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J Bergsland

Publications and source records attributed to J Bergsland.

At least 55 records · Page 3Linked to original sources
PubMed1999

"Single suture" for circumflex exposure in off-pump coronary artery bypass grafting.

Exposure of coronary vessels in the circumflex territory for surgery off cardiopulmonary bypass (CPB) is a challenge. Ricardo Lima from Brazil described a series of sutures that enable surgeons to expose the marginal circumflex vessels on the beating heart. We have modified this technique and only use a "single suture" placed in the oblique sinus of the posterior pericardium. This allows for successful exposure of all coronary vessels with minimal manipulation of the heart. This simple technique enhances surgery on the beating heart and is especially useful to bypass topographically "difficult" posterior and lateral coronary vessels.

Cardiopulmonary Bypass↗
PubMed1999

Flow measurement in coronary surgery.

BACKGROUND: Many of the modern less invasive approaches to coronary artery bypass grafting (CABG) are performed without the use of the heart lung machine and cardiac asystole. Even after the introduction of mechanical stabilizers, the ability to achieve a technically perfect anastomosis is less certain in beating heart bypass surgery. Our group has begun to assess the surgical results of beating heart CABG using Transit Time Flow Measurement (TTFM). Our experience indicates that a meticulous and controlled method of assessing the results of intraoperative flow measurements can improve the quality of information and increases the accuracy of diagnosing technical problems with newly constructed bypass grafts. For this reason, we developed a standard algorithm for using and interpreting intraoperative TTFM. METHODS: From January to August of 1998, 161 patients underwent off-pump CABG with a total of 323 distal anastomoses (2.0 grafts per patient). All completed grafts were tested intraoperatively with TTFM and the decision to accept or revise any individual graft was based on a decision nomogram using key values readily available from the TTFM output. RESULTS: Thirty-two grafts (9.9%) were surgically revised based on unsatisfactory flow curves, the Pulsatile Index, or both. All revised grafts were found to have a significant technical error, such as an intimal flap, thrombus, conduit kinking, or dissection. There were no major complications, myocardial infarctions, or deaths in the entire series of patients. CONCLUSIONS: Based on our favorable use of TTFM, we strongly recommend that patency of every graft be assessed whether the operation is performed off pump or on cardiopulmonary bypass. Guidelines for performing and interpreting TTFM ensure a high degree of confidence in the completed graft. The decision to revise a graft can be made based on simple parameters easily acquired from the TTFM device. Any concern about quality or quantity of flow should prompt immediate revision.

Algorithms↗
PubMed1999

Changing referral pattern in off-pump coronary artery bypass surgery: a strategy for improving surgical results.

BACKGROUND: We have previously shown that a less invasive surgical approach (LISA) can reduce mortality and morbidity in coronary artery bypass grafting (CABG). This appears to have led to the referral of increasingly high risk patients for this procedure as compared to patients undergoing traditional CABG. The purpose of this paper is to compare preoperative risk factors and postoperative complications in both LISA and conventional CABG cases using the New York State database. METHODS: From January 1997 to September 1998, 1,993 patients underwent CABG in our institution: 1,384 with CPB (group A) and 609 without CPB (group B). In group B (LISA), a well defined strategy was followed in an effort to prevent hemodynamic instability during coronary exposure, avoid myocardial ischemia, verify graft patency, and use alternative surgical incisions in reoperations. RESULTS: Analysis of preoperative risk factors using the NYS database showed a significant increase in comorbidities in group B (p < 0.005), while at the same time postoperative complications and risk-adjusted mortality were lower (p = NS). CONCLUSION: Our data demonstrates that by using the LISA, high risk patients can undergo CABG with equal or lower mortality and morbidity than traditional CABG.

Comorbidity↗
PubMed1998

Minimally invasive coronary artery bypass grafting using the right gastroepiploic artery without pump.

OBJECTIVE: To explore the feasibility to operate on the right coronary artery and its branches utilizing the right gastroepiploic artery (RGEA) without cardiopulmonary bypass (CPB). All cases were performed since May 1996. METHODS: A small mid-line incision including splitting of the lower sternum gave excellent exposure. The inferior surface of the heart was dissected to expose and stabilize the target vessel. The heart rate was controlled with a Diltiazem drip. CPB was not necessary in any case. The right coronary artery was bypassed in four patients, the posterior descending artery branch in five patients and the terminal circumflex of the left coronary artery in one patient. After grafting, patency of the anastomosis was demonstrated by Doppler echocardiogram. RESULTS: No patient had perioperative mortality or complications. No patient had recurrent angina. Color Doppler echocardiographic imaging studies before discharge confirmed patency of the graft in eight of ten cases. In two cases, the gastroepiploic artery could not be visualized. Angiographic visualization was positive in four out of five cases. CONCLUSIONS: The gastroepiploic artery is an excellent conduit for vascularization of the inferior aspect of the heart. The operation can be done using a minimally invasive technique and without the use of cardiopulmonary bypass. This approach seems especially applicable in selective reoperative cases.

