Chapter category: Heart
Effects of Vascular-Interrupting and Hemostatic Devices on Coronary Artery Endothelial Function in Beating Heart Coronary Artery Bypass Surgery
Off-Pump Coronary Artery Bypass Surgery
Edited by: Raymond CartierISBN: 1-58706-075-2
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Chapter authors:
Roland G. Demaria and Louis P. Perrault
Coronary artery bypass grafting was first conceived and experimented on by the French Nobel Prize winner in Medicine Alexis Carrel at the beginning of the previous century. 1 Sabiston, in 1962, performed the first aortocoronary venous bypass graft in humans, and Kolesov, the first left internal mammary artery (IMA) to left anterior descending (LAD) coronary artery in 1966.2,3 All these operations were undertaken on the beating heart. At the end of the 1960s, Favaloro and the Cleveland Clinic team launched the era of modern coronary artery bypass surgery with the use of the extra-corporeal circulation.4 All these pioneers were confronted by the problem of blood flow control at the anastomotic site. Different techniques, such as compression, irrigation of the area or external cross-clamping with poor stabilization were tried. Rapidly, cardiopulmonary bypass (CPB) was almost universally adopted for coronary bypass surgery, allowing surgeons to achieve a bloodless and motionless operative field. The majority of coronary operations were soon performed with this technique, and beating heart coronary revascularization was abandoned as a routine procedure. Because CPB caused a major systemic inflammatory response with subsequent risks of hemorrhagic and neurological complications, and perhaps for economic reasons, some surgical teams remained faithful to the technique and were involved in its revival. In the last decade, beating heart coronary artery bypass surgery has regained tremendous popularity in the cardiovascular community.5,6 Nevertheless, specific technical difficulties are still associated with this approach; heart stabilization or coronary bleeding at the anastomotic site. These issues may alter the quality of anastomosis and result in a greater need for reoperation or percutaneous coronary angioplasty.7 Therefore, the ideal technique to obtain a bloodless field on coronary anastomotic sites, mandatory for the surgeon’s optimal visualization, remains unresolved.
Additional chapters from this book:
Principles of Stabilization and Hemodynamics in OPCAB Surgery
Raymond Cartier
Stabilization of the myocardium during coronary grafting remains a major task in OPCAB surgery. In the early beginning, only the anterior territory of the heart was targeted and acceptable rudimenta...
Understanding the Mechanisms of Hemodynamic and Echocardiographic Changes during OPCAB Surgery
Pierre Couture, Andre Denault, Patrick Limoges, Peter Sheridan and Denis Babin
Coronary artery bypass grafting (CABG) on the beating heart has become a widely applied procedure. OPCAB grafting is quite attractive because of the obvious advantages of avoiding cardiopulmonary by...
Historical Considerations
Raymond Cartier
Recently, performing coronary artery surgery on the beating heart received prime attention even though the concept is evidently not a new one. In 1910, Alexis Carrel (Fig. 1) was the first to propos...
Sutureless Coronary Artery Bypass Grafting: Experimental and Clinical Progress
Kenton J. Zehr
The vision of vascular surgery became clearer in 1902, when Alexis Carrel described his triangulation technique for suturing blood vessels together.1 He experimented with vessels of many sizes and t...
Effects of Vascular-Interrupting and Hemostatic Devices on Coronary Artery Endothelial Function in Beating Heart Coronary Artery Bypass Surgery
Roland G. Demaria and Louis P. Perrault
Coronary artery bypass grafting was first conceived and experimented on by the French Nobel Prize winner in Medicine Alexis Carrel at the beginning of the previous century. 1 Sabiston, in 1962, perf...
Cardiopulmonary Bypass and Inflammation
Francois Dagenais
In the 1920s, Brukhonenko was the first to advance the concept of total body perfusion with removal of the heart.1 However, the development of a true heart-lung machine could not be fully explored u...
The Future of Coronary Artery Surgery: Quo Vadimus?
Ray C.-J. Chiu
As Dr. Paul Cartier vividly described in the Foreword of this book, there has been great progress in coronary artery surgery in the past half century. Thanks to the courageous and ingenious efforts ...
OPCAB Surgery in High Risk-Patients
Gengarr Apoo and Raymond Cartier
The advent of cardiopulmonary bypass (CPB) circulation in the past half century has revolutionized the field of cardiac surgery. Although CPB has been associated with very low morbidity, its side-ef...
Cerebral Complications Following Coronary Artery Bypass Grafting Surgery
Marzia Leache and Raymond Cartier
Cerebral complications constitute the leading cause of morbidity and disability after heart surgery. Although many cerebral deficits resolve with time, others remain a major handicap with devastatin...
Systematic OPCAB Surgery for Multivessel Disease With the CoroNeo Cor-Vasc Device
Raymond Cartier
Introduced in the mid-1960s for single vessel, OPCAB surgery is currently applicable to multivessel disease.1-4 The advent of mechanical stabilizers has been, without any doubt, a giant leap in the ...
Indications and Surgical Strategies for OPCAB
Nicolas Durrleman and Raymond Cartier
Since its reintroduction in the late 1990s, OPCAB surgery has been adopted by the inter national community in a proportion fluctuating from 1% to 98%.1,2 This large vari ability clearly reflects an ...
Potential Benefit of OPCAB Surgery
Marzia Leache and Raymond Cartier
Since the introduction of the extra-corporeal circulation (ECC) in the late fifties, its use has been seen as a necessary evil to perform surgery on the heart. The systemic inflamma tory reaction ge...
