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Francesco Musumeci - One of the best experts on this subject based on the ideXlab platform.

  • Endovascular balloon versus transthoracic Aortic Clamping for minimally invasive mitral valve surgery: impact on cerebral microemboli.
    Interactive cardiovascular and thoracic surgery, 2006
    Co-Authors: Daniele Maselli, Raffaella Pizio, Gabriele Borelli, Francesco Musumeci
    Abstract:

    To evaluate micro embolic events occurrence during minimally invasive mitral valve procedures, comparing balloon endovascular Aortic occlusion (Group I) and transthoracic Aortic Clamping technique (Group II), 36 patients (20 in Group I and 16 in Group II) undergoing minimally invasive mitral valve surgery were selected by CT scan and Doppler studies for absence of atherosclerotic disease at Aortic, coronary or peripheral level. Assignment to one of the two groups was made on the basis of surgeon's preference. Continuous automated intra-operative transcranial Doppler was used to monitor micro embolic events during five operative steps: cardiopulmonary bypass (CPB) setup, time interval from CPB start until Aortic clamp positioning, first minute after clamp-on, first minute after clamp-off, first ten minutes after CPB weaning start. More embolic events were observed in Group II than in Group I (total 143.4+/-30.6 per patient vs. 78.9+/-28.6 per patient). A large amount of embolic events occurring mainly when the Aortic clamp was positioned and released accounted for the observed differences. In a low risk population for embolic events occurrence, endovascular balloon Aortic Clamping determined less embolic signals than transthoracic Aortic Clamping.

  • Institutional report - Valves Endovascular balloon versus transthoracic Aortic Clamping for minimally invasive mitral valve surgery: impact on cerebral microemboli
    2006
    Co-Authors: Daniele Maselli, Raffaella Pizio, Gabriele Borelli, Francesco Musumeci
    Abstract:

    To evaluate micro embolic events occurrence during minimally invasive mitral valve procedures, comparing balloon endovascular Aortic occlusion (Group I) and transthoracic Aortic Clamping technique (Group II), 36 patients (20 in Group I and 16 in Group II) undergoing minimally invasive mitral valve surgery were selected by CT scan and Doppler studies for absence of atherosclerotic disease at Aortic, coronary or peripheral level. Assignment to one of the two groups was made on the basis of surgeon’s preference. Continuous automated intra-operative transcranial Doppler was used to monitor micro embolic events during five operative steps: cardiopulmonary bypass (CPB) setup, time interval from CPB start until Aortic clamp positioning, first minute after clamp-on, first minute after clamp-off, first ten minutes after CPB weaning start. More embolic events were observed in Group II than in Group I (total 143.4"30.6 per patient vs. 78.9"28.6 per patient). A large amount of embolic events occurring mainly when the Aortic clamp was positioned and released accounted for the observed differences. In a low risk population for embolic events occurrence, endovascular balloon Aortic Clamping determined less embolic signals than transthoracic Aortic Clamping. 2006 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

  • Endovascular Aortic Clamping for pseudoaneurysms of the Aortic root with Aortic regurgitation.
    The Annals of thoracic surgery, 2005
    Co-Authors: Daniele Maselli, Gianluca Santise, Andrea Montalto, Francesco Musumeci
    Abstract:

    Background We propose a safer strategy for surgical treatment of retro-sternal pseudoaneurysms of the Aortic root with severe Aortic regurgitation. The objective was to allow safer re-entry in a quite and bloodless field eliminating the risk of ventricular distension and avoiding deep hypothermia. Methods In 6 patients presenting with postsurgical Aortic root pseudoaneurysms in close proximity to the sternum associated with Aortic regurgitation, we used the following techniques: femorofemoral cardiopulmonary bypass; transfemoral Aortic endoClamping; percutaneous retrograde cardioplegia administration before sternotomy in patients with normal descending aorta; femoroaxillary cardiopulmonary bypass; transaxillary Aortic endoClamping; percutaneous retrograde cardioplegia administration before sternotomy in patients with concomitant disease of the descending aorta. Results All patients survived the operation and were discharged home. Arterial cannulation and endoclamp insertion were uneventful. Reentry was uncomplicated. Deep hypothermia was avoided in all cases. No occurrences of even minor neurologic problems were observed. None of these patients experienced a postoperative low cardiac output syndrome. Postoperative course was complicated in 1 patient with re-entry for bleeding; acute renal insufficiency requiring hemofiltration in 2 patients; pneumonia in 1 patient; and soft tissues sternotomy infection in 1 patient. Conclusions In patients presenting with a pseudoaneurysm of the Aortic root attached to the sternum and concomitant Aortic regurgitation it is possible, by closed chest endovascular Aortic Clamping, to eliminate risks of ventricular distension and to avoid deep hypothermia.

