bluuebunny/crossref_metadata_2025_split huggingface dataset:
Planned Simultaneous Beating-heart Totally Endoscopic Coronary Artery Bypass (TECAB) and Percutaneous Intervention in a Single Operative Setting
Authors: Srivastava Sudhir , Gadasalli Suresh , Tijerina Orlando , Barrera Reyna , Quismundo Shaune , Srivastava Vishwa 
Published: May 2008

Background Staged hybrid revascularization integrated with minimally invasive coronary artery bypass grafting (CABG) and arrested heart totally endoscopic CABG has been reported. We report the first case of planned simultaneous hybrid coronary revascularization, integrating beating-heart TECAB, and percutaneous intervention (PCI) in the same operative setting. Methods A 73-year-old woman with symptoms of angina and a history of diabetes was found to have 2-vessel coronary artery disease involving the left anterior descending (LAD) and the right coronary artery (RCA). Left internal thoracic artery (LITA) to the LAD grafting was done on a beating heart in a totally endoscopic manner using the da Vinci robotic system through 4 ports. Immediately after LITA to LAD TECAB, percutaneous angioplasty and stent placement was done through the right femoral artery using the OEC 9800 mobile C-arm in the operating room. Results There was no stenosis noted in the RCA after the intervention. LITA angiography showed a completely patent anastomosis. The total operative time for both procedures was 165 minutes. Occlusion and anastomotic times were 14 and 8 minutes, respectively. Total PCI and fluoroscopy times were 10 and 3 minutes, respectively. The patient received clopidogrel (Plavix) and aspirin in the immediate postoperative period and was discharged home on the second postoperative day. Conclusion This planned hybrid approach involving a beating-heart single-vessel TECAB and simultaneous angioplasty-stent in a single operative setting achieved complete coronary artery revascularization in a less invasive way.
Off-Pump Coronary Artery Bypass Leads to a Regional Hypercoagulable State Not Detectable Using Systemic Markers
Authors: Kon Zachary N. , Kwon Michael H. , Collins Michael J. , Kallam Seeta , Sangrampurkar Rupali , Ozeki Toshinaga , Brown Emile N. , Romar Linda G. , Pierson Richard N. , Gammie James S. , Brown James M. , Griffith Bartley P. , Poston Robert S. 
Published: May 2008

Objective It is believed that off-pump coronary artery bypass grafting (OPCAB) leads to hypercoagulability, but efforts to document such a state have been unrevealing. We hypothesized that OPCAB increases the risk of developing a regional hypercoagulable state. Methods Blood was obtained from the aorta and coronary sinus (CS) after CABG performed off- (N = 69) or on-pump (N = 35) to determine the transcardiac gradients of F1.2 (thrombin production), XIIa (coagulation activation), myoglobin (ischemia) and IL-6, IL-8 using ELISA and platelet-derived microparticles using FACS. Platelet function was measured using aggregometry. Regional myocardial pH and SVG flow were recorded intraoperatively. SVG biopsies were analyzed for endothelial integrity (EI) using immunohistochemistry and graft patency was determined by predischarge CT angiography. Results Compared with on-pump, OPCAB provoked significantly higher transcardiac F1.2 (117±200 v. 31±38%), FXII-a (14±29 v. 2±4%), microparticles (14± −9.5% v. 6.4±—4.1%), IL-6 (119±183 v. 28±39%), and a trend toward increased IL-8 (67±94 v. 24±46%, P = 0.077). Myoglobin release after OPCAB, also greater than on-pump CABG (54±89 v. 8±14%, P < 0.01), correlated with regional pH change (R = −0.96, P < 0.0001), and F1.2 release (R = 0.55, P = 0.0002). In contrast, systemic changes in these markers were all less after OPCAB. SVG flow was significantly reduced in OPCAB (39.4 versus 66.5 mL/min, P = 0.0002), but EI and graft patency rates were the same. Conclusions Through the use of transcardiac assays, we illustrated that regional coagulation was enhanced after off- compared with on-pump CABG. If the findings of this pilot study are confirmed, OPCAB may require additional antithrombotic therapies to respond to this local hypercoagulable state.
Starfish™ Heart Positioner Maintains Right Ventricular Function During Lateral Wall Displacement
Authors: Ishikawa Nobuki , Watanabe Go , Ohtake Hiroshi , Terada Takuro 
Published: May 2008

