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1.
Ann Card Anaesth ; 2014 Jan; 17(1): 46-51
Article Dans Anglais | IMSEAR | ID: sea-149693

Résumé

The fetal death rate associated with cardiac surgery with cardiopulmonary bypass (CPB) is as high as 9.5‑29%. We report continuous monitoring of fetal heart rate and umbilical artery flow‑velocity waveforms by transvaginal ultrasonography and their analyses in relation to events of the CPB in two cases in second trimester of pregnancy undergoing mitral valve replacement. Our findings suggest that the transition of circulation from corporeal to extracorporeal is the most important event during surgery; the associated decrease in mean arterial pressure (MAP) at this stage potentially has deleterious effects on the fetus, which get aggravated with the use of vasopressors. We suggest careful management of CPB at this stage, which include partial controlled CPB at initiation and gradual transition to full CPB; this strategy maintains high MAP and avoids the use of vasopressors. Maternal and fetal monitoring can timely recognize the potential problems and provide window for the required treatment.


Sujets)
Adulte , Pression artérielle/physiologie , Auricule de l'atrium/imagerie diagnostique , Procédures de chirurgie cardiaque/méthodes , Pontage cardiopulmonaire , Femelle , Surveillance de l'activité foetale/méthodes , Rythme cardiaque/physiologie , Rythme cardiaque foetal , Implantation de valve prothétique cardiaque , Humains , Fluxmétrie laser Doppler , Insuffisance mitrale/chirurgie , Sténose mitrale/chirurgie , Grossesse/physiologie , Issue de la grossesse , Résultat thérapeutique , Sténose tricuspidienne/imagerie diagnostique , Artères ombilicales/physiologie , Artères ombilicales/imagerie diagnostique
2.
Ann Card Anaesth ; 2008 Jul-Dec; 11(2): 91-6
Article Dans Anglais | IMSEAR | ID: sea-1565

Résumé

Minimally invasive surgery with robotic assistance should elicit minimal pain. Regional analgesic techniques have shown excellent analgesia after thoracotomy. Thus the aim of this study was to compare thoracic epidural analgesia (TEA) technique with paravertebral block (PVB) technique in these patients with regard to quality of analgesia, complications, and haemodynamic and respiratory parameters. This was a prospective randomised study involving 36 patients undergoing elective robotic-assisted coronary artery bypass grafting (CABG). TEA or PVB were administered in these patients. The results revealed no significant differences with regard to demographics, haemodynamics, and arterial blood gases. Pulmonary functions were better maintained in PVB group postoperatively; however, this was statistically insignificant. The quality of analgesia was also comparable in both the groups. We conclude that PVB is a safe and effective technique for postoperative analgesia after robotic-assisted CABG and is comparable to TEA with regard to quality of analgesia.


Sujets)
Analgésie péridurale/effets indésirables , Pontage aortocoronarien/méthodes , Femelle , Humains , Mâle , Adulte d'âge moyen , Bloc nerveux/effets indésirables , Mesure de la douleur , Complications postopératoires , Études prospectives , Tests de la fonction respiratoire , Robotique , Interventions chirurgicales mini-invasives/méthodes , Résultat thérapeutique
4.
Indian Heart J ; 2006 May-Jun; 58(3): 265-8
Article Dans Anglais | IMSEAR | ID: sea-5446

Résumé

The development of minimally invasive techniques represents a significant improvement in the repair of atrial septal defect by total endoscopy. Robot-assisted repair obviates the need for a sternotomy or thoracotomy. This is the case report of a 45-year-old male, who underwent atrial septal defect repair through the total endoscopic technique. The peri-operative management and associated problems in the post-operative period have also been described.

