Search

To determine the efficacy of using the harmonic scalpel and robotic assistance to facilitate thoracoscopic harvest of the internal thoracic artery (ITA).A case series.London Health Sciences Centre, University of Western Ontario, London, Ont.Fifteen consecutive patients requiring harvest of the ITA for coronary artery bypass grafting.Robot-assisted, video-enhanced coronary artery bypass (RAVECAB) through limited-access incisions, using the harmonic scalpel and a voice-activated robotic assistant.Ease and duration of the harvesting technique, complications of the procedure, graft flow and patency, and duration of postoperative hospitalization.RAVECAB facilitated thoracoscopic dissection of the ITA with the harmonic scalpel in all cases. There were no conversions to a standard approach and no reoperations for bleeding. The mean (and standard deviation) ITA harvest time was 64.1 (22.9) minutes (range from 40 to 118 minutes). Robotic voice command capture rate was greater than 95%. Mean (and SD) intraoperative graft flows were 33.1 (26.8) mL/min (range from 14 to 126 mL/min). There was 100% graft patency on postoperative angiography. There were no deaths, perioperaive myocardial infarction or arrhythmias. Mean (and SD) postoperative hospitalization was 3.3 (0.8) days.RAVECAB is a demanding procedure that addresses many of the disadvantages of the "conventional" minimally invasive coronary artery bypass. It allows complete pedicle dissection with minimal ITA manipulation and assures sufficient conduit length and a tension-free coronary artery anastomosis. All anastomoses were performed under direct vision through a 5- to 8-cm inferior mammary incision.

The contribution of a liaison psychiatrist to a cardiac transplant programme is described. Ninety one patients were referred to the transplant unit for assessment over four years, and of these, 86 were assessed by the psychiatrist. A high prevalence of preoperative anxiety and depression was found. Thirty four transplants were performed on 33 patients during the study and 22 patients survived. Six patients developed transient delirious episodes during the first 10 postoperative days, three showed symptoms of considerable anxiety, and three developed social and behavioural problems during the convalescent period. Subjects with higher scores on the somatic scale of the general health questionnaire showed increased postoperative mortality. In conclusion, the liaison psychiatrist is useful in evaluating and managing heart transplant patients before and after operation.

The successful operative treatment of aortic valve disruption caused by forceful blunt chest trauma in a 30-year-old previously healthy man is reported. The patients' left coronary cusp was completely avulsed at its annular insertion. Aortic valve replacement with a 23-mm Carpentier-Edwards porcine xenograft was performed. The literature on this rare condition is reviewed.

With careful refinements in the pump oxygenator and a nonblood prime, bloodless open heart surgery may be performed almost routinely. In our series these measures reduced blood trauma, with a remarkable preservation of blood elements, especially platelets, and a corresponding elimination of postoperative bleeding. The mean hematocrit value decreased from 38 to 27% and recovered to 33% in the first 3 hours of postoperative diuresis. Mannitol and furosemide were rarely needed. Of 61 adult patients whp underwent open heart surgery for aortocoronary bypass or valve replacement, the last 43 had a bloodless procedure. Of the 43, 26 (60%) required no bank blood postoperatively (in the operating room or the intensive care unit). In these 26 the operative mortality was 4% (1 patient). Bloodless techniques are invaluable during periods of bank blood shortage. They avoid the dangers of hepatitis and transfusion reaction, and they may minimize the incidence of postperfusion lung syndrome as well as renal complications.

Six left atrial myxomas were detected at one hospital in a 15-month period. These tumours are not as rare as was once thought and they frequently cause systemic problems. The diagnosis may easily be missed, but echocardiography is a simple way of establishing the diagnosis. Excision of the tumour usually results in marked symptomatic improvement.

Highly specific nerve staining using thiocholine techniques has been applied to a study of nerve regeneration in titanium rabbit ear chambers. Early and extensive ingrowth of nerves rich in true cholinesterase activity was demonstrated.