Background The authors examined parameters of cardiovascular function using Starfish and deep pericardial sutures (DPS) in a beating heart porcine model and to clarify toleration of right ventricular function with Starfish in lateral wall displacement. Methods Eight healthy pigs were used. In addition to normal pressure monitor catheters, a Swan-Ganz continuous cardiac output (CO) and end diastolic volume thermodilution catheter was used for precise and quantitative monitoring of the right ventricular function. Results Lateral displacement of the heart with DPS resulted in a significant hemodynamic compromise. Cardiac output and right ventricular ejection fraction (RVEF) decreased from 3.0 ± 0.9 to 2.6 ± 1.0 L/min (P = 0.014) and from 27.9 ± 3.0% to 23.3 ± 4.8% (P = 0.019). With Starfish™, CO and RVEF were maintained from 3.0 ± 0.9 to 3.0 ± 0.9 L/min (P = 0.743) and from 27.9 ± 3.0% to 28.3 ± 3.8% (P = 0.476). Conclusion Starfish™ contributed to the stability of hemodynamics by maintaining the right ventricular function. Lateral displacement with PDS resulted in significant hemodynamic compromised compared with Starfish™ and baseline neutral position.
Off-Pump versus Conventional Coronary Artery Bypass Grafting: A Meta-Analysis and Consensus Statement from the 2004 ISMICS Consensus Conference
Authors: Puskas John , Cheng Davy , Knight John , Angelini Gianni , DeCannier Didier , Diegeler Anno , Dullum Mercedes , Martin Janet , Ochi Masami , Patel Nirav , Sim Eugene , Trehan Naresh , Zamvar Vipin 
Published: May 2008

Background The purpose of this evidence-based consensus statement is to systematically review and meta-analyze the randomized and nonrandomized evidence comparing off-pump (OPCAB) to conventional coronary artery bypass (CCAB) surgery and to provide consensus on the role of OPCAB in low- and high-risk surgical patients. Methods and Results This consensus conference was conducted according to the American College of Cardiology (ACC)/American Heart Association (AHA) standards for development of clinical practice guidelines. The Steering Committee collated all published studies of OPCAB versus CCAB through May 2004 and developed six questions central to controversies surrounding OPCAB surgery in mortality, morbidity, and resource utilization. For mixed-risk patient populations, meta-analysis of 37 randomized clinical trials (3,369 patients, Level A) reported across a total of 53 papers, and two meta-analyses of nonrandomized trials (Level B) comparing OPCAB versus CCAB were identified. For high-risk patient populations, we performed a meta-analysis of 3 randomized and 42 nonrandomized trials (26,349 patients, Level B). Conclusion Meta-analysis of Level A and B evidence provided the basis for the following consensus statements in patients undergoing surgical myocardial revascularization: (1) OPCAB should be considered a safe alternative to CCAB with respect to risk of mortality [Class I, Level A]; (2) With appropriate use of modern stabilizers, heart positioning devices, and adequate surgeon experience, similar completeness of revascularization and graft patency can be achieved [Class IIa, Level A]; (3) OPCAB is recommended to reduce perioperative morbidity [Class I, Level A]; (4) OPCAB may be recommended to minimize midterm cognitive dysfunction [Class IIa, Level A]; (5) OPCAB should be considered as an equivalent alternative to CCAB in regard to quality of life [Class I, Level A]; (6) OPCAB is recommended to reduce the duration of ventilation, ICU and hospital stay, and resource utilization [Class I, Level A]; (7) OPCAB should be considered in high-risk patients to reduce perioperative mortality, morbidity, and resource utilization [Class IIa, Level B].
Transabdominal Off-Pump Coronary Artery Bypass Grafting Using the Right Gastroepiploic Artery
Authors: Tavilla Giuseppe 
Published: May 2008

Background Anastomosis of the right gastroepiploic artery to vessels of the inferior wall of the heart can be performed using a transabdominal approach without sternotomy and without cardiopulmonary bypass. Methods From July 1999 to December 2004, 18 patients presenting with only right coronary artery disease were operated on by the transabdominal approach using a pedicled right gastroepiploic artery graft. In 14 patients, it was a redo operation. In all redo patients, a patent graft to the anterior wall was present. Median EuroSCORE was 5 (range 1–13). The right descending posterior artery was grafted in 10 patients, the right coronary artery in 8 patients. Results There was no hospital mortality and no conversion to sternotomy. Hospital morbidity consisted only of a right pleural hemothorax and a superficial wound infection. No blood transfusion was necessary in 16 (89%) patients. Hospital stay averaged 6 days. Follow-up is complete and averaged 2 years (range 0.5–5.5 years). There was no late mortality. Seventeen patients (94%) were asymptomatic. One patient who experienced return of angina 1 year after the procedure underwent a percutaneous transluminal coronary angioplasty of the right coronary artery. Thirteen patients underwent a stress test at median follow-up of 14 months without signs of myocardial ischemia. Conclusions Off-pump coronary bypass grafting using a right gastroepiploic artery by the transabdominal approach is a safe and effective procedure with a low hospital morbidity and excellent follow-up. In redo operations, this technique excludes the risk of damaging patent grafts to the left coronary system.
Cardioscopic Trans-septal Cryoablation of Left Atrium in Nonmitral Cases
Authors: Ohtsuka Toshiya , Ninomiya Mikio , Maemura Taisei 
Published: May 2008

