Field Of Cardiovascular Surgery Research Articles

Cardiovascular surgery for realization of regenerative medicine

Regenerative medicine is emerging as a new approach to the treatment of severe cardiovascular diseases that are resistant to conventional therapies. Although the type of cell transplanted (e.g., pluripotent stem cells, bone marrow-derived stem cells, skeletal myoblasts, or cardiac stem cells) influences the outcome of stem cell transplantation, the method of transplantation is also important, as the efficiency of engraftment after simple needle injection is poor. Scaffold-free cell sheet transplantation technology is one of the most promising methods in this regard. Although the results of clinical trials of stem cell therapy have been marginal to date, further elucidation of the actual mechanisms of cardiac repair following cell therapy would enhance the potential for full-scale implementation of stem cell therapy. In addition to stem cell therapy, the field of cardiovascular regenerative medicine includes interspecific chimera technology, drug delivery systems using biodegradable materials, and gene therapy. Integration of these new modalities with conventional therapies will be important to realize the goal of cardiovascular regenerative medicine tailored to the condition of each individual patient. Cardiovascular surgery would be an excellent means of carrying out this strategy and could potentially resolve the health problems of the increasing number of advanced cardiovascular patients. Herein, we review the recent basic and clinical research associated with the realization of regenerative medicine in the field of cardiovascular surgery.

Portal Vein Anastomosis with Parachute Method in Hepatectomy and Pancreatectomy

In advanced cancers of hepatobiliary and pancreatic lesions, major vascular resection and reconstruction are necessary to accomplish curative resection. Stenosis of vascular anastomosis is a concern in case of portal or superior mesenteric venous anastomosis with different vascular calibers. We attempted to apply parachute anastomosis in such a situation, which has often been used in the field of cardiovascular surgery. We applied this procedure in 4 cases of two hepatectomies in intrahepatic cholangiocarcinomas and two pancreatectomies in pancreatic carcinomas, in which combined vascular resection was necessary. After anastomosis, the orifice of anastomotic veins was well matched and did not show stenosis or poor blood flow on ultrasonographic examination. Parachute anastomosis in the portal or superior mesenteric vein is a useful procedure to prevent vascular stenosis, particularly in case of anastomosis with different calibers.

Clinical application of laser treatment for cardiovascular surgery.