Daniele Maselli - One of the best experts on this subject based on the ideXlab platform.

  • Endovascular balloon versus transthoracic Aortic Clamping for minimally invasive mitral valve surgery: impact on cerebral microemboli.
    Interactive cardiovascular and thoracic surgery, 2006
    Co-Authors: Daniele Maselli, Raffaella Pizio, Gabriele Borelli, Francesco Musumeci
    Abstract:

    To evaluate micro embolic events occurrence during minimally invasive mitral valve procedures, comparing balloon endovascular Aortic occlusion (Group I) and transthoracic Aortic Clamping technique (Group II), 36 patients (20 in Group I and 16 in Group II) undergoing minimally invasive mitral valve surgery were selected by CT scan and Doppler studies for absence of atherosclerotic disease at Aortic, coronary or peripheral level. Assignment to one of the two groups was made on the basis of surgeon's preference. Continuous automated intra-operative transcranial Doppler was used to monitor micro embolic events during five operative steps: cardiopulmonary bypass (CPB) setup, time interval from CPB start until Aortic clamp positioning, first minute after clamp-on, first minute after clamp-off, first ten minutes after CPB weaning start. More embolic events were observed in Group II than in Group I (total 143.4+/-30.6 per patient vs. 78.9+/-28.6 per patient). A large amount of embolic events occurring mainly when the Aortic clamp was positioned and released accounted for the observed differences. In a low risk population for embolic events occurrence, endovascular balloon Aortic Clamping determined less embolic signals than transthoracic Aortic Clamping.

  • Institutional report - Valves Endovascular balloon versus transthoracic Aortic Clamping for minimally invasive mitral valve surgery: impact on cerebral microemboli
    2006
    Co-Authors: Daniele Maselli, Raffaella Pizio, Gabriele Borelli, Francesco Musumeci
    Abstract:

    To evaluate micro embolic events occurrence during minimally invasive mitral valve procedures, comparing balloon endovascular Aortic occlusion (Group I) and transthoracic Aortic Clamping technique (Group II), 36 patients (20 in Group I and 16 in Group II) undergoing minimally invasive mitral valve surgery were selected by CT scan and Doppler studies for absence of atherosclerotic disease at Aortic, coronary or peripheral level. Assignment to one of the two groups was made on the basis of surgeon’s preference. Continuous automated intra-operative transcranial Doppler was used to monitor micro embolic events during five operative steps: cardiopulmonary bypass (CPB) setup, time interval from CPB start until Aortic clamp positioning, first minute after clamp-on, first minute after clamp-off, first ten minutes after CPB weaning start. More embolic events were observed in Group II than in Group I (total 143.4"30.6 per patient vs. 78.9"28.6 per patient). A large amount of embolic events occurring mainly when the Aortic clamp was positioned and released accounted for the observed differences. In a low risk population for embolic events occurrence, endovascular balloon Aortic Clamping determined less embolic signals than transthoracic Aortic Clamping. 2006 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

  • Endovascular Aortic Clamping for pseudoaneurysms of the Aortic root with Aortic regurgitation.
    The Annals of thoracic surgery, 2005
    Co-Authors: Daniele Maselli, Gianluca Santise, Andrea Montalto, Francesco Musumeci
    Abstract:

    Background We propose a safer strategy for surgical treatment of retro-sternal pseudoaneurysms of the Aortic root with severe Aortic regurgitation. The objective was to allow safer re-entry in a quite and bloodless field eliminating the risk of ventricular distension and avoiding deep hypothermia. Methods In 6 patients presenting with postsurgical Aortic root pseudoaneurysms in close proximity to the sternum associated with Aortic regurgitation, we used the following techniques: femorofemoral cardiopulmonary bypass; transfemoral Aortic endoClamping; percutaneous retrograde cardioplegia administration before sternotomy in patients with normal descending aorta; femoroaxillary cardiopulmonary bypass; transaxillary Aortic endoClamping; percutaneous retrograde cardioplegia administration before sternotomy in patients with concomitant disease of the descending aorta. Results All patients survived the operation and were discharged home. Arterial cannulation and endoclamp insertion were uneventful. Reentry was uncomplicated. Deep hypothermia was avoided in all cases. No occurrences of even minor neurologic problems were observed. None of these patients experienced a postoperative low cardiac output syndrome. Postoperative course was complicated in 1 patient with re-entry for bleeding; acute renal insufficiency requiring hemofiltration in 2 patients; pneumonia in 1 patient; and soft tissues sternotomy infection in 1 patient. Conclusions In patients presenting with a pseudoaneurysm of the Aortic root attached to the sternum and concomitant Aortic regurgitation it is possible, by closed chest endovascular Aortic Clamping, to eliminate risks of ventricular distension and to avoid deep hypothermia.

