By Siavosh Khonsari, Colleen Flint Sintek
Now in its Fourth variation, this article is a pragmatic, seriously illustrated advisor to systems in cardiac surgical procedure. Chapters hide received and congenital illnesses and comprise surgical anatomy, surgical exposures, and step by step procedural info. The authors point out pitfalls with a chance signal and flag issues of designated curiosity with "NB" (Nota Bene). This variation has contributions from Abbas Ardehali, MD, FACS, the director of the UCLA middle, heart-lung, and lung transplant application. Highlights comprise a brand new bankruptcy on center transplantation. additionally incorporated are updates in minimally invasive surgical procedure and vascular and endovascular surgical procedure.
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Extra resources for Cardiac Surgery: Safeguards and Pitfalls in Operative Technique, 4th Edition
These can be dissected free and retracted with a few pledgeted sutures (Fig. 5-2A). Fine Prolene sutures are inserted in the adventitia of the aortic wall on each side of the proposed incision line, which should be 10 to 15 mm above the origin of the right coronary artery. When the ascending aorta has been cross-clamped, the aortic wall is incised for a short distance between these sutures. A small leaflet retractor is introduced into the lumen of the aorta to expose the aortic valve. Retractor Injury Often the aortic wall is dilated and thinned out, particularly in elderly patients with poststenotic dilation.
Injury to the Femoral Artery A tourniquet or clamp used to tighten the umbilical tape around the proximal femoral artery and cannula may injure the wall of the artery. This can be avoided by placing a peanut sponge under the umbilical tape before tightening it. Femoral Artery Dissection The surgeon should always look for a column of pulsating blood in the femoral cannula; in the absence of obvious pulsation, it is very likely that the cannula tip is not in the lumen of the vessel. Axillary Artery Cannulation The axillary artery has emerged as a safe, usually disease free, and accessible alternative site for arterial cannulation.
A small transverse arteriotomy is made where the arterial wall appears to be relatively normal. A tapered cannula of appropriate size is then gently introduced through a transverse arteriotomy into the arterial lumen and is secured in place (Fig. 2-12A). FIG 2-10. Aortic cannulation, completed. Cannula Slippage The perfusion pressure may cause the cannula to slip out. It should be secured by tying it to the umbilical tape already placed around the artery (Fig. 2-12B). Cannula Injury to the Arterial Wall The cannula tip may injure the arterial wall and cause separation of intimal plaque, which can result in retrograde aortic dissection (Fig.
Cardiac Surgery: Safeguards and Pitfalls in Operative Technique, 4th Edition by Siavosh Khonsari, Colleen Flint Sintek