Search PubMed⌕ Search

Biomedical subjects

Hratch L Karamanoukian

Publications and source records attributed to Hratch L Karamanoukian.

At least 19 recordsLinked to original sources
PubMed2006

Inclusion of sevoflurane in cardioplegia reduces neutrophil activity during cardiopulmonary bypass.

OBJECTIVE: The purpose of this study was to examine the effects of sevoflurane cardioplegia on neutrophil response and complement activation after cardiopulmonary bypass (CPB). DESIGN: A prospective, randomized clinical investigation. SETTING: University-affiliated hospital; single institutional. PARTICIPANTS: Twenty-one male patients undergoing coronary bypass surgery using CPB. INTERVENTIONS: Eleven patients were randomly assigned to receive sevoflurane 2% as a part of the cardioplegic mixture (SEV). The control group (n = 10) received no sevoflurane in their cardioplegia (control). MEASUREMENTS AND MAIN RESULTS: Myeloperoxidase activity (MPO) was assayed in coronary sinus blood as a surrogate for neutrophilic response at the termination of CPB. MPO activity in the coronary sinus blood was lower in the patients who received sevoflurane compared with controls. MPO activity was higher in patients with cardiac events at 4-year follow-up when compared with asymptomatic patients. IL-8, C4b, C3d, C5a, and CH50 were assessed in coronary sinus and peripheral blood at time of CPB initiation (T0) and upon the termination of CPB (T2). Peripheral blood sampling occurred at the sixth hour after T0 (T6). IL-8 levels were significantly inhibited in the SEV group when compared with controls at T2 and T6. CH50 (an index of global activation of complement system) decreased 30% at T2 and 52% at T6. The classic component of the complement pathway (C4b) was effectively inhibited in the SEV group, whereas the common pathway (C3d and C5a) was similar in both groups. CONCLUSIONS: The addition of sevoflurane to cardioplegia is associated with an inhibition of neutrophils after CPB. A major component of the neutrophil response appears to be IL-8 mediated, although the classic complement pathway is also inhibited by sevoflurane.

Cardiopulmonary Bypass↗
PubMed2006

Transfer of training in robotic-assisted microvascular surgery.

BACKGROUND: Transfer of training refers to the ability to transfer acquired skills from one discipline to another. This study aims to determine whether experience in traditional freehand microsurgery facilitates mastery of robotic microsurgery. METHODS: Microsurgical anastomoses of coronary arteries harvested from explanted pig models were used to demonstrate whether prior experience with microsurgery is required in learning robot-assisted microsuturing. Eighty microsurgical anastomoses were performed. Three fully trained vascular surgeons (n = 3) (Group A) and 5 midlevel surgical residents (n = 5) (Group B) performed the anastomoses. Each subject performed 5 freehand and 5 robotic-assisted (Zeus robotic system) anastomoses. Anastomosis time and integrity of anastomoses were recorded, including errors of management (EOM) (breaking suture, breaking knots, breaking or damaging needles). RESULTS: For fully trained surgeons, all anastomoses in the robotic-assisted group were mechanically intact. There was significantly increased anastomosis time with the robot (Robot: 14 minutes, versus freehand: 7.2 minutes, P < 0.01). The robotic-assisted anastomoses were associated with a higher EOM (Robot: 1.2, versus freehand: 0.3, P < 0.01). Surgical trainees had longer anastomosis times with robotic assistance (Robot: 14.8 minutes, versus freehand, 12.7 minutes; P < 0.01) and increased EOM (Robot: 1.6, versus freehand: 1.0; P < 0.05).Overall, surgical trainees and fully trained vascular surgeons had longer anastomotic times with robotic assistance [Robot: 14.0 versus 14.8 minutes; P = not significant (NS)], and EOM (Robot: 1.6, versus freehand: 1.2; P = NS) were not significantly different. CONCLUSION: The technical feasibility of performing a safe and efficient robotic-assisted microsurgical anastomosis in explanted vessels was repeatedly tested and demonstrated in this study within reasonable time required for the anastomosis. Compared with conventional microanastomosis, both fully trained surgeons and residents demonstrated an ability to master the robotically assisted procedure with similarly longer anastomosis times and EOM. This study indicates that robotically assisted microanastomosis can be mastered equally well by surgical trainees and fully trained vascular surgeons.

Anastomosis, Surgical↗
PubMed2006

The effects of restricted work hours on clinical training.

Resident education has changed dramatically over the past 10 years. With the implementation of restricted work hours on clinical training, questions have arisen whether these restricted hours will affect clinical competency. This manuscript attempts to answer this question through a survey performed to assess the perception of residents about duty-hour restrictions and the potential effect on residents' clinical exposure. In this study, a majority of the respondents did believe that work-week restrictions significantly affected patient care and clinical exposure. However, few respondents were willing to accept an additional year of training to compensate for the loss of this clinical exposure. Regardless, work-hour restrictions are here to stay and will probably be further limited in the future. Training programs will have to adjust to provide the necessary clinical exposure while complying with these new ACGME guidelines.

