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Biomedical subjects

J Bergsland

Publications and source records attributed to J Bergsland.

At least 37 records · Page 2Linked to original sources
PubMed2000

Perspectives of a cardiac surgery resident in-training on off-pump coronary bypass operation.

BACKGROUND: Contemporary residency training in the cardiac component of cardiothoracic operation is focused mainly on attaining technical proficiency in coronary artery revascularization. Most trainees in cardiothoracic operation are required to perform 35 cases of coronary revascularization in order to fulfill the minimum requirements for certification by the American Board of Thoracic Surgery. Although experience in minimally invasive coronary revascularization is not required for board certification in cardiothoracic operation, it is recognized by both trainees and program directors as an important component of contemporary training in less-invasive surgical approaches (LISA) for coronary artery disease. The objective of this study was to describe the training of residents in off-pump coronary revascularization in an accredited training program. METHODS: A retrospective analysis of a single resident's experience in minimally invasive coronary revascularization over an 18 month period in a 2-year residency program in cardiothoracic operation was carried out. RESULTS: Of the 166 total cases of coronary bypass operation, the resident performed 61 cases (37% of the total) off-pump as primary surgeon with attending supervision. Patients undergoing off-pump coronary bypass had an average of 2.4 grafts (range 1 to 5) and conventional coronary artery surgeon (on cardiopulmonary bypass) performed by the resident had an average of 4 grafts (range 2 to 5). The marginal/circumflex system was bypassed in patients that required revascularization of the marginal/circumflex system, which was 56% (n = 36 of 62) in the off-pump group and 90% for the conventional group using cardiopulmonary bypass. The conversion rate from off-pump technique to conventional coronary bypass using cardiopulmonary bypass was 3.2% in this series. CONCLUSIONS: Technical innovations and evolution of techniques to better stabilize the heart for off-pump coronary revascularization have made the procedure both effective and safe. Our experience has shown that cardiothoracic residents can be taught the skills necessary to perform coronary revascularization off cardiopulmonary bypass. There are currently no standards for the training of cardiothoracic residents in off-pump coronary artery operation. We propose that at least 50 cases be performed under supervision by a trained surgeon to obtain adequate credentials in minimally invasive coronary revascularization.

Aged↗
PubMed2000

[Is coronary artery bypass grafting under extracorporeal circulation the only technic that assures complete myocardial revascularization? Pros and cons].

Like other technical advances in medicine, the initial phase of rejection of off-pump revascularization has given way to its acceptance with some limitations. Today's main concern is whether the technique can be safely applied to access all coronary arteries, specially the postero-lateral vessels of the heart. We believe that off-pump CABG has proven to be an excellent alternative to the standard revascularization techniques avoiding the risks and complications of cardiopulmonary bypass (CPB). It can be applied to any case with minimal incidence of conversions thus avoiding the complications of CPB. In this debate we describe our technique, discuss our experience with complete myocardial revascularization, and suggest that the CPB machine should be a readily available tool for more complex cases rather than the current concept that it is an indispensable element for myocardial revascularization.

Coronary Artery Bypass↗
PubMed2000

Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting.

OBJECTIVE: To determine whether coronary graft patency can be predicted by transit time flow measurement (TTFM). METHODS: From May 1 1997 to December 31 1998, TTFM was prospectively evaluated in 409 patients undergoing coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB). All grafts (1145) were tested with TTFM. RESULTS: Thirty-seven out of 1145 grafts (3.2%) were revised in 33 patients (7.6%). In six cases (18.1%) use of CPB was necessary during revision due to hemodynamic instability. The remaining patients underwent revision off-pump. Thirty-four grafts (91.9%) were revised for both low flow and abnormal flow curve patterns. Findings at revision included: thrombosis of the anastomosis (n=6), stenosis at the toe or heel of the anastomosis (n=8), coronary flap or dissection (n=5), dissection of the internal mammary artery (n=5), graft kinking (n=4), flap at proximal anastomosis (n=1), coronary stenosis distal to the graft (n=3), and no findings (n=2). After revision all flow values and flow patterns improved. Although three additional grafts (8.1%) were revised for low flow (<7 ml/min) despite normal flow patterns, there were no findings at revision and flow values and curves remained unchanged after revision. Postoperatively, one patient developed a stroke (3%), one had an acute myocardial infarction (MI) (3%), one had a sternal wound infection (3%), and one required prolonged ventilatory support (3%). CONCLUSION: Evaluation of TTFM is valuable in determining the status of a coronary graft after CABG. Correct interpretation of flow patterns allows for correction of abnormalities prior to chest closure.

