Abstract:

Coronary artery bypass surgery (CABG) has been an established technique for the treatment of severe coronary artery disease for more than 20 years and is one of the most frequently performed surgical procedures in industrialized countries. Continuous technical and pharmacologic refinements in perioperative management, including advances in anesthesia and cardiopulmonary bypass (CPB) techniques (i.e., stop ping the heart and using a heart/lung pump to keep the blood flowing through the body) have improved the results of coronary surgery. However, the trade-off for such advancements is often increased costs and resource utilization. While the results or outcomes of inhospital mortality and morbidity have reached a plateau, an increasing number of "high-risk" patients are being considered for procedures that were previously contraindicated in their situations. Therefore, innovations for alternative methods of surgical myocardial revascularization continue to develop, with the aim of both improving the results of coronary surgery and reducing the use of healthcare resources.

Authors:

Federico Benetti, M.D. - Benetti Foundation, Rosario, Argentina; Massimo A. Mariani, M.D. - Thoraxcentrum, University Hospital Groningen, The Netherlands

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Abstract:

The advancements in cardiac valvular replacement devices over the past 25 years have left residual problems with biological and mechanical prostheses. The extensive developments were introduced to reduce or eliminate valve-related complications, namely thromboembolism, anticoagulant-related hemorrhage, and structural failure, as weil as to optimize hemodynamic performance. Residual problems persist with both biological and mechanical prostheses. Structural failure of porcine and pericardial bioprostheses persists over time with leaflet degeneration and dystrophic calcification. Thrombus formation from blood stasis and the resultant thromboembolic phenomena despite anticoagulant management remain a continuing problem with mechanical prostheses. The innovative technologies under investigation will likely significantly improve the clinical performance of both biological and mechanical prostheses.

Authors:

FW. R. Eric Jamieson, M.D., F.R.C.S. (C); Samuel V. Lichtenstein, M.D., Ph.D., F.R.C.S. (C) - University Heart Centre, St. Paul¹s Hospital, Vancouver Hospital and Health Sciences Centre, Vancouver, Canada

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Abstract:

Cardiac surgery is currently performed on 800,000 patients each year worldwide. Complications involving the central nervous system account for the major adverse sequelae of the procedure and are increasing substantially as more elderly patients are undergoing surgery. Strokes occur in 5% of patients undergoing coronary artery bypass grafting (CABG), and in as many as 13% of patients undergoing open heart surgery. Neuropsychologic impairment occurs more commonly and is persistent in 35% of patients 1 year after surgery.

Authors:

Denise Barbut, M.D., M.R.C.P. - Cornell University Medical College, New York, N.Y.

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Abstract:

Interrupting the venous return from below the diaphragm is usually associated with sudden hypotension, hypovolemic cardiac failure, and increased bleeding secondary to acute venous hypertension and hepatic congestion. Shaw, Starzl, and Griffith developed a veno-veno bypass technique to shunt the somatic and splanchnic venous return around the retrohepatic vena cava to the superior vena cava. This permitted continuation of venous return and simultaneous blood warming, allowing surgeons to perform complex procedures in a dry operative field. These bypass techniques have evolved since their introduction in the 1980s and are now being applied for the removal of otherwise nonresectable tumors of the liver, adrenal gland, and kidney. Further, traumatic injuries to the hepatic veins and the retrohepatic cava associated with a high mortality rate can be repaired safely using vascular isolation techniques and bypass.

Authors:

Rob Granger, M.D.; Charles H. Scudamore, M.D., F.A.C.S., F.R.C.S. (C, Ed, Eng); Andrzej K. Buczkowski, M.D.; Emma J. Patterson, Bsc (Hon), M.D.; Steven Chung, B.Sc., M.Sc., Ph.D., M.D., F.R.C.S.C. - University of British Columbia, Vancouver, Canada

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