TY - JOUR. T1 - Antemortem diagnosis of an endomyocardial breast cancer metastasis by transvenous endomyocardial biopsy. AU - Lieberman, E. B.. AU - Arthur, J.. AU - Steenbergen, C.. AU - Bashore, T. M.. PY - 1993/1/1. Y1 - 1993/1/1. N2 - Endomyocardial breast cancer metastases are extremely rare and have previously been diagnosed antemortem only through median sternotomy and cardiotomy. We report a case of endomyocardial breast cancer metastasis which was diagnosed antemortem by transvenous endomyocardial biopsy.. AB - Endomyocardial breast cancer metastases are extremely rare and have previously been diagnosed antemortem only through median sternotomy and cardiotomy. We report a case of endomyocardial breast cancer metastasis which was diagnosed antemortem by transvenous endomyocardial biopsy.. UR - http://www.scopus.com/inward/record.url?scp=0027536468&partnerID=8YFLogxK. UR - http://www.scopus.com/inward/citedby.url?scp=0027536468&partnerID=8YFLogxK. U2 - 10.1378/chest.103.4.1280. DO - ...
Need for Blood Transfusion. Six (27%) patients of the sternotomy approach group and 2 (13%) of the MIS approach required transfusion, with no statistical difference between both groups (P=0.49).. Incidence of AF. Six (27%) patients of the sternotomy approach and seven (47%) of MIS approach had AF in the postoperative period, with no statistical difference between the groups (P=0.92).. Length of Stay in the ICU and Length of Hospital Stay. The average length of stay in the ICU was 3.9±2.5 days for the sternotomy approach and 3.4±1.2 days for the MIS approach, with no statisticaldifference (P=0.975).. The average length of hospital stay was 11±9.0 days for the sternotomy group and 7.1±2.0 days for MIS group, with no statistical difference (P=0.454).. Short-term Mortality and Surgical Wound Infection. Until hospital discharge, no cases of death or wound infection were documented for both approaches.. DISCUSSION. Aortic valve disease is common in clinical practice and surgical treatment is still ...
Complications following median sternotomy include infectious or noninfectious dehiscence, mediastinitis, osteomyelitis, chronic sternal pain and non-union. Comorbid patients often have poorer bone quality and impaired wound healing that make them more susceptible to these complications, particularly those with diabetes, osteoporosis, pulmonary disease or obesity. Physiologic loads sustained with coughing or valsalva may be sufficient to cause dehiscence in this high risk group[10]. The key factor is compromised sternal stability by wire breakage, excessive shearing forces, or lateral displacement of the sternal halves. The majority of dehiscence is caused by steel wires cutting through sternal bone. Some physicians select more durable closure methods rather than using the standard wire cerclage to avoid the unstable sternum[11]. Management of dehiscence varies by severity but often requires surgical debridement, rewiring, rigid plate fixation, or muscle flaps[12].. Post-sternotomy pain syndrome ...
Comparison of Ministernotomy with Minithoracotomy Regarding ABSTRACT Purpose: This prospective clinical study focuses on postoperative pain and internal mammary artery (IMA) characteristics
Objective. To improve the results of surgical treatment of the aorta ascendance pathology in combination with affection of aortal valve due to minimization of operative trauma.. Materials and methods. In Amosov National Institute of Cardio-Vascular Surgery in period 01.01.2015 - 01.01.2019 yr 70 patients were operated, in whom the operative access of a J-like ministernotomy was applied.. Results. Operative mortality was absent. Mechanical ventilation after the intervention have lasted (4.5 ± 0.5) hours. All the patients were delivered to Department of Reanimation and Intensive Therapy during (36 ± 3.5) hours after the operation. Complications of this procedure were noted in 5 (7.1%) patients.. Conclusion. The procedure for correction of the aortal heart failures, combined with the aorta ascendance aneurism, using miniinvasive access, may serve as the median sternotomy clinical alternative.. ...