Aged↗
PubMed1998

Elimination of cardiopulmonary bypass: a prime goal in reoperative coronary artery bypass surgery.

OBJECTIVE: The purpose of this study was to evaluate morbidity and mortality in reoperative coronary artery bypass surgery using the New York State database. METHODS: Patients undergoing reoperative coronary artery bypass between January-1995 and December 1996 were included. Patients were operated using cardiopulmonary bypass (CPB group, n = 184) or without cardiopulmonary bypass (non-CPB group, n = 105) by surgeon preference. Groups were compared for preoperative risk factors, postoperative mortality and major complications. RESULTS: Crude mortality was lower in the non-CPB group, despite a higher expected mortality, resulting in a risk-adjusted mortality of 1.3% versus 2.7% for the CPB group (NS). Of non-CPB patients, 91.4% were without complications, while only 72.1% of CPB patients (P < 0.0001) were complication-free. Major complications were significantly reduced in non-CPB patients compared to CPB patients: stroke 0% versus 3.8% (P < 0.04), cardiovascular complications 4.8% versus 15.8% (P < 0.005), other major complications 1.9% versus 10.4% (P < 0.007). Postoperative IABP support was needed in 1.9% of the non-CPB group patients and in 14.2% of the CPB group (P < 0.0007). CONCLUSIONS: The main object of reoperative CABG is to relieve symptoms, since the survival benefit of the procedure has not been demonstrated. Performance of reoperative coronary artery bypass surgery without cardiopulmonary bypass significantly reduces morbidity. We conclude that cardiopulmonary bypass should be avoided whenever possible in reoperative coronary bypass surgery.

Aged↗
PubMed1998

Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB): a strategy for improving results in surgical revascularization.

BACKGROUND: Coronary artery bypass grafting (CABG) was performed on patients with cardiopulmonary bypass (CPB group) or without CPB (non-CPB group). A series of CABG patients, performed between January 1, 1995 and September 30, 1997 is included. METHODS: Data were collected and analyzed as determined by the New York State Department of Health. Preoperative comorbidity, postoperative morbidity and mortality were compared. There were 2869 patients in the CPB group and 505 patients in the non-CPB group. RESULTS: Demographics of the two groups were similar but preoperative risk factors were more common in patients undergoing CABG without CPB. Of the non-CPB patients, 31.9% had reoperations as compared to 8.5% in CPB patients (p = 0.00005). The presence of an extensively calcified aorta was more common in the non-CPB patients (5.9% vs. 2.8%, p = 0.0002). Immune deficiency was also more common in the non-CPB group (p = 0.001). Risk-adjusted mortality was similar in the two groups while major complications were much less common when CPB was not utilized. In CPB patients only 84.3% avoided major complications, while among non-CPB patients 90.1% were complication-free (p = 0.0008). CONCLUSIONS: CABG without CPB is an attractive method of surgical revascularization. Increasing age and preoperative comorbidity in patients referred for CABG dictate changes in surgical strategy, of which avoidance of CPB appears most beneficial.

Adult↗
PubMed1997

Heat shock protein 70 expression in native and heterotopically transplanted rat hearts.

Heat shock proteins (hsp) are intracellular proteins that are rapidly synthesized in response to a variety of stress factors. Recent studies in rats have shown that these proteins can elicit a lymphocyte response during cardiac allograft rejection. We studied the expression of the inducible (i) and constitutive (c) forms of hsp70 in rat cardiac allograft and isograft recipients to evaluate their utility as indicators of transplant rejection. Heterotopic transplantation of rat hearts was performed, using Lewis to Lewis isografts and ACI to Lewis allografts. Sham-operated rats were used as controls. Transplanted isograft, allograft, and native hearts of the transplant recipients and their livers and spleens were harvested at 5 days posttransplant and analyzed for hsp70 (i) and (c) expression by Western blots. Seven animals were studied in each group. Isografts at 3 and 60 days and allografts at 8 days were also studied. Quantification of band densities was carried out by laser densitometry. Physiological function of the native hearts of the transplant recipients was studied using Langendorff preparations. High levels of hsp70 (i) were noted in the transplanted and native hearts of the transplant recipients but not in their livers or spleens or in the hearts of the sham-operated control animals. Myocardial function of the native hearts of the transplant recipients was not significantly different from that of the controls. Significantly higher levels of hsp70 (c) were present in mild and severely rejecting allografts compared with controls and nonrejecting isografts. In the rat model of heterotopic cardiac transplantation, high levels of hsp70 (i) in the native hearts of the allograft and isograft recipients suggest a transplant-related, cardiac-specific stress process, not previously described. Heat shock protein 70 (c) expression is significantly increased during early and late allograft rejection and may serve as an indicator of transplant rejection.

