Сегодня 03 декабря 2023
Медикус в соцсетях
Задать вопрос

ЗАДАТЬ ВОПРОС РЕДАКТОРУ РАЗДЕЛА (ответ в течение нескольких дней)

Не публикуется
служит для обратной связи
Антиспам - не удалять!
Ваш вопрос:
Получать ответы и новости раздела
20 мая 2002 00:00   |   Antonio M. Calafiore, MD*a, Michele Di Mauro, MDa, Giovanni Teodori, MDa, Gabriele Di Giammarco, MDa, Sergio Cirmeni, MDa, Marco Contini, MDa, Angela L. Iacò, MDa, Marco Pano, MDa

Impact of aortic manipulation on incidence of cerebrovascular accidents after surgical myocardial revascularization

Background. The impact of aortic manipulation on incidence of cerebrovascular accidents (CVAs) was evaluated in patients who underwent myocardial revascularization.
Methods. From January 1988 to December 2000, 4,875 patients had coronary operations; 33 who survived less than 24 hours and 19 who had aortic cannulation without cross-clamping were excluded. According to the degree of aortic manipulation, patients were divided into two groups: group A, aortic cannulation, cross-clamping, with (A1, n = 597) or without (A2, n = 2,233) side-clamping, and group B, with (B1, n = 460) or without (B2, n = 1,533) side-clamping. Patients in group A (n = 2,830) were operated on with and patients in group B (n = 1,993) were operated on without cardiopulmonary bypass (CPB). Univariate and multivariate analyses were applied to identify independent predictors of higher incidence of CVAs.
Results. Forty-nine patients (1.0%) had a postoperative CVA, 24 early and 25 delayed, with a 30−day mortality of 34.7%. Independent CVA predictors were low output syndrome, presence of extracoronary vasculopathy, conversion from off to on pump, and any aortic manipulation. This latter risk factor was significant in patients with extracoronary vasculopathy, but not in patients without. Side-clamping was not a risk factor in patients operated on with CPB, but it was in no-CPB cases. Patients in group B1 had the same CVA incidence as patients in group A2. Therefore CPB, per se, was not a risk factor for higher CVA incidence.
Conclusions. Aortic manipulation must be avoided in patients with extracoronary vasculopathy. Maintenance of a good hemodynamic status is crucial for any patient to reduce CVA incidence. Patients with extracoronary vasculopathy are at higher risk, and a correct surgical strategy should be tailored for each case. In no-CPB cases use of side-clamping provides the same CVA risk as in patients in whom CPB, aortic cannulation, and cross-clamping were used.


Смотри также
20 мая 2002  |  00:05
Isolated myocardial revascularization with intermittent aortic cross-clamping: experience with 800 cases
Background. We investigated the clinical outcome of elective and nonelective myocardial revascularization performed with intermittent aortic cross-clamping. Methods. Prospective data on 800 consecutive
20 мая 2002  |  00:05
Effects of skeletonization on intraoperative flow and anastomosis diameter of internal thoracic arteries in coronary artery bypass grafting
Background. We examined the hypothesis that complete skeletonization of an internal thoracic artery (ITA) results in increased diameter of the graft for anastomosis and therefore improves graft
20 мая 2002  |  00:05
Intraoperative evaluation of coronary anastomosis by transit-time ultrasonic flow measurement
Background. Intraoperative assessment of the anastomosis is important during coronary bypass on a beating heart. The purpose of this study is to predict the quality of anastomosis using transit-time
20 мая 2002  |  00:05
Coronary end-to-side sleeve anastomosis using adhesive in off-pump bypass grafting in the pig
Background. In the exploration of facilitated coronary anastomosis strategies, we assessed a new octyl-cyanoacrylate adhesive in combination with a modified end-to-side sleeve anastomosis in off-pump
20 мая 2002  |  00:05
Repetitive atrial flutter as a complication of the left-sided simple maze procedure
Background. Of 41 patients who had undergone a left-sided simple maze procedure, 4 (9.8%) developed repetitive tachycardia due to atrial flutter, and required radiofrequency catheter ablation.