Background A modified maze procedure in which trans-septal cardioscopy was used for cryoablation in the left atrium is described. Methods The technique was used in 11 consecutive patients (9 men and 2 women, 56.5 ± 19.8 years) with permanent atrial fibrillation (Af) and concomitant nonmitral cardiac or aortic disease: aortic valvular disease in 4 patients, atrial septal defect (ASD) in 2 patients, tricuspid regurgitation in 2 patients, acute aortic dissection in 1 patient, arch aneurysm in 1 patient, and coronary artery disease in 1 patient. The mean Af duration detected in 7 cases was 18.5 ± 10.1 months. Partial sternotomy was used in aortic valve replacement, ASD closure, and tricuspid valve plasty, and fullsternotomy was used in aortic graft replacement and coronary artery bypass. Cardiopulmonary bypass was established, aortic cross-clamp was performed, a right atriotomy was created, a cryoablation probe and cardioscope (3 mm) were introduced into the left atrium through a 1-cm cut at the fossa ovalis or ASD, and cardioscopic left-atrial endocardial cryoablation was performed. The right-side maze procedure was conducted directly. The atrial appendages were excised in each case. Results Left-atrial cardioscopic cryoablation required 25.0 ± 5.5 minutes, and no deaths or procedure-related morbidities occurred. The mean follow-up period was 12 ± 8.5 months. One patient with tricuspid regurgitation died of liver failure. With the exception of coronary and acute dissection cases, all patients have maintained a sinus rhythm. Conclusion Although experience is limited, videocardioscopic trans-septal left-atrial cryoablation is a viable method for nonmitral Af cases, and the partial sternotomy approach can be performed.
Intermediate-Term Results of 505 Consecutive Minithoracotomy Mitral Valve Procedures
Authors: Martin Jeffrey S. , Davis R. Duane , Glower Donald D. 
Published: May 2008

Background Patient demand for less invasive surgery and interest in avoiding sternotomy has led to the increased use of the minithoracotomy for mitral valve surgery. Although the feasibility of this approach has been established, few data are available regarding intermediate-term results. Methods A total of 505 consecutive minithoracotomy mitral valve procedures performed between 1996 and 2004 were analyzed. Procedures were mitral replacement (191/505, 38%) and repair (314/505, 62%). Concomitant cardiac procedures were performed in 78 cases (13%) (maze 36, tricuspid 29, atrial septal defect/patent foramen ovale 13) and reoperation in 92 cases (18%). Arterial cannulation was ascending aorta in 403 cases (80%), femoral in 101 cases (20%), and axillary in 1 case (< 1%). An endoluminal aortic clamp was used in 406 cases (80%), an external clamp was used in 19 cases (4%), and 80 procedures (16%) were performed with ventricular fibrillation. Robotic assistance was used in 12 cases (2%). Results Mean patient age was 58.7 years (range 18–90 years). Median follow-up was 3.1 years. Operative mortality was 4 of 505 cases (<1%). Major complications included stroke in 7 cases (1%) and reoperation for bleeding in 18 cases (4%); there were no cases of mediastinitis. Late complications included chronic aortic dissection in 1 case (<1%) and mitral reoperation in 13 cases (3%) (subacute bacterial endocarditis 6, failed repair 2, other 5). Five-year survival was (83% ± 2%) and freedom from mitral reoperation was (96% ± 1%). Follow-up echocardiograms were available in 246 of 314 cases (78%) mitral repairs and mean mitral regurgitation grade was 1 ± 1. Mitral regurgitation was grade 3–4+ in 14 of 246 cases (6%) (subacute bacterial endocarditis 4, low ejection fraction 5, other 5). Five-year freedom from 3–4+ mitral regurgitation was 89% ± 3%. Conclusions Mitral valve surgery via minithoracotomy can be performed safely with a low perioperative complication rate. A durable technical result and excellent long-term survival can be expected.
Midterm Follow-up of Robotic Biventricular Pacing Demonstrates Excellent Lead Stability and Improved Response Rates
Authors: DeRose Joseph J. , Balaram Sandhya , Ro Charles , Swistel Daniel G. , Steinberg Jonathan S. , Joshi Sandeep , Ashton Robert C. 
Published: May 2008

