CARDIAC SURGERY TEXTBOOK PDF
Johns Hopkins Textbook of Cardiothoracic Surgery. David D. Yuh, MD, FACC, FACS, Editor, Luca A. Vricella, MD, FACS, Editor, Stephen C. Yang, MD, Editor. This chapter contains section titled: Introduction. Cardiopulmonary bypass: heart —lung machine. Myocardial protection. Closed cardiac surgery. Textbook of Surgery, Third Edition. Chapter 57 CHAPTER PDF. FULL BOOK PDF. PDF Minimally invasive cardiac surgery. The future of.
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Cardiothoracic Surgery x · Download result of the search .pdf) Cardiothoracic Surgery (Oxford Specialist Handbooks in Surgery) (2 ed.) Joanna Chikwe The ESC Textbook of Intensive and Acute Cardiovascular Care (2 ed.) Marco Tubaro . Cardiovascular Surgery, the Clinic for Cardiovascular Disease and the Clinic for in Germany, the Clinic of Cardiovascular Surgery of the German Heart Centre. The material in this eBook also appears in the print version of this title: ISBN: , .. Cardiac Surgery, Vice Chairman, Department of Surgery.
Gross and John P. JAMA ; 9 —2. Crafoord C, Nylin G.
Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg ;— Landmark article May 19, The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia.
By Alfred Blalock and Helen B. JAMA ; 16 — Brock RC.
Pulmonary valvotomy for the relief of congenital pulmonary stenosis; report of three cases. Br Med J ;1 —6. The surgical correction of aortic regurgitation preliminary report. Bull Georgetown Univ Med Cent ;6 3 —1. The surgical treatment of mitral stenosis: the first heart operation. Am J Cardiol ; 1 —7. Starr A, Edwards ML. Mitral replacement: clinical experience with a ball-valve prosthesis.
Ann Surg ;— Partial and complete prostheses in aortic insufficiency. J Thorac Cardiovasc Surg ;— Biological factors affecting long-term results of valvular heterografts. J Thorac Cardiovasc Surg ;58 4 — Lewis FJ, Taufic M.
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Closure of atrial septal defects with the aid of hypothermia; experimental accomplishments and the report of one successful case. Surgery ;33 1 —9. The first open-heart repairs of ventricular septal defect, atrioventricular communis, and tetralogy of Fallot using extracorporeal circulation by cross-circulation: a year follow-up. Ann Thorac Surg ;41 1 :4— Gibbon JH Jr.
The development of the heart-lung apparatus. Am J Surg ; 5 — Intracardiac surgery with the aid of a mechanical pump-oxygenator system gibbon type : report of eight cases. Proc Staff Meet Mayo Clin ; 30 10 —6. A simple, expendable, artificial oxygenator for open heart surgery. Surg Clin North Am — DeBakey ME. The development of vascular surgery. Am J Surg ; 6 — Milestones in the treatment of aortic aneurysm: Denton A.
Tex Heart Inst J ;32 2 —4. Beck CS. The development of a new blood supply to the heart by operation. Ann Surg ; 5 — Vineberg A, Miller G. Internal mammary coronary anastomosis in the surgical treatment of coronary artery insufficiency.
Can Med Assoc J ;64 3 — Survival after coronary endarterectomy in man. J Am Med Assoc ; 6 —6. Direct-vision coronary endarterectomy for angina pectoris. N Engl J Med ; 21 —9. Current status of cardiac surgery: a 40 year review.
Cardiac Surgery Books
J Am Coll Cardiol ; 14 3 — Konstantinov IE. Robert H. Goetz: the surgeon who performed the first successful clinical coronary artery bypass operation.
Ann Thorac Surg ;69 6 — Heart to heart: the twentieth century battle against cardiac disease.
An oral history. Favaloro RG. Critical analysis of coronary artery bypass graft surgery: a year journey. Barnard CN. The operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town. S Afr Med J ;41 48 —4. History of experimental heart transplantation.
Heart Transplantation III — DiBardino DJ. The history and development of cardiac transplantation. Tex Heart Inst J ;26 3 — Studies on orthotopic homotransplantation of the canine heart. Surg Forum ;—9.
Clinical use of the total artificial heart.
N Engl J Med ; 5 —8. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med ; 23 — Fang JC. Rise of the machines—left ventricular assist devices as permanent therapy for advanced heart failure. N Engl J Med ; 23 —5. Pig-to-non-human primate heart transplantation: immunologic progress over 20 years. J Heart Lung Transplant ;26 3 —8. Cardiac surgery, infection. Surgical infection. The etiopathogenesis remains little understood but it is believed that contamination of the wound during surgery, most commonly by gram-positive bacteria, is the main cause .