Animals↗
PubMed1997

Beneficial effects of fluosol-polyethylene glycol cardioplegia on cold, preserved rabbit heart.

BACKGROUND: Because of its high oxygen-carrying capacity, especially at low temperatures, fluosol may enhance heart preservation. METHODS: Hearts of male New Zealand white rabbits (1.5-2.0 kg) were excised and flushed through the aorta with 0 degree C St. Thomas' Hospital solution, fluosol, or polyethylene glycol or fluosol-polyethylene glycol cardioplegic solution. Hearts were then stored for 12 hours at 0 degree C and reperfused with Krebs-Henseleit buffer at 36.5 degrees C for 60 minutes using a Langendorff system. RESULTS: Myocardial contractile function was significantly greater in the fluosol-polyethylene glycol cardioplegia-preserved group (p < 0.01) and polyethylene glycol-cardioplegia preserved group (p < 0.05) than in the St. Thomas' Hospital solution-preserved group. The myocardial high-energy phosphate content was significantly higher in the fluosol-polyethylene glycol-cardioplegia-preserved group (p < 0.01), with reduced release of lactate dehydrogenase (p < 0.01) in comparison with the St. Thomas' Hospital solution-preserved group. CONCLUSIONS: The addition of fluosol and polyethylene glycol to the cardioplegic solution may enhance long-term cold heart preservation.

Animals↗
PubMed1997

Avulsion of the left internal mammary artery after minimally invasive coronary bypass.

Minimally invasive direct coronary artery bypass grafting is a relatively new procedure. An unusual complication occurred in a patient after a period of heavy lifting, namely, avulsion of the left internal mammary artery graft. He presented with a clinical picture of myocardial infarction and shock. Diagnostic work-up and surgical management are described.

Humans↗
PubMed1997

Partial left ventriculectomy to treat end-stage heart disease.

BACKGROUND: It is reasoned that reducing left ventricular diameter (Laplace's law) in patients with dilated cardiomyopathy, will improve ventricular function. METHODS: Partial left ventriculectomy was performed in 120 patients with end-stage dilated cardiomyopathies of varying causes. Most patients were in New York Heart Association functional class IV. The procedure consisted of removal of a wedge of left ventricular muscle from the apex to the base of the heart. Depending on the distance between the two papillary muscles, the mitral valve apparatus was either preserved, repaired, or replaced with a tissue prosthesis. RESULTS: The 30-day mortality was 22% and the 2-year survival was 55%. Although 10% of surviving patients showed no improvement in New York Heart Association functional class, most of the surviving patients were in either class I (57%) or II (33.3%), and the others were in class III and IV. CONCLUSIONS: Partial left ventriculectomy can be used to treat end-stage dilated cardiomyopathy. Further studies and a longer follow-up period are needed to fully assess the effects of this procedure.

Adolescent↗
PubMed1997

Coronary artery bypass grafting without cardiopulmonary bypass--an attractive alternative in high risk patients.

