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Biomedical subjects

E W Jansen

Publications and source records attributed to E W Jansen.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Minimally invasive arterial coronary bypass grafting: on beating heart and via smaller access].

Postoperative recovery after (arterial) coronary bypass grafting mostly takes several months because of the effects of the heart-lung machine and the cardioplegia which are mostly haematological, pneumological and neurological in nature. The morbidity can be reduced by operating on the beating heart and via smaller access. One possibility is the 'Octopus' method developed in Utrecht, which involves local fixation of the beating heart. The postoperative recovery of the first 45 patients was favourable.

Anastomosis, Surgical↗
PubMed1997

Hemodynamic changes during displacement of the beating heart by the Utrecht Octopus method.

BACKGROUND: Coronary bypass grafting of posterior circumflex branches requires full displacement of the heart (apex pointing ventrally), which, in the beating heart, results in an arterial pressure drop. We analyzed its origin. METHODS: To facilitate displacement, the Utrecht "Octopus" method was applied in 8 anesthetized beta-blocked pigs and the beating heart was fully retracted. RESULTS: Displacement decreased stroke volume from 75 +/- 17 mL (mean +/- standard deviation) to 43 +/- 13 mL (p < 0.001), a 44% +/- 3% decrease that resulted in a decrease in cardiac output by 32% +/- 5% (mean +/- standard error of the mean; p < 0.001), a decrease in mean arterial pressure by 26% +/- 5% (p < 0.01), and an increase in heart rate by 26% +/- 6% (p < 0.01). Right ventricular end-diastolic pressure increased from 5 +/- 1 to 8 +/- 1 mm Hg (p < 0.01). Twenty degrees head-down tilt normalized cardiac output and mean arterial pressure. Right ventricular end-diastolic pressure increased to 10 +/- 2 mm Hg (p < 0.001) and left ventricular end-diastolic pressure to 11 +/- 3 mm Hg (p < 0.01). CONCLUSIONS: Displacement of the beating heart in the pig induced a 44% drop in stroke volume, which is attributed to biventricular interference with pump function. The Trendelenburg maneuver reestablished the control circulatory status at the expense of augmented right and left ventricular preloads and an increased heart rate.

Animals↗
PubMed1997

Experimental off-pump grafting of a circumflex branch via sternotomy using a suction device.

BACKGROUND: We have shown previously in the pig that coronary artery bypass grafting on the beating heart may be facilitated by local cardiac wall immobilization by a suction device ("Octopus") applied to the anterolateral side of the heart. The purpose of this study was to investigate the feasibility of the method on the posterolateral side. METHODS: In a consecutive series of 8 pigs, after median sternotomy, the posterior wall was taken hold of by the Octopus and subsequently brought up anteriorly and immobilized while hemodynamics were monitored. A posterolateral branch of the circumflex artery was grafted with the left internal mammary artery. After the coronary artery was ligated proximally, the heart was repositioned. At 6 weeks, bypass graft angiography and functional testing (postocclusion hyperemia testing) were performed. After sacrifice, histologic examination of the anastomosis was performed. RESULTS: Dislocation of the heart to expose the distal anastomosis site caused a minor drop in mean arterial blood pressure from 71 +/- 14 (baseline) to 63 +/- 6 mm Hg (dislocated) (not significant) and recovery to 70 +/- 12 mm Hg, 15 minutes after repositioning. Cardiac output decreased from 4.0 +/- 1.0 to 3.2 +/- 0.7 L/min (p = 0.02) and recovered to 4.3 +/- 0.3 L/min. No inotropic drugs were necessary. Anastomosing required 21.5 +/- 6.5 minutes. Baseline graft flow was 8 +/- 3 mL/min and increased threefold to 24 +/- 10 mL/min (p < 0.05) at postocclusive hyperemia testing. At sacrifice after 6 weeks (n = 8), graft flow increased fourfold from 5 +/- 2 to 20 +/- 8 mL/min (p = 0.002) (n = 7). At histologic examination all eight anastomoses were patent without stenosis or mural thrombus. CONCLUSIONS: Off-pump coronary artery bypass grafting of the posterolateral circumflex branches using the Octopus method on the beating pig heart is feasible, with full patency maintained for at least 6 weeks.

Anastomosis, Surgical↗
PubMed1997

Video-assisted coronary bypass grafting on the beating heart.

