Minimally invasive cardiopulmonary bypass with cardioplegic arrest: A closed chest technique with equivalent myocardial protection Daniel S. Schwartz,

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Presentation transcript:

Minimally invasive cardiopulmonary bypass with cardioplegic arrest: A closed chest technique with equivalent myocardial protection Daniel S. Schwartz, MDa, Greg H. Ribakove, MDa, Eugene A. Grossi, MDa, John H. Stevens, MDb, Lawrence C. Siegel, MDc, Frederick G. St. Goar, MDd, William S. Peters, MB, ChBb, David McLoughlin, MDa, F.Gregory Baumann, PhDa, Stephen B. Colvin, MDa, Aubrey C. Galloway, MDa The Journal of Thoracic and Cardiovascular Surgery Volume 111, Issue 3, Pages 556-566 (March 1996) DOI: 10.1016/S0022-5223(96)70307-0 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Diagram of the minimally invasive CPB system used in this series of experiments. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Roentengram illustrating the proper position of the endovascular aortic clamp (EAC) in the ascending aorta with opacification of the balloon at the tip of the catheter. The endovascular pulmonary artery venting catheter (EPV) and the venous bypass cannula (VC) are overlying the cardiac silhouette. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 A, Representative plot of instantaneous left ventricular pressure and myocardial segment length dimension for cardiac cycles over a range of end-diastolic volumes. B, Left ventricular regional stroke work expressed as a function of end- diastolic length for each cardiac cycle yields linear relationship with a slope and x-intercept. C, The area under the segmental preload recruitable work area versus end-diastolic length relationship is equal to the preload recruitable work area (equation 3) for two different time periods in the same subject. Lw1 and Lw2 are the different x-intercepts and Lwmax is the maximal value of the x-intercept for the entire experiment. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 A, Representative plot of instantaneous left ventricular pressure and myocardial segment length dimension for cardiac cycles over a range of end-diastolic volumes. B, Left ventricular regional stroke work expressed as a function of end- diastolic length for each cardiac cycle yields linear relationship with a slope and x-intercept. C, The area under the segmental preload recruitable work area versus end-diastolic length relationship is equal to the preload recruitable work area (equation 3) for two different time periods in the same subject. Lw1 and Lw2 are the different x-intercepts and Lwmax is the maximal value of the x-intercept for the entire experiment. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 A, Representative plot of instantaneous left ventricular pressure and myocardial segment length dimension for cardiac cycles over a range of end-diastolic volumes. B, Left ventricular regional stroke work expressed as a function of end- diastolic length for each cardiac cycle yields linear relationship with a slope and x-intercept. C, The area under the segmental preload recruitable work area versus end-diastolic length relationship is equal to the preload recruitable work area (equation 3) for two different time periods in the same subject. Lw1 and Lw2 are the different x-intercepts and Lwmax is the maximal value of the x-intercept for the entire experiment. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 X-axis intercept (Lw) of the end-diastolic pressure–length relationship represented as boxplots of the mean values before and after CPB. NS, Not significant. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Slope (Mw) of the end-diastolic pressure–length relationship represented as a boxplot of the mean values before and after CPB. NS, Not significant. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 6 Myocardial contractile function quantified by work area (PRWA) as a percentage of the mean pre-CPB value. NS, Not significant. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 7 Myocardial contractile function quantified by the stroke work–end-diastolic length relationship (SWEDL) as a percentage of the mean pre-CPB value. NS, Not significant. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 8 Emax of the end-systolic pressure–length relationship represented as a boxplot of the mean values before and after CPB. NS, Not significant. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 9 Myocardial regional temperatures of the left and right ventricles before, during, and after CPB. NS, Not significant. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 10 Electron micrographs of left ventricular biopsy specimens from the same animal showing normal ultrastructure before minimally invasive CPB (A) and after 60 minutes of reperfusion (B). (Uranyl acetate and lead citrate, ×6600.) The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 10 Electron micrographs of left ventricular biopsy specimens from the same animal showing normal ultrastructure before minimally invasive CPB (A) and after 60 minutes of reperfusion (B). (Uranyl acetate and lead citrate, ×6600.) The Journal of Thoracic and Cardiovascular Surgery 1996 111, 556-566DOI: (10.1016/S0022-5223(96)70307-0) Copyright © 1996 Mosby, Inc. Terms and Conditions