Humans↗
PubMed2003

A pediatric surgery study: parent usage of the Internet for medical information.

PURPOSE: The goal of this study was to (1) determine parents access to and use of the Internet for information relating to their child's health; (2) investigate parents methods of searching for such information; and (3) evaluate the information found in relation to its readability, accuracy, and influence. METHODS: A study was conducted of 150 parents of outpatients in the Pediatric Surgery Clinic of a local Children's Hospital. Parents completed study surveys over a 6-week time frame. RESULTS: All parents (150 of 150, 100%) completed the surveys. The median age of the parents was 35 years, 83% (124 of 150) were mothers, and most (32%) attained a high school diploma. Of the 128 parents having Internet access, 71% used the Internet to search for health-related information. A majority of parents, 98%, agreed or somewhat agreed that the information they found was comprehensible and helpful. All respondents at least somewhat trusted information found, and 52% were at least somewhat influenced by online information when making a medical decision. CONCLUSIONS: Many parents use the Internet for additional medical information, but they do not access this information frequently. The overwhelmingly positive impression of online health information suggests parents are unaware of the dangers of encountering misleading sources, an issue of special concern when considering the amount of influence this information carries. A movement must be made to create uniform guidelines for health information on the Internet. In the meantime, pediatric surgeons must take a role in guiding parents toward accurate online sources and becoming more Internet proficient themselves.

Adolescent↗
PubMed2003

Minimally invasive mitral valve surgery: from Port Access to fully robotic-assisted surgery.

Currently, there is a growing interest in minimally invasive cardiac surgery, and despite early criticisms, it has become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results. The interest in performing cardiac valve operations through minimal incisions was stimulated by Port Access technology and has evolved to include robotically assisted video-enhanced valve surgery. Robotic assistance has led to shorter operating times and represents an ideal tool to prepare for fully robotic-assisted cardiac procedures. This report will highlight minimally invasive mitral valve surgery with its evolution from Port Access techniques to fully robotic-assisted surgery. The nuances, strengths, and shortcomings, as well as the potential to enhance the valvular procedure, the promise to reduce hospital stay, earlier return to normal activity, less pain, better cosmesis, and the rethinking of surgical dogma that wide surgical exposure is essential for such complex intracardiac surgery are discussed.

Cardiac Catheterization↗
PubMed2003

Heparin dose, transfusion rates, and intraoperative graft patency in minimally invasive direct coronary artery bypass.

BACKGROUND: Many investigators have demonstrated the short-term and midterm efficacy of minimally invasive direct coronary artery bypass (MIDCAB). However, the influence of heparin dosing during MIDCAB on postoperative and immediate graft patency is less well defined. This report outlines our experience with MIDCAB employing a variety of heparinization protocols. METHODS: The traditional MIDCAB approach was used in 152 patients who underwent single-vessel off-pump coronary artery bypass. Before the left internal mammary artery was divided, a 150-U/kg bolus of heparin sodium was given to 76 patients (group 1), and 300 U/kg was given to another 76 patients (group 2). Additional heparin was given during the procedures to maintain an activated clotting times of greater than 300 seconds for group 1 and greater than 400 seconds for group 2. RESULTS: On average, patients in group 1 required more boluses of heparin during treatment than patients in group 2. A larger standard deviation from the mean was observed for the activated clotting time in group 1 at any time during treatment than for patients in group 2. The number of revised grafts was smaller in group 2 (1/76, 1.3%) than in group 1 (4/76, 5.2%). All of these revisions revealed thrombus at the site of anastomosis. In addition, noncoronary thrombotic complications were seen in 5 patients in group 1, and none were seen in group 2. CONCLUSION: Coronary artery surgery without cardiopulmonary bypass does not trigger the systemic inflammatory response, but surgical tissue trauma remains a constant. The preserved hemostasis theoretically may lead to a procoagulant state. This study demonstrates that insufficient anticoagulation therapy can lead to intracoronary thrombosis following MIDCAB as well as increased noncoronary thrombotic complications.

Anticoagulants↗
PubMed2003

Are you ready to become a robo-surgeon?

Robotic and minimally invasive surgery represents the future of modern surgical care. However, its role during the training of surgical residents has yet to be investigated. A previous study conducted by our group surveyed program directors at accredited general surgery training programs in the United States to determine the prevalence and application of robotics in their residency programs. This current study is a follow-up survey sent to residents across the United States to see whether they were being adequately trained and exposed to robotic surgery during their training. A survey was sent to 1800 general surgery residents, and their responses were tabulated and analyzed. Twenty-three per cent of the 1800 residents responded to our survey. An overwhelming 57 per cent of the responders indicated a high interest in robotic surgery. However, 80 per cent of the responders indicated not having a robotic training program. Robotic surgery has led to many promising advancements within the surgical subspecialties. With this emerging technology comes the need for a greater emphasis on the training of surgeons in robotics during their residency.

