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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Periodicità: Bimestrale

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 2000 Agosto;41(4):579-83

CARDIAC PAPERS 

 TECHNICAL NOTES

Monitoring aspects during post-access cardiac surgery

Ceriana P., Pagnin A., Locatelli A., Maurelli M., Minzioni G. *, Spreafico P. *, Degani A. *, Viganò M. *

From the Depart­ment of Anes­thesia and Inten­sive ­Care I
*Car­di­o­sur­gical ­Centre ''C. ­Dubost'' IRCCS Pol­i­clinico S. ­Matteo, ­Pavia, ­Italy

Objec­tive. To ­report the expe­ri­ence ­gained at our Car­di­o­sur­gical ­Centre ­with the ­recently intro­duced ­port-­access tech­nique.
­Methods. Experi­mental ­design: Pros­pec­tive col­lec­tion of ­data ­from the ­month of ­October 1997. Set­ting: ­Regional Uni­ver­sity Hos­pital. ­Patients: ­Adult ­patients under­going cor­o­nary ­bypass ­graft or ­mitral ­valve sur­gery. Inter­ven­tions: ­Port-­access tech­nique ­makes it pos­sible to ­carry out ­open-­heart pro­ce­dures ­through a ­minithor­a­cotomy and extrath­o­racic car­di­o­pul­mo­nary ­bypass ­with a set of prop­erly ­designed cath­e­ters (Heart­port ­EndoCPB™ ­system) for car­di­o­plegia ­delivery and ­heart ­venting. Meas­ures: Tran­se­soph­a­geal echog­raphy and pres­sure ­traces are the ­main mon­i­toring ­tools ­used for the cor­rect place­ment of ­these cath­e­ters and for the clin­ical man­age­ment of the ­patient.
­Results. ­Sixty-two ­cases ­have ­been per­formed so far. A com­plete descrip­tion of the pro­ce­dure, ­with mon­i­toring ­aspects and prob­lems encoun­tered is ­thoroughly pre­sented.
Con­clu­sions. The ­major dif­fer­ences ­with tra­di­tional car­diac sur­gery are ­that inter­rup­tion of myo­car­dial per­fu­sion is not ­achieved ­through a trans­versal ­clamp but ­through an endo­vas­cular occlu­sive bal­loon and ­that tho­racic ­access is by min­i­thor­a­cotomy. ­Unlike tra­di­tional ­open sur­gery, the sur­geon has no ­direct ­vision of the posi­tion of the ­clamp and the anes­the­sio­lo­gist can not vis­u­ally ­inspect the con­trac­tile ­state of the ­heart. The oper­a­tive ­team has to ­cope ­with a mul­ti­fac­eted ­system of mon­i­tored var­i­ables ­that ­must be con­tin­u­ously inte­grated and inter­preted. ­Tight coop­er­a­tion and con­tin­uous com­mu­ni­ca­tion ­between anaesthe­sio­lo­gist, sur­geons and per­fu­sionist ­appear to be ­more impor­tant ­than in any ­other car­diac oper­a­tion.

lingua: Inglese


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