BACKGROUND: Concepts to make coronary artery bypass operations less invasive include minimization of access incisions, elimination of cardiopulmonary bypass, and no manipulation of the aorta. A spectrum of minimally invasive coronary bypass procedures now exist that eliminate the median sternotomy (port-access approach), cardiopulmonary bypass ("off-pump bypass"), or both (minimally invasive direct coronary artery bypass procedure). Although all have advantages in decreasing the morbidity of myocardial revascularization, significant limitations exist including surgeon experience, access, exposure, visualization, hemodynamic support, and technique of anastomosis. METHODS: In an attempt to extend the applicability of the current minimally invasive techniques, efforts are being made both to extend the indications for the procedure as well as to modify the technical aspects. Our current experimental protocol involves a ports-only approach with three-dimensional video imaging, percutaneous Hemopump circulatory support, Octopus coronary immobilization, and an endoscopically sutured coronary anastomosis. RESULTS: In a series of animal studies we have been able to successfully accomplish a totally endoscopic coronary artery bypass procedure on a beating heart without cardiopulmonary bypass. CONCLUSIONS: Although endoscopic coronary artery bypass without cardiopulmonary bypass is possible, many technical challenges remain. Three-dimensional video imaging, wall motion immobilization and presentation, and an axial-flow device can facilitate the procedure. Future enabling technology including motion robotics and nonvisual imaging systems may ultimately further minimize the invasiveness of surgical myocardial revascularization.

Coronary Artery Bypass↗
PubMed1997

Less invasive off-pump CABG using a suction device for immobilization: the 'Octopus' method.

OBJECTIVE: Target site immobilization is essential to enable meticulous anastomosis suturing during coronary artery bypass grafting on the beating heart. A novel device ('Octopus') was developed for local heart muscle immobilization by suction. The purpose of this study was to investigate the efficacy of the method through a limited access. METHODS: The suction device, placed on either side of the recipient coronary artery and fixed to the operating table-rail through an arm construction, restrains anastomosis site motion to 1 x 1 mm. A total of 27 patients underwent off-pump arterial bypass grafting using this method. Preoperatively, all patients had angina class III (NYHA) and were failed or unsuitable candidates for balloon angioplasty. Surgical access was via a 10-cm anterior thoracotomy (n = 26) or 10-cm subxiphoid incision (n = 1). RESULTS: Harvesting of the graft required 48 +/- 12 min (mean +/- S.D.). Immobilization with the 'Octopus' was effective and facilitated precise anastomosis suturing of 20 single and 7 sequential grafts. Immobilization did not change cardiac index and mean arterial blood pressure. During coronary surgery, however, inotropic drug support was used in 5 of 27 (18%) of patients. There was no myocardial infarction. Only minor transient complications were met. There were electro-cardiographical signs of pericarditis in 6 patients. The postoperative hospital stay ranged from 2 to 6 days, mean 4.0 +/- 1.2 days. The mean follow-up is 6.5 +/- 4 months (range, 1-12 months). All patients except one were in functional class I without angina. Social activities were resumed within 4 weeks. At 6 months angiography was performed in 15 out of 27 patients. The patency rate of 19 out of 20 anastomoses was 95%. All distal grafts were patent. One side to side anastomosis was occluded. CONCLUSIONS: The 'Octopus' immobilization method is safe and effective. It facilitates less invasive CABG in selected patients and gives way to fast recovery by reducing invasiveness.

Adult↗
PubMed1996

Coronary artery bypass grafting without cardiopulmonary bypass and without interruption of native coronary flow using a novel anastomosis site restraining device ("Octopus").

OBJECTIVE: This study assessed the feasibility of coronary artery bypass grafting on the beating heart without interruption of native coronary blood flow using a novel anastomosis site restraining device. BACKGROUND: Recently, an end-to-side bypass technique was described that does not require interruption of flow in the recipient artery. METHODS: By means of a suction device ("Octopus"), in 31 pigs the epicardium was grasped and immobilized through an arm contraption fixed to the operating table. In the first 15 consecutive pigs (study I), the two-dimensional motion of an epicardial beacon was monitored. In 16 subsequent pigs (study II), an internal mammary artery was grafted under the microscope in two steps to a proximal coronary artery segment, without cardiopulmonary bypass. First, the internal mammary artery was sutured end-to-side to the outside of the coronary artery. Secondly, an orifice was punched in the partitioning coronary wall by an excimer laser catheter introduced through a temporary side-branch of the internal mammary artery. RESULTS: Study II: During 43 suction periods in four anastomosis areas, immobilization was achieved for 15 to 169 min (>30 h in total) in 13 open- and 9 closed-chest procedures without hemodynamic deterioration. The area circumscribed by the edges of the beacon trajectory (area in which the anastomosis is to be tracked) was reduced from 73.0 +/- 43.0 mm(2) (mean +/- SD) to 1.3 +/- 0.5 mm(2) (p<0.001) in the open-chest and to 0.2 +/- 0.2 mm(2) in the closed-chest procedure. At 6 weeks, no myocardial or coronary suction lesions were found. Study II: Nonocclusive anastomosis surgery required 25 +/- 3 min. No leakage, serious arrhythmias, graft closure or hemodynamic deterioration occurred during the procedure or for 2 h after ligating the coronary artery proximally. At 6 weeks, all seven grafts were patent. CONCLUSIONS: Coronary bypass on the beating heart without interruption of coronary flow is feasible. In both open- and in closed-chest procedures, the "Octopus" reduced anastomosis site motion to about 1 X 1 mm without adverse consequences.

