Biomedical subjects

Raymond Cartier

Publications and source records attributed to Raymond Cartier.

38 records · Page 3Linked to original sources

PubMed2002

Vacuum-assisted venous drainage does not increase the neurological risk.

BACKGROUND: Vacuum-assisted venous drainage (VAVD) with negative pressure applied to integral sealed-hardshell venous reservoir facilitates valvular surgery through minimally invasive approaches. Despite concerns regarding air entrainment from the right atrium, cerebral microemboli of air and neurological complications, VAVD was used in patients who underwent valvular surgery throughout the last two years in our institution. METHODS: We compared the rate of neurological complications in patients who underwent surgery with and without VAVD from June 1997 to July 2001. VAVD was added to solid venous reservoirs with membrane oxygenators and arterial filters. Clinical results were prospectively entered in our valve database and were used for the analysis. RESULTS: Eight hundred twenty-two consecutive patients averaging 65 +/- 11 years of age underwent aortic, mitral and tricuspid valve replacements including 40 redos (40/822, 5%) and 265 associated CABG (265/822, 32%) with VAVD in 1999 to 2001 compared to 723 patients averaging 63 +/- 11 years of age (p = 0.01) who underwent the same procedures with 79 redos (79/723, 11%) and 177 CABG (177/723, 24%) without VAVD in 1997 to 1999. CPB time averaged 117 +/- 50 minutes in VAVD patients compared to 108 +/- 43 minutes in those without VAVD (p = 0.001). Thirty-day mortality averaged 5% (39/822) in patients with VAVD and 4% (30/723) in those without VAVD (p = 0.6). Seven patients of the VAVD group (7/822, 1%) and 11 patients without VAVD (11/723, 1.5%, p = 0.2) suffered from temporary or permanent neurological deficit. CONCLUSION: VAVD is a useful adjunct to modern cardiopulmonary bypass systems. When used with appropriate care, VAVD does not appear to significantly increase air microemboli and is not associated with an increased neurological risk following valvular surgery.

Aged↗

PubMedDate not supplied

Current trends and technique in OPCAB surgery.

BACKGROUND AND AIM OF THE STUDY: Aging of the population, increased surgical risk, and technical improvement have contributed to the recent revival of off pump coronary artery bypass surgery (OPCAB). We present our experience with the systematic use of this technique. METHODS: Between September 1996 and June 2000, 500 OPCAB procedures were performed at the Montreal Heart Institute (95% of all procedures during time frame, single surgeon). Contraindications were unstable hemodynamics, intramyocardial left anterior descending artery, and reoperation with extensive adhesions. Stabilization was achieved with pericardial sutures and mechanical compression. Surgical strategy was to first bypass the culprit lesion. Anesthetic management consisted of adequate fluid loading and minimal use of alpha-agonist. This cohort was compared to a contemporary cohort of 1,444 patients operated with cardiopulmonary bypass (CPB). RESULTS: Demographics and risk factors were comparable for all. OPCAB patients received more grafts (3.1 +/- 0.9 vs 2.9 +/- 0.7, p = 0.006), conversion rate was low (0.4%), and complete revascularization was achieved in 93%. Operative mortality and perioperative myocardial infarction were comparable in both groups. Transfusion need, CK-MB count, postoperative use of intra-aortic balloon pump, and creatinine increase were less significant in OPCAB. Postoperative hemorrhage, atrial fibrillation, prevalence of cerebrovascular accident, and hospital stay were comparable for both groups. These results are comparable to those currently reported in the literature. CONCLUSION: OPCAB surgery in the current era has established its safety and short-term efficacy although long-term clinical results are still warranted. Considering the changing pattern in surgical practice, OPCAB surgery should remain a therapeutic option in modern cardiac surgery.

Brain↗