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New Intraoperative Techniques to Improve Advanced Aortic Root Surgery

Alrashidi, Faleh LU (2010) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2010:39.
Abstract
Study I: Thirteen patients underwent a modified Ross operation in which the free-standing pulmonary autograft was supported externally by a Dacron vascular prosthetic jacket (DVPJ). The tailor-made DVPJ prevented dilatation of the neo-aortic root significantly following a median follow-up of 47 months compared to a cohort of l3 matched patients undergoing conventional Ross operation.



Study II: Acute intraoperative plateletpheresis (APP) with 25% circulating platelet yield was performed in18 young adult patients undergoing Ross operation. APP in combination with 2 million units of aprotinin reduced the combined need of all blood product transfusions by 47% compared to a matched cohort of 19 patients also undergoing the... (More)
Study I: Thirteen patients underwent a modified Ross operation in which the free-standing pulmonary autograft was supported externally by a Dacron vascular prosthetic jacket (DVPJ). The tailor-made DVPJ prevented dilatation of the neo-aortic root significantly following a median follow-up of 47 months compared to a cohort of l3 matched patients undergoing conventional Ross operation.



Study II: Acute intraoperative plateletpheresis (APP) with 25% circulating platelet yield was performed in18 young adult patients undergoing Ross operation. APP in combination with 2 million units of aprotinin reduced the combined need of all blood product transfusions by 47% compared to a matched cohort of 19 patients also undergoing the Ross operation and receiving 2 million units of aprotinin alone (p=.036).



Study III: Twenty patients undergoing elective open left heart surgery were de-aired alternately and prospectively either with the conventional technique, (pleural cavities unopened, dead space ventilation during cardiopulmonary bypass) or with a new de-airing technique (pleural cavities open, ventilator disconnected during cardiopulmonary bypass, staged perfusion and ventilation of lungs) The new de-airing technique significantly reduced the de-airing time (10 vs 17 minutes, p<.001) and provided significantly greater freedom from residual air emboli (p= <.001).



Study IV: The new de-airing technique was modified by applying active suction in the aortic root before release of the aortic cross clamp (Lund technique). Twenty patients undergoing elective open left heart surgery were prospectively randomized to either the Lund technique or to a standardized CO2 insufflation technique. The magnitude of air emboli as observed on a transesophageal echocardiogram and the number of microembolic signals as recorded by transcranial Doppler were significantly lower with the Lund technique during the de-airing period (P=.00634) and in the first 10 minutes (p =.000377) after weaning from the cardiopulmonary bypass (CPB). The de-airing time was also significantly shorter with the Lund technique (9 vs 15 minutes, p=.001). Arterial pH during CPB was significantly lower in the CO2 group (P=.00351) despite significantly higher gas flows (P=.0398) in the oxygenator. (Less)
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author
supervisor
opponent
  • Assoc Prof, Cardiothoracic surgeon Thelin, Stefan, Uppsala Univerity
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Modified Ross Operation, Aortic Root surgery, Microemboli signals (MES), Transcranial Doppler (TCD), Acute plateletphersis (APP), Transesophageal echocardiography (TEE), de-airing
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2010:39
pages
150 pages
publisher
Heart and Lung division, Faculty of Medicine
defense location
I Segerfalksalen Wallenberg Neurocentrum
defense date
2010-04-22 09:15
ISSN
1652-8220
ISBN
978-91-86443-54-2
language
English
LU publication?
yes
id
a83288d7-eecd-4b46-b0c4-a1cbee656d7c (old id 1581296)
date added to LUP
2010-04-09 09:42:18
date last changed
2018-05-29 12:18:52
@phdthesis{a83288d7-eecd-4b46-b0c4-a1cbee656d7c,
  abstract     = {Study I: Thirteen patients underwent a modified Ross operation in which the free-standing pulmonary autograft was supported externally by a Dacron vascular prosthetic jacket (DVPJ). The tailor-made DVPJ prevented dilatation of the neo-aortic root significantly following a median follow-up of 47 months compared to a cohort of l3 matched patients undergoing conventional Ross operation. <br/><br>
<br/><br>
Study II: Acute intraoperative plateletpheresis (APP) with 25% circulating platelet yield was performed in18 young adult patients undergoing Ross operation. APP in combination with 2 million units of aprotinin reduced the combined need of all blood product transfusions by 47% compared to a matched cohort of 19 patients also undergoing the Ross operation and receiving 2 million units of aprotinin alone (p=.036). <br/><br>
<br/><br>
Study III: Twenty patients undergoing elective open left heart surgery were de-aired alternately and prospectively either with the conventional technique, (pleural cavities unopened, dead space ventilation during cardiopulmonary bypass) or with a new de-airing technique (pleural cavities open, ventilator disconnected during cardiopulmonary bypass, staged perfusion and ventilation of lungs) The new de-airing technique significantly reduced the de-airing time (10 vs 17 minutes, p&lt;.001) and provided significantly greater freedom from residual air emboli (p= &lt;.001). <br/><br>
<br/><br>
Study IV: The new de-airing technique was modified by applying active suction in the aortic root before release of the aortic cross clamp (Lund technique). Twenty patients undergoing elective open left heart surgery were prospectively randomized to either the Lund technique or to a standardized CO2 insufflation technique. The magnitude of air emboli as observed on a transesophageal echocardiogram and the number of microembolic signals as recorded by transcranial Doppler were significantly lower with the Lund technique during the de-airing period (P=.00634) and in the first 10 minutes (p =.000377) after weaning from the cardiopulmonary bypass (CPB). The de-airing time was also significantly shorter with the Lund technique (9 vs 15 minutes, p=.001). Arterial pH during CPB was significantly lower in the CO2 group (P=.00351) despite significantly higher gas flows (P=.0398) in the oxygenator.},
  author       = {Alrashidi, Faleh},
  isbn         = {978-91-86443-54-2},
  issn         = {1652-8220},
  keyword      = {Modified Ross Operation,Aortic Root surgery,Microemboli signals (MES),Transcranial Doppler (TCD),Acute plateletphersis (APP),Transesophageal echocardiography (TEE),de-airing},
  language     = {eng},
  pages        = {150},
  publisher    = {Heart and Lung division, Faculty of Medicine},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {New Intraoperative Techniques to Improve Advanced Aortic Root Surgery},
  volume       = {2010:39},
  year         = {2010},
}