Flow measurement in coronary surgery

BACKGROUNDMany of the modern less invasive approaches to coronary artery bypass grafting (CABG) are performed without the use of the heart lung machine and cardiac asystole. Even after the introduction of mechanical stabilizers, the ability to achieve a technically perfect anastomosis is less certain in beating heart bypass surgery. Our group has begun to assess the surgical results of beating heart CABG using Transit Time Flow Measurement (TTFM). Our experience indicates that a meticulous and controlled method of assessing the results of intraoperative flow measurements can improve the quality of information and increases the accuracy of diagnosing technical problems with newly constructed bypass grafts. For this reason, we developed a standard algorithm for using and interpreting intraoperative TTFM.METHODSFrom January to August of 1998, 161 patients underwent off-pump CABG with a total of 323 distal anastomoses (2.0 grafts per patient). All completed grafts were tested intraoperatively with TTFM and the decision to accept or revise any individual graft was based on a decision nomogram using key values readily available from the TTFM output.RESULTSThirty-two grafts (9.9%) were surgically revised based on unsatisfactory flow curves, the Pulsatile Index, or both. All revised grafts were found to have a significant technical error, such as an intimal flap, thrombus, conduit kinking, or dissection. There were no major complications, myocardial infarctions, or deaths in the entire series of patients.CONCLUSIONSBased on our favorable use of TTFM, we strongly recommend that patency of every graft be assessed whether the operation is performed off pump or on cardiopulmonary bypass. Guidelines for performing and interpreting TTFM ensure a high degree of confidence in the completed graft. The decision to revise a graft can be made based on simple parameters easily acquired from the TTFM device. Any concern about quality or quantity of flow should prompt immediate revision

Changing referral pattern in off-pump coronary artery bypass surgery: a strategy for improving surgical results

We have previously shown that a less invasive surgical approach (LISA) can reduce mortality and morbidity in coronary artery bypass grafting (CABG). This appears to have led to the referral of increasingly high risk patients for this procedure as compared to patients undergoing traditional CABG. The purpose of this paper is to compare preoperative risk factors and postoperative complications in both LISA and conventional CABG cases using the New York State database. From January 1997 to September 1998, 1,993 patients underwent CABG in our institution: 1,384 with CPB (group A) and 609 without CPB (group B). In group B (LISA), a well defined strategy was followed in an effort to prevent hemodynamic instability during coronary exposure, avoid myocardial ischemia, verify graft patency, and use alternative surgical incisions in reoperations. Analysis of preoperative risk factors using the NYS database showed a significant increase in comorbidities in group B (p < 0.005), while at the same time postoperative complications and risk-adjusted mortality were lower (p = NS). Our data demonstrates that by using the LISA, high risk patients can undergo CABG with equal or lower mortality and morbidity than traditional CABG

A Pediatric Surgery study: Parent usage of the internet for medical information

Purpose: The goal of this study was to (1) determine parents access to and use of the Internet for information relating to their child's health; (2) investigate parents methods of searching for such information; and (3) evaluate the information found in relation to its readability, accuracy, and influence. Methods: A study was conducted of 150 parents of outpatients in the Pediatric Surgery Clinic of a local Children's Hospital. Parents completed study surveys over a 6-week time frame. Results: All parents (150 of 150, 100%) completed the surveys. The median age of the parents was 35 years, 83% (124 of 150) were mothers, and most (32%) attained a high school diploma. Of the 128 parents having Internet access, 71% used the Internet to search for health-related information. A majority of parents, 98%, agreed or somewhat agreed that the information they found was comprehensible and helpful. All respondents at least somewhat trusted information found, and 52% were at least somewhat influenced by online information when making a medical decision. Conclusions: Many parents use the Internet for additional medical information, but they do not access this information frequently. The overwhelmingly positive impression of online health information suggests parents are unaware of the dangers of encountering misleading sources, an issue of special concern when considering the amount of influence this information carries. A movement must be made to create uniform guidelines for health information on the Internet. In the meantime, pediatric surgeons must take a role in guiding parents toward accurate online sources and becoming more Internet proficient themselves. Copyright 2003, Elsevier Science (USA). All rights reserved

The world wide web and robotic heart surgery

Purpose: The primary goal of this study was to (1) determine patients' access to and use of the Internet for healthrelated information before and after endoscopic atraumatic coronary artery bypass (Endo-ACAB) surgery, (2) investigate patients' methods of searching for such information, and (3) suggest future improvements for Internet-based patient education. The secondary goal of this study was to determine (1) patients' health-related quality of life and (2) degree of satisfaction following the Endo-ACAB procedure. Methods: A follow-up study was conducted of 50 consecutive patients who had undergone Endo-ACAB procedures at the Center for Less Invasive Cardiac Surgery and Robotic Heart Surgery in Buffalo, New York. Study surveys were designed cooperatively by a communication scientist specializing in Internet studies and cardiac surgeons. Patients completed surveys over a period of 18 months, from January 2001 to June 2002. Results: All 50 patients (100%) in the targeted study group completed the survey. Forty-four (88%) of these respondents reported having Internet access. The Web was cited as the most popular source of initial information on Endo-ACAB, with 36% of patients (18) first learning about the procedure through an Internet search. All 44 patients with Internet access used the Web as an additional source of information before surgery, but only 20% (7/35) did so after surgery. Most patients (91%, 40/44) felt that their surgeon should develop a Web site to detail the Endo-ACAB procedure. An investigation of patient quality of life showed that 96% of patients were not experiencing any symptoms related to t heir surgery. All 50 patients reported high degrees of satisfaction with the Endo-ACAB procedure, and 98% (49) said that they would recommend the surgery to someone else. Conclusion: A vast majority of patients are realizing the benefits of the Internet as a tool to educate themselves, both before and after surgery. The request by an overwhelming majority of patients that surgeons develop Web sites, however, shows that patients may not be completely satisfied with the current form or content of health sites on the Internet. Surgeons will see the benefits of Web-based education only when they ensure that their patients have access to adequate and credible health-related information. The early results of robotic surgery suggest a promising future and the need to investigate the role of the Internet in its growth