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Perioperative nurse training in cardiothoracic surgical robotics.

AORN journal 2001年第6期74卷 851-852页

作者： Connor, M.A. Reinbolt, J.A. Handley, P.J. Center for Advanced Surgery Sarasota Memorial Hospital Sarasota Fla. USA.

The exponential growth of OR technology during the past 10 years has placed increased demands on perioperative nurses. Proficiency is required not only in patient care but also in the understanding, operating, and troubleshooting of video systems, computers, and cutting edge medical devices. The formation of a surgical team dedicated to robotically assisted cardiac surgery requires careful selection, education, and hands-on practice. This article details the six-week training process undertaken at Sarasota Memorial Hospital, Sarasota, Fla, which enabled staff members to deliver excellent patient care with a high degree of confidence in themselves and the robotic technology.

关键词：冠状动脉分流术/仪器和设备冠状动脉分流术/方法冠状动脉分流术/护理佛罗里达在职培训/方法围手术期护理/教育规划制订机器人/教育技术转让胸外科手术电视辅助/仪器和设备胸外科手术电视辅助/方法胸外科手术电视辅助/护理美国人类

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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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A review of 1,582 consecutive octopus off-pump coronary bypass patients

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ANNALS OF THORACIC SURGERY 2000年第3期70卷 1017-1020页

作者： Hart, JC Spooner, TH Pym, J Flavin, TF Edgerton, JR Mack, MJ Jansen, EWL Pinnacle Hlth Syst Harrisburg PA USA Healthsyst Minnesota Pk Nicollet Heart Ctr Minneapolis MN USA Albert Einstein Med Ctr Philadelphia PA 19141 USA Cardiac Surg Associates Minneapolis MN USA Med City Dallas Dallas TX USA Univ Utrecht Hosp Utrecht Netherlands

Background. Off-pump coronary bypass may provide a safer form of surgical revascularization by avoiding the unwanted complications of cardiopulmonary bypass, particularly in the increasingly complex patients being referred for operation. This study reviews the entire experience of the Medtronic Octopus System (Medtronic, Minneapolis, MN) for beating heart bypass from 7 surgeons. Demographics, operative procedures, early outcomes, and trends in usage were examined. Methods. Patients were selected for off-pump procedures by the individual surgeons. Data were entered prospectively into locally maintained databases and then collected for collation and analysis. Results. A total of 1,582 consecutive Octopus patients were entered, representing the entire Octopus experience of each surgeon. Proportions of oh-pump procedures relative to standard bypass increased over time, as did the percentage of patients receiving three or more grafts, 24.6% in 1997 and 55.9% in 1999. A total of 3,653 anastomoses were performed, 1,905 to the left anterior descending system, 837 to the circumflex distribution, and 911 to the right coronary territory. Morbidity was low. Few patients required conversion to cardiopulmonary bypass (2.6%;0.2% urgently). Permanent stroke occurred in 0.6% and myocardial infarction in 1.2%. Operative mortality was 1%. Conclusions. Octopus off-pump bypass was demonstrated to be a safe procedure with widening applicability. With experience surgeons tend to apply the system to increasing proportions of their patients and are able to revascularize all coronary territories. (Ann Thorac Surg 2000;70:1017-20) (C) 2000 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/方法前瞻性研究外科手术微创性/方法治疗结果老年人女(雌)性人类男(雄)性中年人

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Effects on coronary endothelial function of the Cohn stabilizer for beating heart bypass operations

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ANNALS OF THORACIC SURGERY 2000年第3期70卷 1111-1114页

作者： Perrault, LP Nickner, C Desjardins, N Carrier, M Montreal Heart Inst Res Ctr Montreal PQ H1T 1C8 Canada Montreal Heart Inst Dept Surg Montreal PQ H1T 1C8 Canada

Background. The effects of different stabilizing methods for minimally invasive beating heart coronary artery bypass grafts (CABG) on coronary endothelial function are unknown. Methods. We compared the effects on endothelial function of the Cohn stabilizer (used with proximal snaring by Retract-o-tape silicone air cushion) and a coronary shunt (CTS flow coil shunt) on an in vivo model of beating heart CABG. The two techniques were applied for 15 minutes on porcine epicardial coronary arteries. Control rings were taken from the same coronary artery. Endothelial function of control and instrumented arterial rings was studied in organ chamber experiments. Evaluation of endothelial coverage was performed with silver nitrate staining. Results. Endothelium-dependent relaxation to serotonin and bradykinin was significantly decreased in the shunt group compared to control, Cohn stabilizer, and snare groups. There were no significant differences in the endothelium-independent relaxation to sodium nitroprusside between groups. Conclusions. Greater endothelium-dependent relaxation with the Cohn stabilizer suggests better preservation of endothelial coverage at the site of application and reduced propensity for coronary spasm and later development of intimal hyperplasia. (Ann Thorac Surg 2000;70:1111-4) (C) 2000 by The Society of Thoracic Surgeons.

关键词：缓激肽/药理学冠状动脉分流术/仪器和设备冠状动脉分流术/方法冠状血管/生理学内皮血管/生理学硝普钠/药理学血清素/药理学外科手术微创性/仪器和设备猪血管舒张/生理学血管舒张药/药理学动物

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Multiple arterial conduits without cardiopulmonary bypass: Early angiographic results

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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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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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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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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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