Collapsed lung. The top of the lung is close to where biopsies need to be taken. Air may get into the pleural space or around the lung. This is commonly called a collapsed lung. It may be necessary to open the pleural space to take the biopsy. If you have air in the pleural space you may require a chest drain to be inserted to remove the air.. Blood clots. This is general risk with any operation that involves staying in hospital.. Injury to large blood vessels that are close to the heart. There is a small risk of major bleeding if one of these vessels is damaged. Bleeding can be controlled and the vessel repaired. To do this an additional incision would need to be made called a median sternotomy or a thoracotomy. If there is severe bleeding you may need a blood transfusion.Median sternotomy or thoracotomy incision. One of these incisions is done to get into the chest to if there is severe bleeding. A median sternotomy is a vertical incision, approximately 20cm long, in the centre of the chest ...
John Pepper of the Royal Brompton and Harefield Hospitals, London, United Kingdom, argues that there is not yet the evidence to support the superiority of minimally invasive aortic valve replacement over a full sternotomy approach ...
171 mini-AVRs were undertaken between 2006 and 2015, out of which 41 patients were aged 80 or above. Patient demographics were as follows: mean age 83.8 years (range 80-91, SD 2.934), female gender 63.4%, diabetes mellitus 9.8%, pulmonary disease 22.0%, LV function: ,30% in 7.3%, 30-5% in 17.1% and ,50% in 75.6%, logistic euroSCORE 13.3 (interquartile range 8.44 - 14.7, SD 9.04). Overall in-hospital and 30-day mortality was 2.4% (1/41), re-exploration rate was 0.0%, renal failure requiring dialysis 2.4% (1/41), permanent pacemaker 2.4% (1/41), CVA 0.0%, conversion to full sternotomy 0.0%. ...
Not every program for cardiac surgery in the United States has advanced expertise in the techniques of minimally invasive surgery of the heart. Many patients in geographical locations without this specific skills are still saying that they are not suitable for these less invasive techniques. This article will present the most important successes that modern minimally invasive heart surgery centers have to offer all heart surgery patients. Its fair to say that many surgeons didnt have the ability, desire or time to acquire skills minimally invasive surgical and will advise their patients to stick to what they are familiar with: surgery through a split sternum (median sternotomy). Most patients would not be able to find out if their case could be treated with a much less invasive, unless they see a Center for minimally invasive heart surgery respectable. You should do a little homework to be able to ask the right questions to your doctor. Patients with the right information are much more likely ...
A 59 year old man was admitted to our cardiac surgical intensive care unit after a third operation on the mitral and aortic valves. His previous operations had been six months before. All three surgeries were done via a median sternotomy, and the left pleural space was never opened during the operations.. The postoperative recovery was initially uneventful. The day after surgery the patient was extubated, and the chest drains removed. The next day, however, we noticed a reduced air entry in the left lower zone of the chest, and a chest x ray showed some haziness in the left lower zone, consistent with a collection of fluid in the left pleural space. … ...
This one has me a little confused...trying to get opinions on how others would code this one. thanks! PROCEDURE PERFORMED: Sternotomy, cardiopulmonary
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TY - JOUR. T1 - Photobiomodulation of surgical wound dehiscence in diabetic individuals by low level laser therapy following median sternotomy. T2 - A case series. AU - Dixit, Snehil. AU - Maiya, Arun. AU - Umakanth, Shashikiran. AU - Borkar, Shirish. PY - 2012/12/1. Y1 - 2012/12/1. N2 - In this single case study we attempt to outline the possible effect of low level laser therapy on delayed wound healing (LLLT) in chronic dehiscent sternotomy of a diabetic individual. The methods that were employed to evaluate changes pre and post irradiation were wound photography, wound area measurement, pressure ulcer scale of healing (PUSH) and visual analogue scale (VAS) for pain. After irradiation, proliferation of healthy granulation tissue was observed with decrease in scores of PUSH for sternal dehiscence and VAS for bilateral shoulders and sternal dehiscence. We found that LLLT irradiation could be a novel method of treatment for chronic sternal dehiscence following coronary artery bypass grafting ...