Data Collection↗
PubMed2003

REVIEW: Fast-Tracking Cardiac Surgery.

A "fast track" approach to cardiac surgery can be defined as a perioperative process involving rapid progress from preoperative preparation through surgery and discharge from the hospital. Although highly individualized among the various heart surgery centers, the fast-track process is a team activity. It requires a team of health care providers to interact with the patient at various phases, from admission to discharge. The necessary elements of the fast-track program are choice and the titration of short-acting anesthetic drugs, standardized surgical procedures, early extubation, rewarming and sustained postoperative normothermia, postoperative pain control, early ambulation, alimentation and discharge, and follow-up after discharge. We review the current approaches to some of these aspects of patient care.

Analgesics, Opioid↗
PubMed2003

A porcine beating heart model for robotic coronary artery surgery.

BACKGROUND: The application of robotically assisted coronary artery surgery continues to be investigated clinically. Consequently, there is a need for a simple method to train surgeons in performing these operations. The aim of the present study was to assess a model using an excised porcine heart for the training of surgeons in creating a robotically assisted arterial anastomosis. METHODS: An ex vivo beating heart model was constructed with a porcine heart and was evaluated by 3 cardiac surgeons previously trained in robotic surgery. All anastomoses from the first half of the study were reviewed to measure anastomotic time, the number of sutures placed, and the rate of suture placement per minute and were compared to those completed in the second half of the study by means of a unpaired Student t test. RESULTS: Fifty-seven anastomoses were completed with the beating heart model, 28 in the first half of the study and 29 in the second half. The mean time to create an anastomosis in the first half of the study was 19.3 minutes (range, 10-28 minutes), compared with 15.0 minutes (range, 7-20 minutes) in the second half; the difference did not meet statistical significance. However, the number of sutures placed per minute did increase in the second half of the study with a mean of 0.77 sutures per minute (range, 0.55-1.25), compared with 0.56 sutures per minute (range, 0.40-0.80) in the first half of the study (P <.0001). The number of sutures per anastomosis also decreased in the second half of the study with a mean of 9.0 sutures (range, 8-11), compared with 10.6 sutures (range, 8-16) in the first half of the study (P =.0049). CONCLUSIONS: This preliminary experience demonstrated technical improvements in the second half of the study. Fewer sutures were placed per anastomosis with better precision, implying a learning curve that could be accelerated with our model. This porcine beating heart model represents an inexpensive training method that mimics the beating heart, complete with coronary blood flow, and may be used multiple times to train and assess a surgeon's skill in robotically assisted coronary surgery.

Animals↗
PubMed2003

The world wide web and robotic heart surgery.

PURPOSE: The primary goal of this study was to (1) determine patients' access to and use of the Internet for healthrelated information before and after endoscopic atraumatic coronary artery bypass (Endo-ACAB) surgery, (2) investigate patients' methods of searching for such information, and (3) suggest future improvements for Internet-based patient education. The secondary goal of this study was to determine (1) patients' health-related quality of life and (2) degree of satisfaction following the Endo-ACAB procedure. METHODS: A follow-up study was conducted of 50 consecutive patients who had undergone Endo-ACAB procedures at the Center for Less Invasive Cardiac Surgery and Robotic Heart Surgery in Buffalo, New York. Study surveys were designed cooperatively by a communication scientist specializing in Internet studies and cardiac surgeons. Patients completed surveys over a period of 18 months, from January 2001 to June 2002. RESULTS: All 50 patients (100%) in the targeted study group completed the survey. Forty-four (88%) of these respondents reported having Internet access. The Web was cited as the most popular source of initial information on Endo-ACAB, with 36% of patients (18) first learning about the procedure through an Internet search. All 44 patients with Internet access used the Web as an additional source of information before surgery, but only 20% (7/35) did so after surgery. Most patients (91%, 40/44) felt that their surgeon should develop a Web site to detail the Endo-ACAB procedure. An investigation of patient quality of life showed that 96% of patients were not experiencing any symptoms related to t heir surgery. All 50 patients reported high degrees of satisfaction with the Endo-ACAB procedure, and 98% (49) said that they would recommend the surgery to someone else. CONCLUSION: A vast majority of patients are realizing the benefits of the Internet as a tool to educate themselves, both before and after surgery. The request by an overwhelming majority of patients that surgeons develop Web sites, however, shows that patients may not be completely satisfied with the current form or content of health sites on the Internet. Surgeons will see the benefits of Web-based education only when they ensure that their patients have access to adequate and credible health-related information. The early results of robotic surgery suggest a promising future and the need to investigate the role of the Internet in its growth.

Aged↗