Stuart I. Myers - One of the best experts on this subject based on the ideXlab platform.

  • loss of renal function and microvascular blood flow after suprarenal Aortic Clamping and reperfusion spacr above the superior mesenteric artery is greatly augmented compared with spacr above the renal arteries
    Journal of Vascular Surgery, 2007
    Co-Authors: Stuart I. Myers, Li Wang, Daniel J Myers
    Abstract:

    Objective Renal insufficiency continues to be a complication that can affect patients after treatment for suprarenal aneurysms and renal artery occlusive disease. To our knowledge, no data are available showing that suprarenal Aortic Clamping and reperfusion (SRACR) above the renal arteries (renal-SRACR) preserves renal function compared with SRACR above the superior mesenteric artery (SMA-SRACR). This study examined the hypothesis that SMA-SRACR–induced downregulation of renal blood flow and function is more severe than renal-SRACR owing to the addition of systemic oxygen-derived free radical (ODFR) release. Methods Male Sprague-Dawley rats (about 350 g) were anesthetized and microdialysis probes or laser Doppler fibers were inserted into the renal cortex (depth of 2 mm) and into the renal medulla (depth of 4 mm). Laser Doppler blood flow was continuously monitored, and the microdialysis probes were connected to a syringe pump and perfused in vivo at 3 μL/min with lactated Ringer's solution. Results SMA-SRACR and Renal-SRACR decreased medullary and cortical blood flow and nitric oxide (NO) synthesis. SMA-SRACR downregulated cortical inducible NO synthase, whereas renal-SRACR did not. The cortex and medulla responded to the decreased blood flow and NO synthesis by increasing in prostaglandin E 2 synthesis, which was due to increased cyclooxygenase-2 content. Superoxide dismutase restored SMA-SRACR (but not renal-SRACR) cortical and medullary NO synthesis, suggesting that ODFRs generated during mesenteric ischemia–reperfusion were one of the systemic mechanisms contributing to decreased renal NO synthesis in the SMA-SRACR model. The 90% decrease in creatinine clearance after SMA-SRACR was greater than the 60% decrease after renal-SRACR. Conclusions These data show that NO is important in maintaining renal cortical and medullary blood flow and NO synthesis after renal and SMA-SRACR. These data also suggest that in addition to the renal ischemia–reperfusion caused by both models, SMA SRACR induces mesenteric ischemia–reperfusion, resulting in the generation of ODFRs, which contribute to decreased renal cortical and medullary NO synthesis. Maintaining splanchnic blood flow or attempting to keep SRACR below the SMA level may be helpful in developing strategies to minimize the renal injury after SRACR.

  • Suprarenal Aortic Clamping and reperfusion decreases medullary and cortical blood flow by decreased endogenous renal nitric oxide and PGE2 synthesis.
    Journal of vascular surgery, 2005
    Co-Authors: Stuart I. Myers, Li Wang, Fang Liu, Lori L. Bartula
    Abstract:

    Objective This study examined the hypothesis that Clamping the aorta above the superior mesenteric artery (SMA) followed by suprarenal Aortic Clamping and reperfusion (SRACR) decreases microvascular blood flow by loss of endogenous medullary and cortical nitric oxide (NO) and prostaglandin (PG) E 2 synthesis. Study Design Anesthetized male Sprague-Dawley rats (350 g) had either microdialysis probes or laser Doppler fibers inserted into the renal cortex to a depth of 2 mm and into the renal medulla at 4 mm. Laser Doppler blood flow was continuously monitored (data reported as percentage of change compared to basal), and the microdialysis probes were connected to a syringe pump and perfused in vivo at 3 μL/min with lactated Ringer solution. Dialysate fluid was collected at basal time zero, following 30 minutes of suprarenal Aortic Clamping (ischemia) followed by 60 minutes of reperfusion and compared to a sham operation. Both groups were treated with saline carrier, indomethacin (INDO) (10 mg/kg, a cyclooxygenase [COX] inhibitor), N G -nitro-l-arginine methyl ester (l-NAME) (20 mg/kg, a NO synthase [NOS] inhibitor), or l-arginine (200 mg/kg, an NO precursor). Dialysate was analyzed for total NO (μM) and PGE 2 (pg/mL) synthesis. The renal cortex and medulla were analyzed for inducible NOS (iNOS) and COX-2 content by Western blot. All data are reported as mean ± SEM, N > 5 and analyzed by analysis of variance. Results SRACR caused a marked decrease in medullary and cortical blood flow with a concomitant decrease in endogenous medullary and cortical NO synthesis. Treatment with l-NAME further decreased blood flow and NO synthesis in the medulla and cortex. l-Arginine restored medullary and cortical NO synthesis and blood flow in the cortex but not the medulla. SRACR did not alter renal medullary or cortical PGE 2 ; however, addition of INDO, COX inhibitor, caused a concomitant decrease in medullary and cortical PGE 2 synthesis and blood flow. Conclusions NO is an important endogenous renal vasodilator that, when maintained can help preserve cortical blood flow following SRACR. These data also suggest that avoidance of COX-2 inhibitors can help maintain endogenous renal cortical and medullary PGE 2 synthesis and thus contribute to maintaining normal blood flow. Clinical Relevance This study is the first to combine in vivo physiologic assays to simultaneously identify clinically relevant intrarenal vasodilators (cortical and medullary) that are required to maintain microvascular blood flow. Identification of endogenous renal cortical and medullary vasodilators responsible for maintaining renal microvascular blood flow will allow development of treatment strategies to preserve these vasodilators following SRACR. Successful preservation of endogenous intrarenal vasodilators will help maintain renal microvascular blood flow and renal function in the treatment of complex Aortic pathology that requires SRACR.

  • Autoregulation of renal and splanchnic blood flow following infra-renal Aortic Clamping is mediated by nitric oxide and vasodilator prostanoids.
    The Journal of cardiovascular surgery, 1996
    Co-Authors: Stuart I. Myers, Richard H. Turnage, R. Hernandez, A. Castenada, R. J. Valentine
    Abstract:

    OBJECTIVE This study examines the hypothesis that nitric oxide and vasodilator prostanoids contribute to the autoregulation of renal artery and superior mesenteric artery (SMA) blood flow following infra-renal Aortic Clamping. EXPERIMENTAL DESIGN Renal and SMA artery blood flow were measured in anesthetized rats. The rats received bolus injection of saline carrier, L-NAME (25 mg/kg) or indomethacin (15 mg/kg) prior to sham or infra-renal Aortic occlusion. In vivo blood flow was measured 1, 30 and 60 minutes during Aortic occlusion and 1, 30, and 60 minutes following release of the Aortic cross clamp. RESULTS Aortic occlusion transiently increased SMA blood flow but did not alter renal artery blood flow. Aortic clamp release resulted in a 40% decrease in both SMA and renal artery blood flow. L-NAME or indomethacin pretreatment decreased both SMA and renal artery blood flow at 60 minutes following infrarenal Aortic occlusion. Indomethacin decreased SMA blood flow at 1 minute following unClamping of the aorta and L-NAME decreased SMA blood flow at 30 and 60 minutes following Aortic clamp release. Both L-NAME and indomethacin markedly decreased renal artery blood flow at all time periods following Aortic clamp release. CONCLUSIONS These data suggest that renal and splanchnic vascular beds utilize endogenous vasodilator eicosanoids and nitric oxide to maintain blood flow during cross Clamping and unClamping of the infra-renal aorta.

Vinay Badhwar - One of the best experts on this subject based on the ideXlab platform.

  • Aortic Clamping Strategy and Postoperative Stroke
    The Journal of thoracic and cardiovascular surgery, 2018
    Co-Authors: Mohamad Alaeddine, Vinay Badhwar, Maria V. Grau-sepulveda, Lawrence M. Wei, Chris C. Cook, Michael E. Halkos, Vinod H. Thourani, Jeffrey P. Jacobs, Roland A. Matsouaka, James M. Meza
    Abstract:

    Abstract Objective The effect of Aortic Clamping strategy on short-term stroke during proximal graft construction for coronary artery bypass grafting (CABG) remains undefined. The aim of this study was to test the hypothesis that partial occluding clamp (POC) technique does not increase incidence of postoperative stroke compared with single clamp (SC) technique for performing proximal coronary anastomoses. Methods We identified 52,611 patients who underwent on-pump CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database from July 1, 2014 to March 31, 2015. Propensity scores for POC were calculated on the basis of validated Society of Thoracic Surgeons predicted risk of postoperative stroke scores and used to adjust for intergroup differences to derive 17,819 matched pairs for analysis. Results Despite a similar number of total bypass grafts between matched SC versus POC groups, myocardial ischemic times were shorter (74.1 ± 29.2 minutes vs 57.0 ± 23.3 minutes; P  Conclusions Aortic Clamping strategy for constructing proximal anastomoses in CABG procedures does not affect short-term incidence of postoperative stroke or mortality. The use of POC incurred shorter myocardial ischemic and perfusion times compared with the SC technique with similar total number of bypass grafts.