This study was aimed to compare the peri-operative outcomes among the mitral valve replace-ment using anterolateral thoracotomy (n=17) and standard median sternotomy (n=17) in a single surgeons practice. The mean age was 24.1 ± 5.3 years in Group I and 41.0 ± 11.5 years in Group II. Female was predominant in Group I. Total operative time and bypass time were significant in both the study groups. Incision scar was not visible in females in Group I but full incision scar was visible in Group II in sitting posture. In Group I patients, majority (52.9%) patients needed short duration of ICU stay in comparison to Group II, and the difference was statistically significant (p,0.05) between the two groups. During discharge, 94.1% wound was well healed in Group I and 70.6% in Group II. Wound dehiscence was nil in Group I, but 23.5% patients developed dehiscence in Group II. However, only 5.9% patient developed unstable sternum in Group II. Cosmetic mitral valve replacement can be done safely through ...
This is a single-center, open-label, randomized controlled trial. Patients scheduled for aortic valve replacement (AVR) at Karolinska University Hospital in Stockholm, Sweden will be eligible. Twenty patients will be randomly assigned to either partial upper sternotomy (20 patients) or full sternotomy AVR (20 patients). Inclusion criteria is severe aortic stenosis referred for medically indicated isolated aortic valve replacement. Exclusion criteria are left ventricular ejection fraction less than 0.45, previous cardiac surgery, or urgent/emergent surgery.. CE-marked and FDA-approved mechanical and bioprosthetic (stented or sutureless) aortic valves will be implanted. Cytokine release will be repeatedly assessed preoperatively and postoperatively (at 0, 6, 12, 18, 24 hours, and 3 days after surgery). Clinical characteristics will be registered. Clinical postoperative ouytcomes will be registered. Routine blood sampling will be performed pre- and postoperatively. All available data will be ...
To produce two comparable groups of patients, the characteristics are recorded using EURO-Score; additionally the groups are matched (Matched-Pairs-Analysis).. All patients are operated by the same surgeon (senior physician Dr. A.K. Menon) under general anaesthesia through median sternotomy with elective or urgent indications.. After induction of anaesthesia, within the first hour after admission to the Intensive Care Unit (ICU) and every further morning in the ICU or Intermediate Care Station (IMC), 10ml blood are removed by a central venous catheter, allowing to measure blood selenium levels in whole blood by electrothermal atomic absorption spectrometry.. All blood draws will be held on vascular access, which is lying independently of the study participation for surgery or for intensive care treatment. The blood samples will be stored until completion of the study and its evaluation (up to 24 months) and are discarded afterwards. All data collected are recorded on a documentation sheet. ...
TY - JOUR. T1 - Pulmonary artery sling. T2 - Results with median sternotomy, cardiopulmonary bypass, and reimplantation. AU - Backer, Carl L.. AU - Mavroudis, Constantine. AU - Dunham, Michael E.. AU - Holinger, Lauren D.. PY - 1999/6. Y1 - 1999/6. N2 - Background. The classic surgical approach to pulmonary artery (PA) sling has been through a left thoracotomy with division of the left PA and reimplantation into the main PA anterior to the trachea. Another approach is anterior left PA translocation with distal tracheal resection. Since 1985, we have repaired PA sling with a median sternotomy approach, cardiopulmonary bypass, and division and reimplantation of the left PA into the main PA with simultaneous repair of associated tracheal stenosis. The purpose of this review is to determine the outcome of that strategy. Methods. From 1985 to 1998, 16 infants had surgical treatment of PA sling, 14 had left PA division and reimplantation into the MPA, 2 patients had repair using the translocation ...
