Aim. We sought to evaluate our experience with endoscopic radial artery harvesting for coronary artery bypass grafting (CABG). Methods. From October 2005 to June 2010, 50 patients who underwent endoscopic radial artery harvesting for an elective CABG were prospectively assessed for harvesting characteristics, complications, postoperative and mid-term outcomes.Results. There were 34 (68%) males and 16 (32%) females, average age 60.8±9.2 years. All but two RA grafts (96%) were successfully harvested endoscopically. Mean harvesting time was 46.2±9.3 min and mean length of harvested grafts was 23.4±2.2 cm. In the post-operative period there were no wound-healing complications; residual forearm edema was recorded in 6 patients (12%) and peripheral neuropathy in 4 patients (8%). At 3 months after the surgery, peripheral neuropathy and residual edema persisted in 2 patients (4%). A significant drop of overall harvesting time (56.2± 18.6 vs. 38.6±8.6 min, P<0.05) and forearm ischemia time (41.8±12.7 vs. 24.2±3.2 min, P<0.01) was found between first and last ten cases in the group. Conclusion. Endoscopic radial artery harvesting was associated with low risk of post-harvesting complications and most of these disappeared within a 3 months follow-up. However, there was a significant learning curve.
A 46-year-old woman was referred to our center with a diagnosis of pulmonary artery dissection, incipient pericardial tamponade, and massive left pleural effusion, which was based on non-gated multi-detector computed tomography (Figure 1) and transthoracic echocardiography, performed at a primary care hospital. Because magnetic resonance imaging and transthoracic echocardiography were not feasible due to the patient's morbid obesity (140 kg), electrocardiogram-gated multi-detector computed tomography was carried out on account of the uncommonness of this diagnosis, prior to considering surgical exploration. This ruled out dissection of the main pulmonary artery trunk (Figure 2). Subsequently, malignant mesothelioma cells were obtained from hemorrhagic pericardial and pleural fluid, and the patient was referred for chemotherapy.
Cíl: Analýza výsledků a vývoje zkušenosti s endoskopickým odběrem vena saphena magna pro chirurgickou revaskularizaci myokardu. Metoda: Do prospektivního sledování bylo zahrnuto celkem 400 elektivních nemocn ých, kteří podstoupili endoskopický odběr vena saphena magna v období od září 2005 do září 2010. Hodnoceny byly demografi cké, perioperační a odběrové charakteristiky a četnost komplikací spojených s endoskopickým odběrem vena saphena magna v krátkodobém a střednědobém sledování. Výsledky odběru byly vztaženy k vývoji zkušeností s technikou odběru a byla doplněna mnohorozměrná analýza vlivu riziko vých faktorů poruch hojení na četnost komplikací endoskopického odběru vena saphena magna.
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