Background Robotically assisted left ventricular (LV) lead placement is an effective minimally invasive rescue procedure for cardiac resynchronization in the setting of failed coronary sinus lead insertion. The long-term response rate and durability of this technique has not been reported. The authors evaluated the midterm outcome of biventricular pacing performed with robotically placed LV leads. Methods Forty-two patients underwent implantation of LV epicardial leads using robotic assistance and the posterior approach. Half of the patients had prior cardiac surgery. All leads were placed in an optimal site along the posterolateral surface of the LV. The patients were prospectively followed up for clinical response, LV reverse remodeling, and LV lead stability over a mean period of 16.7 ± 9.5 months (range, 3–34 months). A multivariate Cox proportional hazards model was used to determine predictors of response. Results All patients had successful LV lead placement with no postoperative mortality. Statistically significant improvements in left ventricular ejection fraction, NYHA heart failure class, systolic left ventricular internal dimension index, and diastolic left ventricular internal dimension index. The 3-month clinical response rate was 81% and dropped to 71% at average maximal follow-up. Multivariate analysis of 9 variables revealed only LVEF greater than 15% and absence of pulmonary hypertension to be predictors of response. No difference in operative time, response rate, or LV lead stability was detected when primary versus reoperative cases were compared. Conclusions Robotic LV lead placement is a reliable technique for optimal lead placement with durable long-term results.
Three-Year Experience with Totally Endoscopic Robotic Thymectomy
Authors: Ro Charles Y. , DeRose Joseph J. , Connery Cliff P. , Balaram Sandhya K. , Ashton Robert C. 
Published: May 2008

Background Robotic technology has facilitated the evaluation and treatment of anterior mediastinal pathology. We describe a 3-year experience using the da Vinci Robotic Surgical System to perform thymectomies for a range of diseases. Methods From March 2002 to November 2004, 9 patients (3 myasthenia gravis, 3 mediastinal mass, 2 myasthenia gravis plus thymoma, 1 hyperparathyroidism) underwent totally endoscopic robotic thymectomy. Medical records and operative databases were reviewed. The cohort was divided into an early experience (group A) and a later experience (group B). Data were analyzed with the Fisher exact test and Mann-Whitney test. Results Complete robotic resection of the thymus was accomplished in all 9 patients. The mean age for the entire cohort was 40 ± 12 years (range 28–66 years) and 78% of the patients were women. No significant differences in age, gender, or operative conversions were detected between the groups. Patients in group A were more likely to have a bilateral approach. Group B demonstrated statistically significant reductions in operating room and operation time and a trend toward decreased chest tube days and length of stay. No morbidity or mortality associated with the procedure was noted in either group. Conclusions Robotic thymectomy is a safe and effective procedure. Its steep learning curve promises to allow more surgeons to adopt minimally invasive approaches to the mediastinum safely and efficiently.
Robotic Replacement of the Descending Thoracic Aorta: An Alternative to Endovascular Therapy?
Authors: Porat Eyal E. , Herrera Peter D. , Sheinbaum Roy , Estrera Anthony L. , Huynh Tam T.T. , Azizzadeh Ali , Meada Riad , Miller Charles C. , Safi Hazim J. 
Published: May 2008