0569] Baisden, C. E., L. V. Greenwald, et al. (1984). "Occult rib fractures and brachial plexus injury following median sternotomy for open-heart operations." Ann Thorac Surg 38(3): 192-194. [0570] Bolotin, G., G. D. Buckner, et al. (2007). "A novel instrumented retractor to monitor tissue-disruptive forces during lateral thoracotomy." J Thorac Cardiovasc Surg 133(4): 949-954. [0571] Bonfils-Roberts, E. A. (1972). "The Rib Spreader: A Chapter in the History of Thoracic Surgery." Chest 61(5): 469-474. [0572] Brown, M. D. and D.C. Holmes (1990). Apparatus and method for measuring spinal instability. USPTO. US. [0573] Buckner, G. D. and G. Bolotin (2006). Force-determining retraction device and associated method. U.S. Pat. No. 4,899,761 [0574] Chaudhuri, O., S. H. Parekh, et al. (2007). "Reversible stress softening of actin networks." Nature 445(7125): 295-298. [0575] Dorfmann, A., B. A. Trimmer, et al. (2007). "A constitutive model for muscle properties in a soft-bodied arthropod." Journal of The ...
Less invasive surgical techniques have transformed surgery in many fields, including cardiothoracic surgery. Smaller incisions mean less blood loss, less discomfort, a shorter hospital stay, and a faster recovery.. Weill Cornell Medicines Department of Cardiothoracic Surgery specializes in many minimally invasive surgical techniques. In fact, our surgeons have pioneered many of these approaches.. Our surgeons specialize in:. Transcatheter aortic valve replacement (TAVR): This minimally invasive approach repairs or replaces a diseased heart valve by threading a catheter up to the heart through a blood vessel in the groin.. Weill Cornell surgeons were leaders in the clinical trials that established this techniques effectiveness.. Mini-sternotomy or partial sternotomy: Many procedures, such as aortic valve replacement, mitral valve repair/replacement, and aneurysm repair can be performed through a small incision and partial sternotomy. This is an alternative to traditional, "open-heart" surgery. ...
article{Mediastinum4535, author = {Alfonso Fiorelli and Francesco Paolo Caronia and Immacolata Mauro and Giuseppe Di Miceli and Mario Santini}, title = {Sternotomy for management of myasthenia gravis: is the time to retire?}, journal = {Mediastinum}, volume = {2}, number = {0}, year = {2018}, keywords = {}, abstract = {Surgical resection is the main treatment for myasthenia gravis (MG) associated with thymic hyperplasia or thymoma. The first thymectomy was performed in 1939 using full median sternotomy, but the morbidity and mortality related to sternotomy let surgeons to explore in selected cases less invasive approaches including transcervical or partial sternotomy (1-4).}, url = {http://med.amegroups.com/article/view/4535 ...
We report the case of a rare complication after coronary artery bypass graft (CABG) with non-traumatic fracture of nitinol thermoreactive sternal clips resulting a postoperative partial sternal dehiscence. A 61-year-old female patient administered to our department with severe coronary stenosis by coronary angiography and stabil angina pectoris symptoms. Physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm for 75/min. Arterial blood pressure was 130/90 mmHg. Lungs and heart were clear to auscultation. Patient was diagnosed with diabetes mellitus (DM) for several years with insulin treatment. She was obese with body mass index (BMI) 36.8 kg/m2. Rest of the physical and clinical evaluation was within normal limits. After preoperative preperation, patient underwent to three vessel CABG with conventional cardiopulmonary bypass. Due to intraoperative findings of obvious sternal osteoporosis and co-morbidities such as DM and higher BMI we applied 3 nitinol ...
2016 Annual Meeting: Single Institutional Experience with 12,165 Median Sternotomies: A Simple Risk Assessment Tool for Deep Wound Infection
Purpose: The goal of this study was to compare the cost-effectiveness of mitral valve surgery (MVS) performed through a minimally invasive (MI) vs median sternotomy (ST) approach.. Methods: From 1/1/03-12/31/08, 847 isolated mitral valve operations were performed at our institution (348 ST, 499 MI). All MI cases were performed via mini-thoracotomy. Propensity matching on 18 preoperative risk factors was done using a logistic regression model. Cost data was obtained from our hospital billing system using standardized UB-92 forms. Total cost and service-specific costs between the two approaches were compared.. Results: The propensity analysis generated 211 matched pairs for a total analysis cohort of 422 patients. There was no significant difference in major baseline characteristics after propensity matching (model c-statistic=0.813). MI surgery was associated with a 6.9 minute longer cross-clamp time (XCT) (p=0.021) and a 23.7 minute longer bypass time (CBT) compared to ST (p,0.001). MI patients ...
