دانلود کتاب Essentials of Operative Cardiac Surgery

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Preface
Contents
1: Echocardiography in Adult Cardiac Surgery
Introduction
Assessment of Biventricular Geometry and Function
LV Geometry, Global and Regional Function
RV Geometry and Function
Intraoperative echocardiography for valve Surgery
MV Assessment
Anatomic Backgound
Mitral Valve Regurgitation (MR)
Aetiology and Mechanisms of MR
Quantitation of MR
The Role of Echo in Guiding MV Repair
Post-Bypass Evaluation
Mitral Valve Stenosis
Aortic valve and Aortic Root
Aortic Regurgitation (AR)
Aetiology and Mechanisms of AR
Quantitation of AR
Consequences of AR on LV Size and Function and Timing for Surgery
The Role of Echo in Guiding AV Repair
Aortic valve Stenosis (AS) [19, 27]
Echocardiographic Factors in the Evaluation of AS
Tricuspid Valve
Artificial Valves
Postoperative Complications
References
2: Cardiac Magnetic Resonance Imaging in Cardiothoracic Surgery
Introduction
The CMR Assessment
Left and Right Ventricular Assessment
Ischaemic Heart Disease
Resting LV Function
Functional Significance of CAD
Myocardial Infarction and Viability
Valvular Heart Disease
Aortic Stenosis
Aortic Regurgitation
Mitral Regurgitation
Mitral Stenosis
Pulmonary Regurgitation
Pulmonary Stenosis
Tricuspid Regurgitation
Tricuspid Stenosis
Hypertrophic Cardiomyopathy
Disease of the Aorta
Safety and Technical Considerations
References
3: Systemic Inflammatory Response and Cardiopulmonary Bypass
Humoral Response
Kinin System Activation and Hageman Factor
The Complement System
Fibrinolytic System Activation
Synthesis of pro-Inflammatory and Anti-Inflammatory Cytokines
Cellular Response
The Endothelium
Neutrophil Activation
Platelet Activation
Metabolic and Endocrine Response
Genetic Predisposition
Pharmacological Therapies
Corticosteroids
Serine Protease Inhibitors (Aprotinin)
Nitric Oxide
Antioxidants
Complement Inhibitors
Phosphodiesterase Inhibitors
Cyclooxygenase Inhibitors
Technical Strategies
Minimized Extracorporeal Circulation System
Heparin Bonded Circuits (HBC) and Biocompatibility
Heparin Management
Leucofiltration and Leukocyte Depletion
Hemofiltration, Ultrafiltration and Hemoadsorption
Centrifugal Pumps
Cardiopulmonary Bypass Temperature
Endotoxemia Reducing Strategies
Selective Decontamination of the Digestive Tract
References
4: Basic Setup in Adult Cardiac Surgery
Introduction
Incisions
Median Sternotomy
Redo Sternotomy
Dividing the Pericardium
Cannulation
Aortic Cannulation
Venous Cannulation
Femoral Artery and Femoral Venous Cannulation
Decompressing the Heart
Aortic Root Vent
Right Superior Pulmonary Vein Vent
Pulmonary Artery Vent
Left Ventricle Apex Vent
De-Airing the Heart
Discontinuing Cardiopulmonary Bypass and Decannulation
Positioning Chest Drains and Chest Closure
References
5: Coronary Artery Bypass Graft with Cardiopulmonary Bypass
Introduction
Which Coronary Vessel Needs Graft
Where the Anastomosis Should Be on the Coronary Arteries
Choice of Conduit
Harvesting the Left Internal Mammary Artery
Harvesting Pedicle Internal Mammary Artery
Harvesting Skeletonized Internal Mammary Artery
Radial Artery Harvesting
Harvesting the Saphenous Vein
Setup for on-Pump Coronary Artery Bypass
Positioning the Heart for Anastomosis of the Right Posterior Descending Coronary Artery (PDA)
Positioning the Heart for Anastomosis of the Circumflex Obtuse Marginal Coronary Artery (OM)
Positioning the Heart for Anastomosis of the Left Anterior Descending Coronary Artery (LAD) and the Diagonal Artery
Performing the Coronary Arteriotomy
Performing the Distal Anastomosis
Short Left Internal Mammary Artery or Hyperinflated Lungs
Performing the Proximal Anastomosis
References
6: Off Pump Coronary Artery Bypass Grafting
Introduction
Total Lesion Revascularisation (TLR)
Pre-Operative Considerations
Operative Technique
Incision and Anticoagulation
Exposure & Stabilisation
Sutures
Modified Swab Technique
Stabilisers
Bloodless Site
Blower/Mister
Sequence of Anastomosis
Positioning the Heart
Anterior Wall Presentation
Inferior Wall Presentation
Lateral Wall Presentation
References
7: Aortic Valve Repair/Replacement
Introduction
Setup
Exposing the Aortic Valve
Decalcification and Excision of Leaflet
Valve Replacement
Suture Placement
Securing the Valve
Aortic Root Enlargement
Nick’s Procedure
Manouguian’s Procedure
Konno/Rastan Procedure
Aortotomy Closure (2 Layered)
Indications
References
8: Surgery for Mitral Valve Disease: Degenerative Repair