  • Effect of Aortic Clamping Strategy on Postoperative Stroke in Coronary Artery Bypass Grafting Operations
    JAMA surgery, 2016
    Co-Authors: Danny Chu, Lawrence M. Wei, Chris C. Cook, Lara W. Schaheen, Victor O. Morell, Thomas G. Gleason, Vinay Badhwar
    Abstract:

    Importance Aortic Clamping technique has been implicated in stroke risk at the time of on-pump coronary artery bypass grafting (CABG) procedures. We hypothesized that partial Aortic Clamping (PAC) use in performing proximal coronary anastomosis does not increase risk of stroke. Objective To determine whether postoperative stroke incidence is influenced by single Aortic Clamping (SAC) or side-biting PAC use in performing proximal anastomosis during CABG procedures. Design, Setting, and Participants In a retrospective cohort study, we analyzed data from 1819 patients who underwent conventional, isolated, nonemergent, first-time, arrested-heart, on-pump CABG at a single US major academic, tertiary/quaternary medical center from January 1, 2005, to December 31, 2013. Postoperative stroke was defined according to Society of Thoracic Surgeons (STS) criteria as any confirmed neurological deficit of abrupt onset that did not resolve within 24 hours. Institutional STS data including STS predicted risk of postoperative stroke score were used to compare patients receiving proximal Aortic anastomoses performed with either SAC (n = 1107) or combined PAC (n = 712) techniques. Exposures Use of SAC or PAC in performing proximal coronary anastomosis. Main Outcomes and Measures Thirty-day periprocedural postoperative stroke rates. Results There were no significant differences in preoperative risk or STS predicted risk of mortality between groups. Patients in the SAC group had longer myocardial ischemic time compared with those in the PAC group (mean [SD], 73.2 [22.8] vs 66.5 [22.8] minutes, respectively; P P P  > .99) and congruent with STS predicted risk of mortality. Preoperative STS predicted risk of postoperative stroke scores were nearly identical between the SAC and PAC groups (mean [SD], 1.5% [1.4%] vs 1.6% [1.4%]; P  = .95), and the 30-day actual observed postoperative stroke rates between the SAC and PAC groups were similar (17 of 1107 patients [1.5%] vs 10 of 712 patients [1.4%], respectively; P  > .99). Conclusions and Relevance In this contemporary study of on-pump CABG, we did not identify any significant differences in the incidence of postoperative stroke regardless of the Clamping method used to perform proximal anastomosis.

Sadettin Karacagil - One of the best experts on this subject based on the ideXlab platform.

  • A new method of intrathecal PO2, PCO2, and pH measurements for continuous monitoring of spinal cord ischemia during thoracic Aortic Clamping in pigs.
    Surgery, 2000
    Co-Authors: Lennart Christiansson, Anders Hellberg, Itaru Koga, Stefan Thelin, David Bergqvist, Lars Wiklund, Sadettin Karacagil
    Abstract:

    Background. Impaired spinal cord circulation during thoracic Aortic Clamping may result in paraplegia. Reliable and fast responding methods for intraoperative monitoring are needed to facilitate the evaluation of protective measures and efficiency of revascularization. Methods. In 11 pigs, a multiparameter PO2, PCO2, and pH sensor (Paratrend 7, Biomedical Sensors Ltd, United Kingdom) was introduced into the intrathecal space for continuous monitoring of cerebrospinal fluid (CSF) oxygenation during thoracic Aortic cross-Clamping (AXC) distal to the left subclavian artery. A laser-Doppler probe was inserted into the epidural space for simultaneous measurements of spinal cord flux. Registrations were made before and 30 minutes after Clamping and 30 and 60 minutes after deClamping. The same measuring points were used for systemic hemodynamic and metabolic data acquisition. Results. The mean CSF PO2 readings of 41 mm Hg (5.5 kPa) at baseline decreased within 3 minutes to 5 mm Hg (0.7 kPa) during AXC (P