass graft on the beating heart. A surgical glove tied to a tube is positioned underneath the left ventricle. Injection of warm saline into the glove will gradually displace the heart and rotate the lateral wall of the ventricle to a midline position. In spite of our use of mechanical stabilizers to decrease mobility of the anastomotic site, compression of the left ventricle is avoided because the water bed created by the injected glove absorbs the movement of the left ventricle and prevents its compression and any potential drop in cardiac output. (Ann Thorac Surg 1999;67:870-1) (C) 1999 by The Society of Thoracic Surgeons.

关键词：冠状动脉分流术/仪器和设备冠状动脉分流术/方法心肌收缩人类

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Vascular clamp for hemostasis and stabilization during minimally invasive direct coronary artery bypass

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ANNALS OF THORACIC SURGERY 1999年第2期68卷 585-586页

作者： Goh, K Inaba, M Yamamoto, H Akasaka, N Sasajima, T Asahikawa Med Coll Dept Surg 1 Asahikawa Hokkaido 0788510 Japan

A soft vascular clamp was used for hemostasis and stabilization of the operative field during minimally invasive direct coronary artery bypass (MIDCAB). The instrument was gently applied so that it clamps the coronary artery by grasping the adjacent myocardium. The method offered dry and stable operative field without a special instrument or technique. The surgical results have been satisfactory. We found application of the vascular clamp to be very helpful for MIDCAB. (C) 1999 by The Society of Thoracic Surgeons.

关键词：动脉/移植冠状动脉分流术/仪器和设备冠状血管/外科学设备设计止血手术/仪器和设备外科器械外科手术微创性/仪器和设备人类

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