Several researches have demonstrated the interaction of pre- and trans-operative risk factors in the genesis of mediastinitis, especially obesity, diabetes, previous heart surgery and the use of internal mammary arteries in the procedures of coronary artery bypass grafting [1,4,5].
Diagnosis is difficult and is generally delayed, thus, a high degree of suspicion is required . Clinical and radiographic findings help in the investigation and the utilization of computed thoracic tomography detects diagnostically significant signs, such as to the presence of mediastinal fluid collection, dehiscence or sternal or pneumo-mediastinal erosion [3,7].
Nevertheless, the definitive diagnosis is achieved by sternal puncture, collecting material for analysis of the bacteria, or from the surgical wound itself. Of these two methods, diagnosis by puncture of the sternum can demonstrate the existence of mediastinitis at an earlier stage in patients in which there is clinic suspicion, because it is a less invasive procedure and has less risks than to reopening the thoracic cavity [8,9]. Treatment demands surgical re-exploration and immediate empirical antibiotic therapy [6,].
In this research we tried to identity pre- and trans-operative predictors of risk related to mediastinitis after heart surgery performed in our department. METHOD A descriptive, analytical cohort observational study was performed from variables obtained from the database of the sector of heart surgery. The data were obtained by the same researcher, according to a specific protocol of the heart surgery recovery unit, during the period in which the patients were hospitalized.
The occurrence of events was recorded until hospital discharge. The qui-squared test was utilized for univariant analysis.
Mediastinitis was defined based on clinical, laboratorial and tomographic criteria.
A review of the literature was performed in the areas of heart and thoracic surgery, using Medline and textbooks. The characteristics of this group and the prevalence of the analyzed variables are summarized in Table 1.
Among the patients who developed mediastinitis, six From the nine analyzed variables, a significant association in the development of mediastinitis was only observed for obesity, diabetes, COPD and mammary artery grafts. Logistic regression analysis identified obesity, diabetes and COPD as independent predictors of higher risk of mediastinitis, as is illustrated in Table 2. These variables remained independent predictors of risk even after taking into consideration gender and age.
The use of mammary artery grafts was seen as a predictor of risk only when associated with obesity. The incidence of mediastinitis varies according to the institution, but it is calculated as being between 0.
Operative Cardiac Surgery
In our service, the incidence of mediastinitis was 2. Many factors have been associated to the development of mediastinitis after heart surgery.
However, there is no consensus in the literature about which factors are more important and if each one is an independent predictor of higher risk for postoperative mediastinitis . Published studies give conflicting results about associated risk factors, probably due to differences in the methodologies used.
Additionally, there can be variations according to the institution where the surgical procedure was performed, as well as its geographic location . The Guidelines of the American College of Cardiology and the American Heart Association utilize an estimation of the risk created by a study group on cardiovascular diseases from England, as is shown in Table 3.
In our study, the factors considered independent predictors of potential risk of mediastinitis were obesity, COPD and diabetes Mellitus. According to the reviewed data, among all the risk factors, obesity seems to be the most important independent risk factor for mediastinitis, as has already been demonstrated in several studies [2,5,].
The exact mechanism by which obese patients are susceptible is not well known. It is probable, that in these patients, the levels of antibiotics in the tissues utilized during prophylaxis in the perioperative period are inadequate, as these patients present with a greater volume.
Additionally, the preparation of the skin of obese patients may be more difficult or even inadequate. An additional factor is that the great quantity of adipose tissue can serve as a substrate for infections of the surgical wound. Ventricular Mechanics Coronary Angiography: Valve and Hemodynamic Assessment Interventional Cardiology Medical Management of Acute Coronary Syndromes Crictical Care for the Adult Cardiac Patient Neuropsychologic Deficits and Stroke Cardiopulmonary Bypass: Technique and Pathophysiology Deep Sternal Wound Infection Myocardial Protection Surgery of the Aortic Root and Ascending Aorta Surgery of the Aortic Arch Descending Thoracic and Thoracoabdominal Aortic Surgery Type A Aortic Dissection Type B Aortic Dissection Surgical Treatment of Aortic Valve Disease Aortic Valve Repair Transcatheter Aortic Valve Replacement The characteristics of this group and the prevalence of the analyzed variables are summarized in Table 1.
COPD has already been demonstrated as a risk factor for mediastinitis in previous studies, although not in isolation [11,26,27]. By genetically altering donor organs—for example, from the pig, so that transplanted porcine organs do not elicit a rejection response in a human recipient—surgeons might one day achieve cardiac transplantation from pigs to human beings. Biological factors affecting long-term results of valvular heterografts. It is probable, that in these patients, the levels of antibiotics in the tissues utilized during prophylaxis in the perioperative period are inadequate, as these patients present with a greater volume.
Medical Management of Acute Coronary Syndromes
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