Home , Papers , Remifentanil versus fentanyl during cardiac surgery on the incidence of chronic thoracic pain (REFLECT): study protocol for a randomized controlled trial. ...
Patients who underwent minimally invasive mitral valve surgery had a shorter length of stay in the intensive care unit and fewer transfusions compared with those who underwent conventional sternotomy, according to a retrospective database analysis. The procedures had similar rates of mortality, stroke and other complications and total hospital costs.
Although several studies have examined factors affecting survival after orthotopic heart transplantation (OHT), few have evaluated the impact of reoperative sternotomy. We undertook this study to examine the incidence and impact of repeat sternotomie
I am confused My Surgeon has to redo sternotomy original done in 1986 not by him for constrictive pericarditis and a CABGX2 for CAD. As far as I can t
Surgical strategy and approach are important in patients with aortic coarctation associated with intracardiac anomalies. In this study, surgical technique, indications and results of the single stage repair of aortic coarctation and intracardiac defects via median sternotomy were discussed. Between January 1987 and August 2002, 158 patients with aortic coarctation or interrupted aortic arch (IAA) underwent surgery. In 17 of them who had associated intracardiac anomalies, single stage approach via median sternotomy were performed. Their ages ranged from 1 month to 13 years (mean 2.2 3.3 years). Ventricular septal defect (VSD) and aortic stenosis were the most common associated lesions. Aortic coarctation was repaired under cardiopulmonary bypass initially and then intracardiac repair was performed. A short period of total circulatory arrest was necessary in two patients with IAA and one patient with extensive arcus hypoplasia. Among the patients who underwent single stage repair of aortic ...
article{f0bea708-f1fa-40b0-ae82-684dfb0fa4b2, abstract = {BACKGROUND: Sternocutaneous fistulas (SCFs) after cardiac surgery represent a complex surgical problem involving multiple hospital admissions, prolonged antibiotic treatment, and repeated debridements. Our objective was to identify the incidence of and risk factors for SCF, and to evaluate long-term survival. METHODS: A total of 12,297 patients underwent sternotomy for cardiac surgery between January 1999 and December 2008, and 32 patients were diagnosed as having SCF during follow-up. Risk factors were identified with multivariate analysis and survival was compared using the log-rank test. RESULTS: The cumulative incidence of SCF at one year was 0.23%. There was no significant difference in mean time from sternal closure after cardiac surgery to intervention for SCF with (n = 9) or without (n = 23) preceding sternal wound infection (SWI); 6.1 +/- 4.2 versus 6.9 +/- 4.6 months, (p = ns). Risk factors for developing SCF were previous SWI ...
A device and method treats pulmonary disease of a patient by expanding the thorax of the patient. Following surgical sternotomy, a separator is implanted in the thorax between the facing sternum surfaces resulting from the surgical sternotomy. The separator has a longitudinal dimension with opposing sidewalls extending along the longitudinal dimension and a width dimension. The facing surfaces of the sternum are engaged with the opposing sidewalls of the separator. Thereafter, the sternum is fixed to the separator for maintaining the sternum in engagement with the opposing sidewalls of the separator and thus maintaining the expanding condition of the thorax.
While several studies presented evidence discussing the effects of an accidental pleurotomy on lung function or outcome, only 4 papers studied the impact of either disconnecting the lungs or direction of sternotomy, and thus only these 4 papers were reviewed. Ronday et al performed the largest PRCT in this area. 666 patients were randomized to either receiving pleurotomy with the lungs disconnected from the ventilator, or randomized to continued ventilation. There were 98 accidental pleurotomies and the incidence was 15.5% in the lungs deflated group and 14% in the lungs inflated group. In addition they could find no risk factors for predicting accidental pleurotomy, and COPD, use of positive pressure ventilation age and sex had no impact. Only the operating surgeon influenced the likelihood of accidental pleurotomy. In 1998 Pick et al performed a prospective cohort study into the incidence of accidental pleurotomy according to the direction of sternotomy. One of the surgeons performed all his ...