5.
Indian Heart J ; 2006 Mar-Apr; 58(2): 144-8
Article Dans Anglais | IMSEAR | ID: sea-4562

Résumé

BACKGROUND: Although quality assessment of coronary artery patients can be done by 30 days risk-adjusted operative mortality, it is still insufficient to study the outcome after primary coronary artery bypass graft surgery (CABG). In our study, we attempted to determine the factors, which can help predict operative mortality before and after CABG. METHODS: The study population consisted of 1000 prospective patients who underwent primary isolated CABG. Assessment was done by dividing the patients into two groups, i.e. non-survivors ( n= 12) and survivors ( n= 988). Data were analyzed using both univariate and multivariate models. RESULTS: On univariate analysis, recent acute myocardial infarction, intra-aortic balloon counterpulsation (IABC), left ventricular ejection fraction (LVEF) <25%, ventilator-associated pneumonia (VAP), tracheostomy, re-exploration, ventricular arrhythmias, low cardiac output (CO), multiple blood transfusions, post-operative renal dysfunction and longer intensive care unit and hospital stay were found as risk factors for mortality. Multivariate analysis showed that LVEF <25%,VAP, ventricular arrhythmias and low CO independently predicted mortality. Prior knowledge of these risk factors can help not only in predicting the outcome and the risks but also helps to plan the surgical and post-operative course of the patients to improve the morbidity and mortality. CONCLUSION: Our data suggest that operative mortality can be predicted prior to and after surgery considering factors such as LVEF, use of IABC, onset of ventricular arrhythmias and low CO.


Sujets)
Sujet âgé , Pontage aortocoronarien/mortalité , Femelle , Humains , Contrepulsion par ballon intra-aortique , Mâle , Adulte d'âge moyen , Analyse multifactorielle , Études prospectives , Facteurs de risque
6.
Indian Heart J ; 2005 Nov-Dec; 57(6): 688-93
Article Dans Anglais | IMSEAR | ID: sea-5302

Résumé

BACKGROUND: Recent advances in minimally invasive technology has expanded the application of the right thoracotomy approach for mitral valve surgery and atrial septal defect closure. The present study examines the feasibility, safety and efficacy of this technique. METHODS AND RESULTS: Between September 1997 and December 2004, 430 patients underwent mitral valve surgery through right anterolateral thoracotomy. The mitral valve was repaired in 62 patients, and 368 patients underwent mitral valve replacement. During same period, 336 patients underwent surgical closure of atrial septal defect. In all cases femoral artery and femoral venous cannulation was used for cardiopulmonary bypass. There was no approach-related limitation to surgical exposure, nor complication in cannulation of femoral vessels through the groin. Mean duration of cardiopulmonary bypass and cross-clamp time was 90 +/- 48 min and 51 +/- 29 min, respectively. Mean intubation time was 14.8 hours (range: 8-28 hours). Mean duration of intensive care andhospital stay was 26 hours (range: 18-38 hours) and 7 days (range: 5-17 days), respectively. In the atrial septal defect group, the mean cardiopulmonary bypass time and aortic cross-clamp time was 29 +/- 14 min and 19 +/- 8 min, respectively. Mean intensive care unit stay and mean hospital stay was 9.8 +/- 2.6 hours and 4.0 +/- 1.9 days, respectively. Hospital mortality was 0.46% (2/430) in the mitral valve group while there was no hospital mortality in atrial septal defect group. At a mean follow-up of 38.0 +/- 6.2 months there was one late death and two re-operations in the patients who underwent mitral valve surgery. CONCLUSIONS: Port-access approach is safe, offers faster recovery, cosmetic advantage, more patient satisfaction: it obviates the complications due to re-entry in redo cases and offers same efficacy as conventional operation. Furthermore, it is an excellent approach for mitral valve surgery in patients who had previous cardiac procedures. It has become our standard approach for repair of atrial septal defect and isolated mitral valve procedures.