OBJECTIVE: This study compares preoperative risk factors, estimated, observed, and risk adjusted mortality, and postoperative complications in patients undergoing coronary artery bypass grafting. Patients were divided in two groups depending on operative method: Group A patients had coronary artery bypass grafting using cardiopulmonary bypass. In group B cardiopulmonary bypass was not utilized. Patients operated on between January 1 1995 and August 31 1996 were compared. Group A consisted of 1829 patients and Group B 172. METHODS: Patients were selected to undergo coronary artery bypass grafting without the use of cardiopulmonary bypass either because the surgeon felt that there were contraindications to--or no need for the heart-lung machine. The decision to avoid the use of cardiopulmonary bypass was taken pre-operatively by the individual surgeon. Median sternotomy, formal left thoracotomy or left anterior small thoracotomy were used. The data was collected and validated by the hospital's professional data collectors. Data-analysis was performed using the NY-state database. RESULTS: Previous heart surgery and extensively calcified ascending aorta were significantly more common in Group B as was estimated and observed mortality. This resulted in identical risk-adjusted mortality of 2.8%. When reoperations were reviewed separately risk adjusted mortality was lower in Group B (2.1 versus 3.1%) but this difference was not statistically significant. Cardiovascular-and other-complications were higher in group A patients. In reoperative patients this difference was significant (P = 0.05). The need for postoperative mechanical assistance was also reduced (Group A: 14.9% versus Group B: 1.3% P = 0.01). CONCLUSION: We conclude that coronary artery bypass surgery can be done safely in selected patients without cardiopulmonary bypass. Mortality is unchanged and complications are less frequent. Cost and hospital utilization are decreased. The greatest benefit is observed in reoperations.

Aged↗
PubMed1997

Concanavalin A, ribose, and adenine resuscitate preserved rat hearts.

Preserved hearts may have cardiac dysfunction associated with inadequate myocardial high-energy phosphates. To resuscitate preserved hearts, hearts from male Wistar adult rats were preserved in 4.0 degrees C cold-modified Krebs-Henseleit buffer (pH 7.40) for 8 h, subjected to 30 min of reperfusion at 36.5 degrees C with the administration of concanavalin A (Con A; 40 mg/L), ribose (0.1 mM), and adenine (0.1 mM). In comparison with the normal control, the preserved group had a decrease in cardiac output (CO; p < 0.001), myocardial adenosine triphosphate (ATP; p < 0.001), and creatine phosphate (CP; p < 0.001), associated with an increase in myocardial Ca2+ (p < 0.01) and release of myocardial adenine nucleosides (ANs; p < 0.001). In comparison with the preserved group, the group reperfused with ribose and adenine had no improvement of these parameters (p > 0.05). The group reperfused with Con A had an increase in CO (p < 0.01) and myocardial CP (p < 0.01), associated with a decrease in myocardial Ca2+ (p < 0.05) and ANs release (p < 0.01), and no change in myocardial ATP. However, the group reperfused with Con A, ribose, and adenine achieved a significant increase in CO (p < 0.005), ATP (p < 0.005), CP (p < 0.005), and a decrease in myocardial Ca2+ (p < 0.01) and ANs release (p < 0.01). Data suggest that the combination of Con A, ribose, and adenine may resuscitate cold-preserved rat hearts.

Adenine↗
PubMed1996

Acute right ventricular failure during aortic valvular operation due to mechanical problem in the right coronary artery.

BACKGROUND: When right ventricular failure occurs during aortic valvular operation, inadequate myocardial protection may be the culprit. However, other causes of right ventricular failure should be considered, such as air or particulate matter embolization. Right ventricular failure unexpectedly occurred during an aortic valvular operation, and the cause was found to be a mechanical problem with the right coronary ostium. METHODS: A mechanical problem with the right coronary artery (RCA) occurred in 9 patients undergoing aortic valvular procedures, which included isolated aortic valve replacement (4 patients), aortic valve replacement and coronary artery bypass (1 patient), Bentall procedure (2 patients), aortic valve reconstruction (1 patient), and double valve replacement and coronary artery bypass (1 patient). Although myocardial protection was considered to be the cause, a mechanical problem was subsequently identified in the RCA, leading that artery to be bypassed with a segment of saphenous vein. RESULTS: The 1 patient in whom the condition was not recognized at time of aortic valve operation died; at autopsy, a damaged and occluded right ostium was confirmed. The other 8 patients who had the RCA bypassed survived. CONCLUSIONS: We conclude that when right ventricular failure unexpectedly occurs during an aortic valvular operation and does not improve with reperfusion, a mechanical problem in the RCA should be considered. In this situation we recommend that the RCA be bypassed with a segment of saphenous vein graft.

Acute Disease↗
PubMed1996

Minimally invasive coronary artery bypass grafting.

Minimally invasive coronary artery bypass grafting has recently been introduced into cardiac surgery. The procedure promises to become an important addition to the surgical treatment of coronary artery disease. This current review gives a historical perspective and an overview of this growing field, based on the experience of three international centers with experience with minimally invasive coronary artery bypass grafting. It is predicted that the field will grow, and that future generation of cardiac surgeons will have to become familiar with this new procedure.

Coronary Artery Bypass↗
PubMed1994

Combination of cyclosporine and splenectomy suppresses interleukin-6 production and major histocompatibility complex class II expression and prolongs cardiac xenograft survival.