Background Replacement of the descending thoracic aorta is traditionally performed via a left thoracotomy. Endovascular treatment of descending thoracic aortic aneurysms has recently evolved as an alternative treatment for selected patients, yet no long-term results are available. The authors replaced the descending thoracic aorta in a group of pigs with an interposition Dacron graft using a closed-chest, totally robotic technique. Methods Ten pigs, weighing 25 to 45 kg, underwent surgery using the DaVinci robotic surgical system. Under single-lung ventilation and CO2 insufflation, the descending thoracic aorta was completely mobilized. Proximal and distal cross-clamps were applied through separate accessory stab wounds. The mid-descending thoracic aorta was excised. An interposition Dacron graft was robotically sewn in an end-to-end fashion to the descending thoracic aorta using interrupted nitinol clips. Results All animals survived the procedure. Mean aortic clamp time was 55 ± 14 minutes. All anastomoses were completed without difficulty with a mean total anastomotic time of 42 ± 11 minutes. The anastomoses were challenged for bleeding by administrating α1-adrenergic receptor agonists to a systolic blood pressure of 200 mm Hg with no evidence of leak. Discussion Robotic replacement of the thoracic aorta is feasible and reproducible. This procedure provides the standard Dacron graft repair with its known long-term results. The added value of robotic technology to the therapeutic armamentarium in the treatment of thoracic aortic aneurysms may be worth the effort required for procedural development. Furthermore, it may serve as a valid alternative to endovascular treatment of thoracic aortic aneurysms.
Clinical Application of an Original Flexible MK Stent-Graft for Nonruptured Thoracic Aortic Aneurysms: Early Experience
Authors: Ohtake Hiroshi , Kimura Keiichi , Watanabe Go , Sanada Junichiro , Matsui Osamu 
Published: May 2008

Objective To obtain early MK stent-grafting results for nonruptured thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. Methods The authors analyzed 47 patients who underwent treatment using MK stent-grafting. All patients (40 men and 7 women; mean age, 70.8 years) underwent elective procedures. Straight, curved, or tapered MK stents were constructed from a nitinol wire and covered with seamless, cylindrical woven polyester fabric grafts. The mean stent-graft diameter was 24 to 48 mm. In cases where the aneurysm had a short proximal neck (under 15 mm), supraaortic arch artery bypass surgery was planned to lengthen the neck. Results Simple stent-grafting without bypass was performed in 26 patients, whereas stent-grafting with supraaortic arch artery bypass was performed in 21 patients. An 18 or 20 F sheath was used as the delivery system in 46 patients (96%). In all 47 patients, the stent-grafts were successfully deployed. Two patients died while in hospital, and another 2 patients suffered a stroke. No other perioperative complications were observed. Postoperative computed tomography after 3 months showed complete thrombus formation in 42 patients (93.3%; 42/45 patients). Conclusions Forty-seven patients with thoracic aortic aneurysm were treated with our original flexible MK stent-graft system. Using a small sheath system, straight or curved M-K stent-grafts could be deployed to adequately fit to the aorta as planned. Furthermore, simultaneous bypass surgery widened the application of stent-grafting. However, careful long-term observation is necessary, and further studies are needed to assess such stent-grafting with bypass surgery.
A New Multisuction Cardiac Positioner for Multivessel Off-Pump Coronary Artery Bypass Grafting
Authors: Arai Hirokuni , Mizuno Tomohiro , Yoshizaki Tomoya , Itoh Fusahiko , Oi Keiji , Someya Takeshi , Tanaka Hiroyuki , Sunamori Makoto 
Published: May 2008

Objective To accomplish successful multivessel off-pump coronary artery bypass grafting, safe, reproducible, and effective exposure of all coronary territories is essential. For this purpose, we developed a new, simple, multisuction cardiac positioner. Methods This new cardiac positioner consists of 3 small independent suction cups and suction tubes made of silicone. Unlike an apical suction cardiac positioner, this positioner has no arm. The suction cups can be applied with negative pressure of 300 mm Hg to various surfaces of the ventricle, including not only the apex but also the lateral, inferior, and right ventricular walls, according to surgeon preference. We applied this positioner in 15 clinical multivessel off-pump coronary artery bypass procedures. Results In all cases, all target vessels including those on the lateral or inferior wall were successfully exposed and grafted without hemodynamic compromise. Surgical exposure, especially on the lateral and inferior walls, was quite similar to that of conventional coronary artery bypass graft procedures performed during cardiopulmonary bypass. Conclusions The multisuction cardiac positioner provided reproducible and easy access in multivessel off-pump coronary artery bypass surgery. This simple, variable, and inexpensive cardiac positioner may be used as a new tool to aid in the performance of successful multivessel off-pump coronary artery bypass surgery.
Single Venous Return for Mitral Valve Operations
Authors: Gammie James S. , Vander Salm Thomas J. 
Published: May 2008

Objective Most cardiac surgeons routinely perform bicaval venous cannulation for mitral valve operations. We describe the technique and advantage of a single-venous cannulation strategy. Methods/Results Single venous cannulation with a 29-French small-bore cannula (facilitated by vacuum-assisted venous drainage) yields reliable decompression of the right heart and affords outstanding exposure of the mitral valve. Conclusions We recommend and use this technique for all mitral valve operations not requiring opening the right atrium.