Anesthesia, General↗
PubMed1990

Epicardial cryosurgery as used in ablation of accessory atrioventricular pathways: effect on valvular function in the dog.

Epicardial cryosurgery for ablation of atrioventricular accessory pathways has surgical advantages. However, it is applied directly to the valve base. To assess the risk of valve impairment, 10 anaesthetized dogs were subjected to standardized epicardial cryosurgery of the right atrioventricular junction. Two of these underwent sham procedure (dissection only). Valve function was assessed by colour Doppler echocardiography preoperatively and at 2 days, 1 week, 2 weeks and 10 weeks postoperatively. Three out of the eight animals subjected to cryosurgery developed moderate (grade 2/4) tricuspid insufficiency, which appeared at 1 week postoperatively, following regression of congestive oedema. Two out of the three cases of TI were associated with leaflet prolapse. No tricuspid insufficiency was seen in the sham-operated animals. At the end of each interval two animals were killed for histological examination. Histological examinations showed that cryolesions extended a maximum of 3 mm into the valve leaflet. The tricuspid insufficiency is attributed to the extensive scarring (including chondroid metaplasia), which causes retraction and restricted motion of the annulus. It is concluded that cryolesions may impair atrioventricular valve function. Patients undergoing cryosurgery should be monitored postoperatively by echocardiography for atrioventricular valve insufficiency.

Animals↗
PubMed1989

Use of a removable vena caval filter for prevention of recurrent embolism after emergency pulmonary embolectomy: a flexible approach.

Intraluminal vena caval filters, inserted via the transvenous approach, are used often in the prevention of recurrent pulmonary embolism. Until lately, such filters have been unremovable. In a recent case, however, we treated a patient who experienced acute massive pulmonary embolism after having undergone an emergency right hemicolectomy. He underwent a successful emergency pulmonary embolectomy with the help of cardio-pulmonary bypass; to prevent recurrent embolism, we inserted a removable intracaval filter through the right atriotomy with an introducer set. On the 7th postoperative day, the absence of significant residual thrombi was confirmed by means of phlebography, and the caval filter was removed percutaneously via the femoral approach. Although the value of routine use of the filter in this application has yet to be established, we feel that it warrants further investigation because it relieves the surgeon, during an emergency procedure, of the need to decide quickly whether or not to place a filter. The question becomes one of whether or not to remove the filter, and that decision can await the results of proper postoperative diagnostic studies.

Journal Article↗
PubMed1984

Ruptured aneurysms of the sinus Valsalvae.

Ruptured aneurysms of the sinus Valsalvae are relatively rare. Six patients have undergone operative treatment in our hospital in a 13-year period. Five of these, all men between the ages of 33 and 54 had a ruptured congenital aneurysm. Acquired aneurysms may occur and rupture at any age. One patient in our series had a mycotic aneurysm. Endocarditis was quite frequently encountered and seemed to play a role at the onset of rupture. Surgical technique consisted of direct closure in 4 patients and closure with a Dacron patch in 2 patients. Repair was successful in 5 patients. The patient with the mycotic aneurysm died after repeated surgery because of septic complications. Mean follow-up now is 3 1/2 years. Ruptured aneurysms of the sinus Valsalvae should be treated operatively by a double approach and, in the presence of an acute progressive endocarditis, without delay.

Adult↗
PubMed1978

Surgical treatment of clavicular fractures with Kirschner wires: a comparative study.

In the period January 1968 to January 1976, 1400 patients were treated for clavicular fractures. In 74 (5 percent) of cases co-adaptation osteosynthesis was carried out and the results are reported. Conservative treatment of clavicular fractures is to preferred. Surgical treatment should be performed only on strict indication. Percutaneous intramedullary Kirschner wire fixation, performed in an atraumatic manner and with proper postoperative treatment, gives good results for simple fractures. A warning is given against over-emphasis on the radiological findings in the treatment of clavicular fractures.

Adult↗