Although untreated Lewis rat recipients will reject a transplanted hamster heart in 3 days, accommodation of heart xenografts can be induced by treatment with cyclosporine and splenectomy, improving graft survival to greater than 50 days. Both humoral and cellular arms of the immune system may be involved in the mechanisms responsible for the prolongation of graft survival. Our objective was to study the impact of cyclosporine and splenectomy on the deposition of antibodies, complement, or both within the graft. We also compared the cellular component of inflammation in treated recipients with that in untreated controls. Inbred male Lewis rats given cyclosporine 15 mg/kg per day were splenectomized 2 days after they had received heterotopic heart transplants from Golden Syrian hamsters. Recipients of syngeneic grafts or untreated xenografts served as controls. Plasma interleukin-6 activity was measured in a standard proliferation assay with 7TD1 hybridoma cells. Deposition of immunoglobulin M, immunoglobulin G, and complement in heart tissue was evaluated by immunofluorescence. Cells infiltrating the graft that expressed major histocompatibility complex class II antigens were identified by immunohistochemical staining with OX6 antibodies. In xenograft recipients receiving immunosuppression, interleukin-6 activity, immunoglobulin M and complement deposition were significantly reduced, graft infiltration was mild, and cardiac function was good compared with the results in those without treatment 3 and 10 days after implantation. Inflammatory cells expressing major histocompatibility complex class II antigens were significantly reduced in immunosuppressed xenograft recipients (2.8 +/- 0.4 cells/high power field) compared with those in xenogeneic controls (9.5 +/- 0.6 cells/high power field; p < 0.0005). The significant decrease in deposition of humoral components (immunoglobulin M and complement), interleukin-6 plasma levels, and expression of major histocompatibility complex class II antigens by inflammatory cells within the nonrejecting grafts suggests that the synergistic benefit of cyclosporine and splenectomy depends on the attenuation of both cellular and humoral mechanisms of xenograft rejection.

Animals↗
PubMed1993

Comparison of cold versus warm cardioplegia. Crystalloid antegrade or retrograde blood?

BACKGROUND: To evaluate the efficacy of warm versus cold and antegrade versus retrograde cardioplegia, 163 patients were randomized in sequence in three groups and underwent isolated coronary artery bypasses (mean, 4 grafts/patients) alternating in sequence. METHODS AND RESULTS: The demographic profiles were identical. Cold crystalloid cardioplegia (group 1) was delivered through the aortic root intermittently. The warm retrograde (group 2) was started antegrade with high potassium solution until the heart stopped. It was continued with retrograde coronary sinus perfusion, 100 mL/min of warm blood. Cold retrograde blood cardioplegia (4:1) (group 3) was started antegrade and continued retrograde through the coronary sinus. The heart temperature was kept at 10 degrees to 15 degrees C. Patients were evaluated intraoperatively and postoperatively for (1) supraventricular tachycardia, (2) ECG changes, (3) lactate dehydrogenase and total CPK and isoenzyme (MB) studies, and (4) hemodynamic studies in the intensive care unit. Warm retrograde and cold retrograde patients had sampling of the ascending aorta (antegrade) and the coronary sinus (retrograde) measuring pH, A-VO2 differences, and CK enzyme leak. RESULTS: The incidence of supraventricular tachycardia was 29% in group 2, 22% in group 1, 18% in group 3; not significant (NS). CPK isoenzyme MB fraction showed identical levels (NS). The warm heart consumed 1.3 to 1.6 mL O2/100 mL flow, while the cold group 3 showed 0.5 to 0.6 mL O2/100 mL flow (P < .001). Cold crystalloid cardioplegia (group 1) was similar to group 3 (0.3 mL O2/100 mL). All three groups were similar hemodynamically (cardiac output, cardiac index, left ventricular stroke work index). Two of 163 patients died in group 2. Four sustained stroke, three in group 2, one with a fatal outcome. CONCLUSIONS: Continuous warm cardioplegia (group 2) did not provide better myocardial protection despite that no CK-MB isoenzyme leak was demonstrated intraoperatively. Intermittent cold crystalloid cardioplegia and cold retrograde provided a clearer operative field and motionless heart. As long as O2 was adequately supplied, under 90 minutes' cross-clamp time, cold crystalloid cardioplegia and cold retrograde blood cardioplegia is safe under hypothermic conditions, whereas warm cardioplegia requires continuous uninterrupted technique with oxygen delivery.

Blood↗