According to the official doc … doctors desperately tried to save Alans life by performing a median sternotomy - its a surgical procedure where doctors literally crack open the sternum to open up the area around the heart and lungs so they can operate.. Alan was stricken with the heart attack at around 11:15 AM last week. He died 3 hours later in surgery at Providence St. Josephs Medical Center in Burbank. Time of death was listed at 2:14 PM.. ...
Designed and developed by clinicians and educators, TOM is the only model on the market able to replicate the level of realism required to engage the entire multi-disciplinary healthcare team in emergency resternotomy. TOM is ideal for team training within the cardiac intensive care and operating theatre setting, and has the capability to simulate a realistic tamponade or catastrophic haemorrhage.. ...
The passenger compartment of the Karl remained stable in the frontal offset test. Examination of the high speed films and of the dummy traces showed that the head of the driver dummy was not stable on the airbag. There was insufficient pressure in the airbag to prevent the head from flattening it and the head made contact, through the deflated bag, with the steering wheel. Thereafter, the head was unstable and rolled off the steering wheel to one side. The score for head protection was penalised and its protection was rated as adequate. Dummy readings in the lower leg indicated marginal protection of this part of the body for the driver. In the full-width rigid barrier frontal impact, the drivers pelvis slid beneath the part of the seatbelt passing over the lap. This is known as submarining and presents risks to the knee, femur and pelvis. The score for this body region was penalised and protection was rated as poor. In the side barrier test, the Karl scored maximum points with good ...
About 930 this morning it started. I have had acid reflux for years but nothing like this. Its this ...Find answers to the question, Why Am I Having This Pressurized Feeling Below My Sternum All Day? from people who know at Ask Experience.
TY - JOUR. T1 - Managing deep sternal wound infections with vacuum-assisted closure. AU - Chen, Yi. AU - Almeida, Aubrey Anthony. AU - Mitnovetski, Sergei. AU - Goldstein, Jacob. AU - Lowe, Cassie E. AU - Smith, Julian Anderson. PY - 2008. Y1 - 2008. M3 - Article. VL - 78. SP - 333. EP - 336. JO - ANZ Journal of Surgery. JF - ANZ Journal of Surgery. SN - 1445-1433. IS - 5. ER - ...
In 1957, the introduction of the median sternotomy to allow access to intrathoracic organs by Julian et al revolutionized the field of thoracic surgery. Since this landmark introduction, sternal wound infection and dehiscence have been reported to occur in approximately 0.
Results: Between 4/06 and 8/07, 13 patients underwent thymectomy for MG. Three patients had open, transsternal thymectomies via median sternotomy during this period. One patient was approached primarily via a median sternotomy due to a BMI of 40. The remaing 12 patients were positioned supine with a shoulder role and the table planed ~45 degrees; left side up. In 2 morbidly obese patients (BMIs 36.7 and 37.2), both with asthma, a thoracoscope was introduced initially into the left hemithorax. However, due to their inability to tolerate one-lung ventilation, the left VATS approach was aborted and a sternotomy was performed without repositioning. Ten patients (median BMI 32.5) underwent a succesful robotic thymectomy via a left VATS approach with complete excision of the mediastinal fat pad and entire thymus. No patient required perioperative blood transfusion or emergent conversion to open procedure for bleeding. There were no post-operative complications in either group. Median LOS was 3 days ...
DEL SOL, M. and OLAVE, E. Abstract : The xiphoid process is the smallest and variable part of the sternum. On basis of different studies performed it can present different shaped. The aim of this study was to determine the morphologic characteristics of the xiphoid process on 50 sternum of adult mapuche individuals obtained from necropsies. The xiphoid process was bifid in 42% of cases, with a spatula shape in 38%, in ovals and ellipsoid shapes in 10% and other forms in 10%. Their maximal diameters average were: vertical 38mm, lateral-lateral 21.9mm and anterior-posterior 2.3mm. Respect to their orientation the xiphoid process presented: without bent in 32% of cases, bent to the left in 24%, bent to the ventral part in 16%, bent to the right in 10% and bent to the dorsal part in 4%. Other combinations (14%). In 12% of cases the presented a foramen. In 58% of cases the xiphoid process was jointed only with the most posterior region of the inferior part of the sternum body. Our study proves the ...