Pathophysiology
Setup
Surgical Access to the Mitral Valve
Left Atriotomy
Transeptal Approach
Assessing the Mitral Valve
Reconstruction of the Posterior Leaflet
The Mi-P Repair (Fig. 8.3)
Quadrangular Repair
Triangular Repair
Reconstruction of the Anterior Leaflet
Artificial Neochordae
Use of Native Chords
Chordal Transposition
Papillary Muscle Repositioning
Annuloplasty
Band Annuloplasty
Ring Annuloplasty
Assessing the Valve Repair
References
9: Surgery for Mitral Valve Disease: Degenerative Replacement
Indications for Mitral Valve Replacement
Choice of Prosthesis
Technique for Mitral Valve Replacement
References
10: Post Ischemic Mitral Regurgitation
Introduction
Ischemic Mitral Valve: Pathophysiological Evolution
Surgical Indications
World Scenario and Surgical Techniques
Prosthetic Ring Choice
Subannular Repair
References
11: Minimally Invasive Mitral Valve Repair/Replacement
Review of Current Evidence
Technique/Details/Operative Steps
Preoperative Evaluation
Cardiac Workup
Vascular Workup
Thoracic Workup
Patient’s Preparation
Anesthetic Management [4]
Right Jugular Access
Patient’s Positioning
Operative Room Set-Up
Surgical Steps
Peripheral Cannulation
General Principles (Fig. 11.2)
Arterial Cannulation
Venous Cannulation
Minimally Invasive Access
Cardiopulmonary Bypass initiation
Cardiac Exposure (Fig. 11.5)
Aortic Cross-Clamping
Mitral Valve Exposure (Fig. 11.6)
Mitral Valve Repair
End of the Procedure
Closure of the Atriotomy, Deairing, Cross-Clamp Removal, Decannulation
Decannulation
Postoperative Care
Results: Outcomes and Data (1/2)
Conclusion
References
12: Tricuspid Valve Repair/Replacement
Introduction
TV Repair
TV Replacement
Setup and Approach
TV Repair
TV Replacement
Assessing the Tricuspid Valve
TV Repair
TV Replacement
TV Repair
The Tri-P Repair
Ring Annuloplasty
Suture Annuloplasty
Other Repair Techniques
Percutaneous Treatment of the Tricuspid Valve
Transcatheter Therapies for Tricuspid Regurgitation
Heterotopic Transcatheter Caval Valve Implantation
Annuloplasty Devices
Trialign
TriCinch
Cardioband
Millipede
Coaptation Devices
FORMA
MitraClip in the Tricuspid Valve
Closure
TV Replacement
Replacement of Tricuspid Valve
Closure
Indications
References
13: Cannulation Strategies for Aortic Root Surgery
Cannulation Strategies
Central Aortic
Femoral
Axillary
Innominate
Femoral Versus Axillary Versus Innominate Artery Versus Central Cannulation
References
14: Ascending Aortic Aneurysm Surgery
Introduction
Patient Presentation and Selection
Operative Planning
Preoperative Imaging
Cannulation Strategy
Circulatory Arrest and Cerebral Protection
Surgical Variations
The Surgery
Setup and Cannulation
Myocardial Protection and Circulatory Arrest
Exposure and Proximal Aortic Surgery
The Distal Anastomosis
Graft to Graft
Outcomes
References
15: Ascending Aortic Dissection Surgery
Acute Type A Aortic Dissection
Chronic Ascending Aortic Dissection
References
16: Valve Sparing Aortic Root Procedure: Yacoub’s Procedure
Morphology and Physiology of the Aortic Root
Background and Indications for Surgery
Intra-operative Transoesophageal Echocardiography (TOE) Measurements
Operative Technique
Cannulation Strategy
Valve Assessment
Preparation of the Aortic Root
Customising the Graft
Remodelling vs. Reimplantation
References
17: Valve-Sparing Aortic Root Surgery by the Reimplantation Technique
Introduction
Choice of Procedure in the Context of Pathology
Ideal Patient Candidates for the Reimplantation Procedure
Aortic Pathology and Mechanism of AI
Operative Technique
Overview and Principles of the Technique
Cannulation and Myocardial Protection
Intraoperative Preprocedural Assessment
Tissue Dissection (Fig. 17.4)
Graft Selection and Sizing
Aortic Annuloplasty (LVOT Suture Line)
Aortic Annuloplasty (Hemostatic Suture Line)
Coronary Button Reimplantation
Reassessment and Secondary Cusp Repair
Post-procedural Intraoperative Assessment
Outcomes of Reimplantation
Reimplantation vs. CVG
Reimplantation in Marfan Syndrome
Reimplantation in Dissection
Reimplantation in BAV
Hemodynamics of Reimplantation
References
18: Coronary Artery Bypass Graft vs. Percutaneous Intervention
Introduction
Criteria for Decision-Making
Predicted Surgical Mortality
Anatomical Complexity of Coronary Artery Disease
Completeness of Revascularization
Results Per Coronary Territory
Isolated Proximal LAD Coronary Artery Disease
Left Main Coronary Artery Disease
Multivessel Coronary Artery Disease
Conclusion
References
Index