Cardiopulmonary Bypass↗
PubMed2000

Left anterior small thoracotomy versus coronary artery bypass graft for single-vessel occlusion. A cost identification analysis.

OBJECTIVES: Single-vessel bypass can often be accomplished through less invasive techniques than conventional coronary artery bypass graft (CABG) at substantially lower cost. We undertook a study to empirically determine the cost savings associated with one such technique, left anterior small thoracotomy (LAST). METHODS: Reviewing medical and billing records, we measured the difference in hospitalization costs between two methods of coronary bypass surgery. The study groups consisted of 50 patients who underwent LAST and 28 who underwent single-vessel conventional CABG during 1995 and 1996. A subsequent validation sample of 50 patients who underwent LAST was also analyzed. Hospitalization costs were estimated using a relative value unit methodology and were risk-adjusted for both perioperative risk factors and changes in operating room technology. RESULTS: Risk-adjusted hospitalization costs for those undergoing LAST were $9,510 and $12,546 for the CABG control subjects (p < .01), with differences in surgical costs reflecting over 62% of this overall difference. Differences in average length of stay were under a half-day (10.0 for LAST vs. 10.46 for CABG). Only one inpatient fatality was reported; therefore, no inference regarding mortality differences could be made. CONCLUSIONS: LAST is substantially less costly than conventional surgery, and the savings are potentially greater if hospital length of stay is reduced to a clinically recommended time of 2 days.

Adult↗
PubMed2000

Graft patency verification in coronary artery bypass grafting: principles and clinical applications of transit time flow measurement.

The increasing popularity of beating-heart coronary surgery has raised concerns and doubts about the quality of the coronary anastomoses performed. Intraoperative graft patency verification methods are not commonly used after coronary surgery and, most of the cardiac surgeons, rely on the simple clinical signs (electrocardiogram tracings and hemodynamic stability) to make a diagnosis of coronary graft occlusion. New transit time ultrasound based methods for graft-patency verification have been adopted in many centers during beating-heart and traditional bypass grafting. Although the results are very encouraging, correct interpretation of the flow findings may prove difficult if specific rules are not properly followed. Flow curves, pulsatility index, and flow values should always be considered simultaneously before revising a coronary graft. Measurements should also be always performed with and without a proximal coronary snare. This article summarizes the main features of flowmetry and provides some technical pitfalls and suggestions to achieve an adequate intraoperative flow measurement adopting the transit time method.

Anastomosis, Surgical↗
PubMed2000

Preoperative angiography and intraoperative transit time flow measurement to detect coronary graft patency in reoperations: an integrated approach--a case report.

Coronary angiography is the gold standard for preoperative diagnosis of coronary artery disease. In reoperative coronary artery surgery the physiologic significance of suspect lesions by angiography can be confirmed by direct intraoperative measurement of blood flow in the old grafts; such interpretation can prevent unnecessary graft revisions.

Aged↗
PubMed2000

Posterior thoracotomy for reoperative coronary artery bypass grafting without cardiopulmonary bypass: perioperative results.

BACKGROUND: This retrospective study evaluates morbidity and mortality of reoperative coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) using a posterior thoracotomy to revascularize the lateral aspect of the heart. METHODS: From January 1995 to July 1999, reoperative CABG without CPB was performed on 67 selected patients using a left posterior thoracotomy approach. Preoperative risk factors, postoperative mortality, and major complications were derived from the New York State database. RESULTS: All patients were operated on without CPB. A total of 1.3 grafts per patient were performed. Freedom from major complications was 95.5%. There were no postoperative cerebro-vascular accidents (CVA) or new neurological deficits. Two patients (3%) had a perioperative acute myocardial infarction. The actual mortality rate was 4.5% (3/67), the expected mortality was 5.1% and the calculated risk adjusted mortality was 2.1%. CONCLUSIONS: Reoperative CABG without CPB to revascularize selected coronary artery targets can be safely performed using a posterior thoracotomy approach.

Aged↗
PubMed2000

Technical tips and pitfalls in OPCAB surgery: the buffalo experience.

The Center for Minimally Invasive and Robotic Heart Surgery has performed more than 1,500 off-pump coronary artery bypass (OPCAB) procedures since 1995. The operation has changed significantly based on experience and development of new tools. These improvements have made the operations safer and applicable to more patients. No patients are presently scheduled for on-pump bypass surgery in our center. The purpose of this paper is to describe some of the problems and pitfalls we have experienced and how to avoid them.

Coronary Artery Bypass, Off-Pump↗