Heart surgery to repair one of the valves in the heart (the mitral valve) is commonly performed in the NHS. To repair the valve, the operation usually involves cutting the breastbone completely (from the collar bone to the bottom of the breastbone); this is called a sternotomy. An operation has been developed which means that the valve can be repaired using a much smaller cut on the side of the chest. This operation is called a mini-thoracotomy. It is currently not known which operation is better for patients and for the NHS because there is no good research to show what effects the two different types of surgery to access the heart and repair the valve have on patients. This is a multi-centre, randomised controlled trial, comparing mitral valve repair (MVr) via minimally invasive thoracoscopically-guided right minithoracotomy (intervention under study) and mitral valve repair via conventional median sternotomy (usual care) to determine return to usual return to usual activity based on change in ...
The usual incision used for CABG is a midline sternotomy (see the image below), although an anterior thoracotomy for bypass of the LAD or lateral thoracotomy for marginal vessels may be used when an o... more
What is minimally invasive cardiac surgery?. Most cardiac operations today are performed through a sternotomy, which involves splitting the entire breastbone. Minimally invasive cardiac surgery encompasses a variety of operations performed through incisions that are substantially smaller and less traumatic than the standard sternotomy. Minimally invasive incisions measure about 3 to 4 inches compared to 8 to 10 sternotomy incisions. Specialized handheld and robotic instruments are used to project the dexterity of the surgeons hands through these small incisions in performing the operations. ...
Cardiac surgery patients are different from many other patients for a number of reasons when it comes to resuscitation post arrest. arterial line, Swan-ganz catheter (generally), and cardiac monitor; thus allowing for very early defibrillation without the use of external cardiac massage (ECM). ECM should be avoided if at all possible due to risk of […]. ...
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Several randomized controlled trials comparing negative-pressure therapy to standard wound care for chronic wounds have been published. Although these studies suggest a benefit for negative-pressure therapy, the majority of the review articles on the
In this brief report, we describe a technique to facilitate hypothermic arrest before a redo sternotomy that is likely to require extensive dissection. This approach may be well-suited for patients with significant aortic insufficiency, as it allows control of left ventricular distention once hypothermic ventricular fibrillation ensues. The procedure entails inserting a second venous cannula through the left ventricular apex through a 7-cm left mini-thoracotomy. We used the technique successfully in a patient with a ruptured, infected ascending aortic pseudoaneurysm and severe aortic insufficiency who had undergone a previous sternotomy. ...
The sternum or breast bone is a flat bone situated just middle of the chest and just below the skin on the front side. It looks like a dagger in adult people. There are two surfaces of it anterior and posterior in adults.
A sternal closure device comprising first and second clamps. The first and second clamps have a generally tubular portion and the second clamp has a portion that is slidably receivable in the tubular portion, and a lock configured to retain said second clamp within said first clamp. A surgical instrument for laterally moving opposed sternal clamps toward one another is also disclosed. The instrument comprises first and second grasping members generally linearly slidably coupled to one another.
A retractor for use in various types of surgical procedures such as harvesting mammary arteries, coronary bypass surgery, heart valve repairs, mitral valve replacement, partial sternotomies, and other types of surgery includes a toothed crossbar to which a pair of small grips are attached. The first grip is attached to an arm which is removably connected to a first block. The first block is movable along the crossbar, thereby permitting the first grip to be moved toward or away from the second grip. The second grip is attached to an arm which is removably connected to a second block. The second block can be fixed or movably connected to the crossbar. The crossbar includes a hinge that enables the grips to be pivoted relative to each other. Pivoting is accomplished by a pair of vertically extending brackets that are connected to the blocks and which are connected to each other by an adjustable connector. Retractor blades of various types are connected to the adjustable connector or to arm-carried rods by
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