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Biomedical subjects

Jacob Bergsland

Publications and source records attributed to Jacob Bergsland.

8 recordsLinked to original sources
PubMed2003

Conversions in off-pump coronary surgery.

METHODS: There have been 784 coronary artery bypass grafting (CABG) procedures performed at a new center for treating cardiovascular disease in Tuzla, Bosnia and Herzegovina, and the surgical team has been fully trained in offpump coronary artery bypass (OPCAB) surgery. All surgical patients were considered for on-pump CABG (ONCAB) and OPCAB surgical procedures. Minimally invasive direct coronary artery bypass grafting and robotic procedures were done as OPCAB. For multivessel median sternotomy cases, the selection criteria were arbitrary (approximately 50% were performed as ONCAB for perfusionist training). Patients who were scheduled for and began their operations as OPCAB but who were then placed on cardiopulmonary bypass during the surgical procedure were counted as conversions. The outcomes of converted patients were studied and are the subject of this report. RESULTS: Of the 784 CABG procedures, 391 (49.6%) were scheduled and performed as ONCAB operations; 357 (45.5%) were performed as OPCAB; and 36 (9.2% of the originally scheduled OPCAB patients or 4.6% of the total number of CABG surgeries) were originally scheduled as OPCAB operations but were converted to ONCAB. Reasons for conversions were hemodynamic instability (21 patients), difficult revision of grafts (8), ventricular fibrillation (5), and poor native vessel (2). Outcomes of patients undergoing conversions were analyzed with respect to the conversion cause. When the cause of the conversion was mild-to-moderate hemodynamic instability or difficult graft revision (n = 27), no adverse ischemic effects were seen; however, when the cause of conversion was severe hemodynamic instability, ventricular fibrillation, or cardiac arrest (n = 9), 6 patients (66.6%) had severe ischemic complications involving the central nervous system or the myocardium. DISCUSSION: Myocardial ischemia must be monitored and treated aggressively in OPCAB surgery. In patients with mild hemodynamic instability, conversion did not adversely affect outcome. In patients with severe hemodynamic compromise and cardiac arrest, serious complications of cerebral and myocardial ischemia were observed. The appropriate timing of conversion is essential.

Cardiopulmonary Bypass↗
PubMed2002

Survey of resident training in robotic surgery.

Robotics has been recognized as a major driving force in the advancement of minimally invasive surgery. However, the extent to which General Surgery residents are being trained to use robotic technology has never been assessed. A survey was sent to program directors of accredited General Surgery training programs to determine the prevalence and application of robotics in surgical training programs. Responses were tabulated and analyzed. Thirty-three per cent indicated interest in minimally invasive surgery. Twelve per cent of responders have used robotics in their practice, and 65 per cent felt robotics will play an important role in the future of General Surgery. Currently residents from 14 per cent of the responding training programs have exposure to robotic technology, and residents from an additional 4 per cent of these programs have limited didactic exposure. Program directors from 23 per cent of responding programs identified plans to incorporate robotics into their program. Robotics have been shown to make standard endoscopic surgical procedures more efficient and cost-effective as well as allowing a variety of procedures that were only possible with conventional methods to be completed with minimally invasive techniques. This new technology promises to be a large part of the future of surgery and as such deserves more attention in the training of General Surgery residents.

Diffusion of Innovation↗
PubMed2002

[Coronary artery bypass grafting without use of cardiopulmonary bypass].

Although it is possible to find a number of comparative studies in the world literature discussing the results of coronary artery bypass surgery (CABG) with and without cardiopulmonary bypass (CPB), until now such analysis has not been made in Bosnia and Herzegovina. The main aim of this scientific work was to compare morbidity and mortality, need for blood transfusions, length of stay in the intensive care unit and total length of hospitalisation in two groups of patients operated with these methods. One hundred and four patients with coronary artery disease operated in Cardiovascular Clinic Tuzla, from September, 1998 to September 2002 divided in two groups, were included in this study. There were 52 patients in the first group operated with CPB and 52 patients in the second group operated without CPB. The groups were matched for gender, age, ejection fraction and preoperative risk factors. The incidence of postoperative complications was lower in patients operated without CPB (5.77% vs. 21.15%). The mortality rate was reduced in patients operated without CPB (0.00% vs. 5.76%). There were reduced need for transfusion in patients operated without CPB (0.28 vs. 1.11 units of blood). The average time spent on respirators was shorter in patients operated without CPB (1.50 vs. 4.76 hours). The average time of total hospitalisation was also shorter in patients operated withouth CPB (6.53 vs. 8.13 days). In conclusion CABG without CPB has many advantages compared to the conventional method. Mortality and morbidity are reduced and there is less need for transfusion. The time spent on mechanical ventilation is reduced and less time is spent in intensive care and the total hospitalisation time is also less.

Cardiopulmonary Bypass↗
PubMedDate not supplied

Partial left ventriculectomy--The Third International Registry Report 2002.

BACKGROUND: An international registry of partial left ventriculectomy (PLV) has been expanded, updated, and refined to include 440 cases voluntarily reported from 51 hospitals in 11 countries. RESULTS: Gender, age, ventricular dimension, etiology, ethnology, myocardial mass, operative variation or presence or absence of mitral regurgitation as well as transplant indication had no effects on event-free survival, which was defined as either absence of death or ventricular failure requiring ventricular assist device or listing for transplantation. Preoperative patient condition such as NYHA functional class IV, depressed contractility, and decompensation requiring an emergency procedure were associated with reduced event-free survival. Other risk factors included early date of surgery, lack of experience, and extended myocardial resection. Performance of PLV reached a peak by 1998 and was largely abandoned by 2000 except in Asia, where experienced institutes continue to perform PLV in patients in better condition with preserved myocardial contractility. CONCLUSION: Avoidance of delineated risk factors appears to improve recent survival and may help stratify high- or low-risk patients for PLV. An integrated approach with mechanical and biological circulatory assist may improve prognosis for patients with dilated failing hearts. While frequency of PLV has decreased, the concept of ventricular volume reduction has been extended to other volume reduction procedures and less invasive procedures now under clinical trial.

Adolescent↗
PubMedDate not supplied

Ventricular volume reduction procedures.

Although partial left ventriculectomy (PLV) has been abandoned in many institutions, a few hospitals continue to perform it with a relatively favorable outcome. Other volume reduction procedures have become popular with renewed interest in ventricular reshaping to improve function. Although recent refined selection criteria have improved survival with PLV, earlier unpredictable results prompted less invasive procedures based on the same physiologic concept of reducing radius or wall tension by wrapping, piercing, or clasping. These new techniques are not only less invasive but also reversible and adjustable and appear safer for less symptomatic patients at risk of progressive heart failure. Nonetheless, mechanisms of action and degrees of volume reduction and/or restriction need to be delineated before widespread clinical application.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Intraoperative graft verification in renal transplants.

The success of an arterial reconstruction is dependent on multiple factors, including patient selection, quality of the vessels, type of vascular conduit employed, and the surgical technique adopted. Transit time flow measurement is a technique that is now the standard of care for immediate graft patency verification following coronary artery bypass graft surgery. This study demonstrates that transit time flow measurement can be successfully used to evaluate renal transplant anastomoses: accurate intraoperative measurements provide a rapid objective assessment of renal graft patency.

Blood Flow Velocity↗