Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery

Nissinen, Juha; Biancari, Fausto; Wistbacka, Jan-Ola; Peltola, T; Loponen, Pertti; Tarkiainen, Pekka; Virkkilä, M.; Tarkka, Matti

doi:10.1177/0267659109354656

Cited by 139 publications

(115 citation statements)

References 14 publications

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“…Contrary to the findings of other studies, however, the incidence of post-operative myocardial infarction (PMI) was higher in trainee cases (1.1% vs. 0.3%, p = 0.008) [6,16]. This may reflect the longer perfusion and aortic cross-clamp time in trainee cases, which have been previously shown to be risk factors for PMI [25]. Nevertheless, the incidence of PMI in the trainee group is comparable to that reported in many other studies and it may represent a chance finding given that the overall incidence of PMI in the current study was low at only 0.4% [6,16,26].…”

Section: Discussioncontrasting

confidence: 64%

Training surgeon status is not associated with an increased risk of early or late mortality after isolated aortic valve replacement surgery

et al. 2014

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Section: Discussioncontrasting

confidence: 64%

Training surgeon status is not associated with an increased risk of early or late mortality after isolated aortic valve replacement surgery

et al. 2014

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“…When a long-term stent graft is inserted, the risk of paraplegia and spinal cord injury must be considered due to extensive sacrifice of spinal arteries impairing collateral blood flow to the spinal cord, combined with inadequate protection during the operation (14). The longer cardiopulmonary bypass and cardiac arrest time, aortic cross-clamping time and cerebral perfusion time might inevitably be associated with post-operative cardiac and cerebral injury and organ dysfunction (25,(29)(30)(31)(32). In some cases, extending the initial surgery to total arch replacement might not be able to eliminate the entire dissection in the downstream aorta, e.g., at the level of coeliac trunk and iliac arteries (14).…”

Section: Discussionmentioning

confidence: 99%

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Poon

Theologou

Harrington

et al. 2016

Ann. Cardiothorac. Surg.

127

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Background: Despite recent advances in aortic surgery, acute type A aortic dissection remains a surgical emergency associated with high mortality and morbidity. Appropriate management is crucial to achieve satisfactory outcomes but the optimal surgical approach is controversial. The present systematic review and meta-analysis sought to access cumulative data from comparative studies between hemiarch and total aortic arch replacement in patients with acute type A aortic dissection.Methods: A systematic review of the literature using six databases. Eligible studies include comparative studies on hemiarch versus total arch replacement reporting short, medium and long term outcomes. A meta-analysis was performed on eligible studies reporting outcome of interest to quantify the effects of hemiarch replacement on mortality and morbidity risk compared to total arch replacement. There was no significant difference in terms of in-hospital mortality between the two groups (RR =0.84; 95% CI: 0.65-1.09; P=0.20; I 2 =0%). Cardiopulmonary bypass, aortic cross clamp and circulatory arrest times were significantly longer in total arch replacement. During follow up, no significant difference was reported from current studies between the two operative approaches in terms of aortic re-intervention and freedom from aortic reoperation.Conclusions: Within the context of publication bias by high volume aortic centres and non-randomized data sets, there was no difference in mortality outcomes between the two groups. This analysis serves to demonstrate that for those centers doing sufficient total aortic arch activity to allow for publication, excellent and equivalent outcomes are achievable. Conclusions on differences in longer term outcome data are required. We do not, however, advocate total arch as a primary approach by all centers and surgeons irrespective of patient characteristics, but rather, a tailored approach based on surgeon and center experience and patient presentation.

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“…4, 5 The aim of right anterolateral thoracotomy approach is to reduce the morbidity, short hospital stays, early discharge and short rehabilitation time. [5][6][7] A study conducted by Ganie et al (2013) comparing anterolateral thoracotomy against standard median sternotomy for mitral valve surgery and observed that the study populartions of both groups were comparable in terms of age, sex, NYHA class of heart failure and ejection fraction. 6 Thoracotomy shows better | Original | Article |…”

Section: Introductionmentioning

confidence: 99%

Early outcome of mitral valve replacement through right anterolateral thoracotomy versus standard median sternotomy

Saha

Ranjan

Adhikary

et al. 2018

Bangabandhu Sheikh Mujib Medical University Journal

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<p class="Abstract">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 anterolateral thoracotomy and it is cost effective especially for the developing countries.</p>

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Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery

Cited by 139 publications

References 14 publications

Training surgeon status is not associated with an increased risk of early or late mortality after isolated aortic valve replacement surgery

Training surgeon status is not associated with an increased risk of early or late mortality after isolated aortic valve replacement surgery

Systematic Review Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

Early outcome of mitral valve replacement through right anterolateral thoracotomy versus standard median sternotomy

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