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Nir RR, Bolotin G. Technological solutions for cardiac surgery in the elderly. Rambam Maimonides Med J 2013; 4:e0020. [PMID: 23908870 PMCID: PMC3730749 DOI: 10.5041/rmmj.10120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The current review addresses contemporary technological advances in cardiac surgery performed on octogenarian patients, namely off-pump coronary artery bypass grafting (CABG), proximal anastomosis device, routine use of intraoperative epiaortic ultrasound, proximal anastomosis without clamping, transcatheter aortic valve implantation (TAVI), and brain protection during cardiac surgery.
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Affiliation(s)
- Rony-Reuven Nir
- Cardiovascular Surgery, Rambam Health Care Campus and the Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Zenati MA, Sonel A, Hattler B, Shroyer AL, Collins J, Messenger J, Baltz JH, Mohr LM, Gabany JM, Novitsky D, Grover F. Patency outcomes of aortic connectors. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2006; 1:255-7. [PMID: 22436755 DOI: 10.1097/01.imi.0000229898.22601.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : Controlled outcome analysis of mechanical aortic connectors for proximal saphenous vein bypass graft anastomosis is lacking. We report the clinical and angiographic outcome of patients receiving the Symmetry aortic connector (St. Jude Medical, Inc St. Paul, MN, US) within a multicenter, prospective, randomized study. METHODS : Twenty-five patients at 3 study sites received aortic connectors at the time of coronary artery bypass surgery. Protocol-defined angiographic follow-up was completed in 19 of 25 patients (76%) at time-points up to 14 months postoperatively; 32 connector anastomoses were evaluated in these 19 patients. Beating heart surgery was performed in 17 patients, and 2 were performed with cardiopulmonary bypass. Age was 69.7 ± 8.1 year; all patients were males. RESULTS : The connector anastomosis patency rate was 15.6% (5/32). There were no deaths during the follow-up period. Four patients (21%) suffered myocardial infarction and 2 additional patients (10.5%) required percutaneous coronary interventions; one of who required 3 percutaneous coronary interventions, the other received one percutaneous coronary intervention. CONCLUSIONS : In this nonrandomized cohort of patients, occlusion rate with Symmetry connectors was significantly greater than anticipated. Patients who have received these connectors during coronary artery bypass surgery may require closer follow-up and evaluation. While the manufacturer has stopped producing this device, there has been no recall of the product, clinical support remains ongoing, and next generation connectors have now been marketed. Consideration should be given to discontinuation of the clinical use of Symmetry connectors.
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Affiliation(s)
- Marco A Zenati
- *Veterans Affairs Cooperative Studies Program Coordinating Center, VA Maryland, Healthcare System, Perry Point, MD and University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore, MD; †VA Pittsburgh Healthcare System and Division of Cardiothoracic Surgery-University of Pittsburgh School of Medicine, Pittsburgh, PA; ‡Denver Veterans Affairs Medical Center, University of Colorado Health Sciences Center School of Medicine, Department of Medicine, Surgery, and Pathology, Cooperative Studies Program National Coordinator and Continuous Improvement in Cardiac Surgery Program, Denver, CO; §University of South Florida, Tampa General Hospital, James A. Haley Veterans Administration Hospital, Tampa, FL
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Zenati MA, Sonel A, Hattler B, Shroyer AL, Collins J, Messenger J, Baltz JH, Mohr LM, Gabany JM, Novitsky D, Grover F. Patency Outcomes of Aortic Connectors. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2006. [DOI: 10.1177/155698450600100507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marco A. Zenati
- VA Pittsburgh Healthcare System and Division of Cardiothoracic Surgery-University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ali Sonel
- VA Pittsburgh Healthcare System and Division of Cardiothoracic Surgery-University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Brack Hattler
- Denver Veterans Affairs Medical Center, University of Colorado Health Sciences Center School of Medicine, Department of Medicine, Surgery, and Pathology, Cooperative Studies Program National Coordinator and Continuous Improvement in Cardiac Surgery Program, Denver, CO
| | - A. Laurie Shroyer
- Denver Veterans Affairs Medical Center, University of Colorado Health Sciences Center School of Medicine, Department of Medicine, Surgery, and Pathology, Cooperative Studies Program National Coordinator and Continuous Improvement in Cardiac Surgery Program, Denver, CO
| | - Joseph Collins
- Veterans Affairs Cooperative Studies Program Coordinating Center, VA Maryland, Healthcare System, Perry Point, MD and University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore, MD
| | - John Messenger
- Denver Veterans Affairs Medical Center, University of Colorado Health Sciences Center School of Medicine, Department of Medicine, Surgery, and Pathology, Cooperative Studies Program National Coordinator and Continuous Improvement in Cardiac Surgery Program, Denver, CO
| | - Janet H. Baltz
- Denver Veterans Affairs Medical Center, University of Colorado Health Sciences Center School of Medicine, Department of Medicine, Surgery, and Pathology, Cooperative Studies Program National Coordinator and Continuous Improvement in Cardiac Surgery Program, Denver, CO
| | - Lisa M. Mohr
- Denver Veterans Affairs Medical Center, University of Colorado Health Sciences Center School of Medicine, Department of Medicine, Surgery, and Pathology, Cooperative Studies Program National Coordinator and Continuous Improvement in Cardiac Surgery Program, Denver, CO
| | - Jennifer M. Gabany
- VA Pittsburgh Healthcare System and Division of Cardiothoracic Surgery-University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Dimitri Novitsky
- University of South Florida, Tampa General Hospital, James A. Haley Veterans Administration Hospital, Tampa, FL
| | - Frederick Grover
- Denver Veterans Affairs Medical Center, University of Colorado Health Sciences Center School of Medicine, Department of Medicine, Surgery, and Pathology, Cooperative Studies Program National Coordinator and Continuous Improvement in Cardiac Surgery Program, Denver, CO
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