Clamp control of the right ventricular angle to facilitate exposure and repair of cardiac wounds

Grabowski, Michael; Buckman, Robert F.; Goldberg, Amy J.; Badellino, Michael M.

doi:10.1016/s0002-9610(99)80312-2

Cited by 16 publications

(9 citation statements)

References 3 publications

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“…Several adjunctive measures are available to assist cardiorraphy including, temporary in-flow occlusion, methods to facilitate repair of posterior cardiac injuries, adenosine infusion and the use of cardiopulmonary bypass for post-cardiorraphy resuscitation [33][34][35][36][37]. Although temporary inflow occlusion appears an attractive option it is of limited value in a hypotensive, acidotic patient [33].…”

Section: Adjuncts and Special Circumstancesmentioning

confidence: 99%

Penetrating Cardiac Injury

2009

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It is understood that penetrating cardiac trauma is a highly lethal injury and those surviving to hospital have an overall mortality approaching 80%. Reported mortality figures vary widely and are extremely dependent on mechanism of wounding, cardiac chambers involved and possibly the presence of cardiac tamponade. Despite significant advances in prehospital care, operative techniques, and intensive care management, the mortality has not changed over several decades. This article will review the anatomic regions of concern for a cardiac injury, clinical presentation, and physical findings. The need for an expeditious evaluation and modalities available including, plain radiographs, sub-xiphoid window, and echocardiography will be considered. Options for surgical exposure, technical details of repairing cardiac injuries, and special circumstances such as injury adjacent to a coronary artery and intra-cardiac shunts are discussed in detail. Outcome data and future directions in managing this challenging injury are also examined.

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Section: Adjuncts and Special Circumstancesmentioning

confidence: 99%

Penetrating Cardiac Injury

2009

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“…This movement can be safely min imized by an assistant's Satinsky clamp on the acute anteroinferior angle of the right ventricle. 26 This tech nique is often more straightforward in a heart that is less filled with blood. Use of the Octopus tissue stabilizer (Medtronic) is also a reasonable alternative, if available.…”

Section: Cardiac Repairsmentioning

confidence: 99%

“…33 In desperate cases, it may be necessary to elevate an atraumatic clamp applied to the acute anterior-inferior margin of the right ventricle and repair the wound as quickly as possible. 26 Defects adjacent to the coronary arteries also warrant additional comment as coronary blood flow can be inad vertently compromised during the repair. Interrupted, horizontal mattress sutures are placed beneath the bed of the coronary vessel to prevent vascular constriction.…”

Section: Cardiac Repairsmentioning

confidence: 99%

Technical considerations in the management of penetrating cardiac injury

Ball

Lee

Kaminsky

et al. 2022

cjs

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Technical considerations in the management of penetrating cardiac injuryPenetrating cardiac injuries require rapid diagnosis, efficient exposure and nuanced technical approaches, within a framework of highly coordinated and integrated multidisciplinary care. Acute care surgeons, with both strategic and technical expertise, are ideally positioned to address the potentially dev astating consequences of these injuries. The aim of this narrative review is to offer a technical approach to the rapid evaluation, exposure, operative repair and postoperative care of penetrating cardiac injuries. A comprehensive review of the cardiac trauma literature, dating back to 1970, has provided a detailed toolbox of approaches to subxiphoid pericardial windows, resuscita tive thoracotomy, median sternotomy, pericardiotomy, aortic clamping, car diac hemorrhage control, cardiac repair, coronary artery injuries, pericardial closure, drain placement, chest wall closures, damage control thoracic pro cedures and immediate postoperative cardiac care, all based on fundamental physiological principles and anatomical considerations. First principles Team dynamics and responsibilitySuccess in the management of penetrating cardiac injuries depends on the presence of predefined systems of trauma care capable of moving patients quickly, accessing necessary resources (e.g., blood bank) and equipment (e.g., resuscitative thoracotomy tray [Figure 1], operating

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“…43 A related and common technique in the modern era to minimize the "to and fro" motion of a beating heart during cardiac repair is the application of a Satinsky vascular clamp. 44 This clamp is gently placed on the heel of the right ventricle with minimal clicks and with the angle overhanging the cardiac edge slightly. Also, the clamp can be used as a handle to elevate the heart and look for and repair any injuries to the posterior cardiac wall.…”

Section: Stabilizing the Beating Heartmentioning

confidence: 99%

Treatment of penetrating cardiac wounds for the general surgeon on call

Khaitan

Feliciano

Rozycki

et al. 2022

J Trauma Acute Care Surg

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Scoop and run" approaches for severely injured patients have been adopted by emergency medical services over the past 40 years. This has resulted in more patients with severe injuries including penetrating cardiac wounds arriving at trauma centers and other acute care hospitals. General surgery trauma teams and general surgeons taking trauma call are the first responders for diagnosis, resuscitation, and operative management of injured patients. By natural selection, 96% to 98% of patients with signs of life on arrival to the trauma center after sustaining a penetrating cardiac wound have injuries that are amenable to repair by a general surgeon, fellow, or senior surgical resident without the need for a cardiothoracic surgeon or cardiopulmonary bypass.This literature and experience-based review summarizes the diagnostic and operative approaches that should be known by all trauma teams and general surgeons taking trauma call. In addition, it describes when a cardiothoracic surgeon should be consulted and briefly reviews how complex penetrating cardiac injuries are repaired.

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Clamp control of the right ventricular angle to facilitate exposure and repair of cardiac wounds

Cited by 16 publications

References 3 publications

Penetrating Cardiac Injury

Penetrating Cardiac Injury

Technical considerations in the management of penetrating cardiac injury

Treatment of penetrating cardiac wounds for the general surgeon on call

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