Sujets)
Adolescent , Adulte , Facteurs âges , Procédures de chirurgie cardiaque/méthodes , Enfant , Études de cohortes , Femelle , Études de suivi , Communications interauriculaires/diagnostic , Humains , Mâle , Adulte d'âge moyen , Insuffisance mitrale/diagnostic , Études rétrospectives , Appréciation des risques , Indice de gravité de la maladie , Facteurs sexuels , Interventions chirurgicales mini-invasives/méthodes , Analyse de survie , Thoracotomie/méthodes , Résultat thérapeutique
7.
Indian Heart J ; 2005 Jan-Feb; 57(1): 44-8
Article Dans Anglais | IMSEAR | ID: sea-5171

Résumé

BACKGROUND: Post-myocardial infarction, anteroseptal dysfunction or akinesia is treated by septal reshaping to improve the surgical outcome in patients with severe left ventricular dysfunction. METHODS AND RESULTS: Between February 2003 to December 2003, 30 consecutive patients with previous anterior wall myocardial infarction and severe ventricular dysfunction underwent septal reshaping. All the dyskinetic and akinetic septal areas were excluded using an oval dacron patch which was sutured from the healthy septal area to the anterior wall, resulting in formation of a new apex. There were two mortalities in the group. After a mean follow-up of 4.2 +/- 1.6 months (1-7 months) it was seen that this procedure resulted in significant reduction of ventricular volume, increase in ejection fraction, an improvement in New York Heart Association class from 2.9 +/- 1.1 to 1.7 +/- 0.3, and a better apical geometry. CONCLUSIONS: In selected patients with left anterior descending artery occlusion resulting in anteroseptal dyskinesia or akinesia, septal exclusion technique provides good clinical and morphological results with significant improvement in left ventricular function.


Sujets)
Adulte , Sujet âgé , Procédures de chirurgie cardiaque , Volume cardiaque , Femelle , Septum du coeur/chirurgie , Humains , Mâle , Adulte d'âge moyen , Infarctus du myocarde/complications , Prothèses et implants , Débit systolique , Résultat thérapeutique , Dysfonction ventriculaire gauche/étiologie
8.
9.
Indian Heart J ; 2002 Mar-Apr; 54(2): 159-63
Article Dans Anglais | IMSEAR | ID: sea-5719

Résumé

BACKGROUND: The incidence of reoperative coronary artery bypass grafting is increasing with an increase in the number of patients undergoing coronary artery bypass surgery. The clinical outcome of redo coronary artery bypass grafting without cardiopulmonary bypass and conventional coronary artery bypass grafting using cardiopulmonary bypass are different. METHODS AND RESULTS: We compared clinical parameters in patients who underwent off-pump (n=156) versus on-pump (n=194) redo coronary artery bypass grafting performed between January 1995 and December 2001 in our institute, to determine if off-pump surgery has improved the surgical outcome of redo coronary artery bypass grafting and emerged as an ideal technique. Patients who underwent on-pump redo surgery required more postoperative blood transfusion (86.53% on-pump v. 12.82% off-pump. p=0.001), prolonged ventilatory support (>24 hours) (16.49% on-pump v. 7.7% off-pump, p=0.021) and higher inotropic support (23.71% on-pump v. 10.89% off-pump, p=0.003). On-pump redo coronary artery bypass grafting was also associated with a prolonged stay in the intensive care unit (40+/-6.2 hours on-pump v. 20+/-4.1 hours off-pump, p=0.001) and longer hospital stay (9+/-4.2 days on-pump v. 5+/-3.4 days off-pump, p=0.001). In-hospital mortality was higher in on-pump patients than in off-pump ones (7.7% v. 3.2%); however, this was not statistically significant (p=0.114). CONCLUSIONS: Off-pump redo coronary artery bypass grafting is a safe method of myocardial revascularization with lower operative morbidity and mortality, less requirement of blood products and early hospital discharge, compared with conventional on-pump redo coronary artery bypass grafting.


Sujets)
Sujet âgé , Transfusion sanguine , Pontage cardiopulmonaire/effets indésirables , Pontage aortocoronarien/effets indésirables , Femelle , Mortalité hospitalière , Humains , Durée du séjour , Mâle , Adulte d'âge moyen , Réintervention , Facteurs de risque , Interventions chirurgicales mini-invasives/méthodes , Résultat thérapeutique
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