Recently, several kinds of lasers have been widely employed in the field of medicine and surgery. However, laser applications are very rare in the field of cardiovascular surgery throughout the world. So, we have experimentally tried to use lasers in the field of cardiovascular surgery. There were three categories: 1) Transmyocardial laser revascularization (TMLR), 2) Laser vascular anastomosis, and 3) Laser angioplasty in the peripheral arterial diseases. By the way, surgery for ischemic heart disease has been widely performed in Japan. Especially coronary artery bypass grafting (CABG) for these patients has been done as a popular surgical method. Among these patients there are a few cases for whom CABG and percutaneous coronary intervention (PCI) could not be carried out, because of diffuse stenosis and small caliber of coronary arteries. Materials and methods of TMLR: A new method of tranasmyocardial revascularization by CO2 laser (output 100 W, irradiation time 0.2 sec) was experimentally performed to save severely ill patients. In this study, a feasibility of transmyocardial laser revascularization from left ventricular cavity through artificially created channels by laser was precisely evaluated. In trials on dogs laser holes 0.2mm in diameter have been shown microscopically to be patent even 3 years after their creation, thus this procedure could be used as a new method of transmyocardial laser revascularization. Clinical application of TMLR: Subsequently, transmyocardial laser revascularization was employed in a 55-year-old male patient with severe angina pectoris who had undergone pericardiectomy 7 years before. He was completely recovered from severe chest pain. Conclusions of TMLR: This patient was the first successful case in the world with TMLR alone. This method might be done for the patients who percutaneous coronary intervention and coronary artery bypass grafting could be carried out. Laser vascular anastomosis: At present time, in vascular surgery there are some problems to keep long-term patency after anastomosis of the conventional suture method, especially for small-caliber vessels. Materials and methods of Laser vascular anastomosis: From these standpoints, a low energy CO2 laser was employed experimentally in vascular anastomosis for small-caliber vessels. Resullts of Laser vascular anastomosis: From preliminary experiments it could be concluded that the optimal laser output was 20-40 mW and irradiation time was 6-12 sec/mm for vascular anastomosis of small-caliber vessels in the extremities. And then, histologic findings and intensity of the laser anastomotic sites were investigated thereafter. Subseqently, good enough intensity and good healing of laser anastomotic sites as well as the conventional suture method could be observed. There were no statistic differences between laser and suture methods. A feasibility of laser anastomosis could be considered and clinical application could be recognized. Clinical applications of Laser vascular anastomosis: On February 21, 1985, arterio-venous laser anastomosis for the patient with renal failure was smoothly done and she could accept hemodialysis. Conclusions of Laser vascular anastomosis: This patient was the first clinical successful case in the world. Thereafter, Laser vascular anastomosis were in 111 patients with intermittent claudication, refractory crural ulcer, and coronary disorders. Thereafter, they are going well. Laser angioplasty: Laser angioplasty for peripheral arterial diseases. There are many methods to treat peripheral arterial diseases such as balloon method, atherectomy, laser technique and stenting graft in the field of endovascular treatment. Recent years, minimal invasive treatment should be employed even in the surgical treatment. However, there are different images between these methods. Materials and methods of Laser angioplasty: We have chosen to use laser for endovascular treatment for peripheral arterial diseases. We have tried to check between laser energy and vessel wall. Results of Laser angioplasty: Subsequently, it could be concluded that optimal conditions for laser angioplasty were 6 W in output and irradiation time was 5 sec. And with another method of feedback control system, temperature of metal tip probe was 200°C and irradiation time was 5 sec for each shot. And histological study and feasibility of angioscopic guidance could be done and clinical application was started. Until now, 115 patients were successfully treated with their life longevity. Conclusions of Laser angioplasty: Thus, laser applications were useful methods to treat a lot of patients with some ischemic problems.

Fifty years of medicine: The surgical heritage of a pioneer – Paul Cartier MD (1919–2008)

Department of Cardiovascular Surgery, Montreal Heart Institute, University of Montreal, Montreal, Quebec Correspondence: Dr Raymond Cartier, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8. Telephone 514-376-3330 ext 3715, fax 514-376-1355, e-mail rc2910@aol.com For more than 45 years, Dr Paul Cartier was active in the field of cardiovascular surgery at the Hotel-Dieu Hospital of Montreal, Quebec. During these years, he witnessed and took part in many premieres in cardiovascular surgery, which made him a privileged actor in this field. The following is a brief review of his long career. When Dr Paul Cartier finished medical school in 1947, medicine had a long way to go. Abdominal aortic aneurysms were treated by proximal and distal ligation, and Dr Clarence Crafoord had just performed the first surgical correction of a congenital aortic coarctation. As well, Dr Charles P Bailey had not yet rehabilitated ‘closed’ mitral commissurotomy, synthetic vascular grafts were science fiction, peripheral vascular surgery was more synonymous with amputation, and thoracic surgery was just emerging. After obtaining his medical degree at the University of Montreal (Montreal), Dr Cartier initiated his surgical residency at the same university with specific orientation in thoracic surgery. In 1951/1952, he left for St Louis, Missouri (USA), where he was appointed as a resident in thoracic surgery under Dr Evarts A Graham (who performed the first pneumonectomy for lung cancer) and Dr T Burford. Then, he moved to Case Western Reserve University in Cleveland, Ohio (USA), under the supervision of Dr Claude S Beck. Although Beck was trained as a neurosurgeon, he had a great deal of interest in congenital and acquired heart disease. During those days, he was busy mastering his astonishing ‘Beck II’ operation, which consisted of direct anastomosis between the coronary sinus and the descending aorta for the purpose of increasing retrograde coronary blood flow to the ischemic heart. In 1952/1953, Dr Cartier moved again, but this time to France − to Broussais Hospital (Paris) − to work with Dr Charles Dubost who, in 1953, performed the first aorto-iliac homograft bypass for an infrarenal aortic aneurysm. Under Dubost’s supervision, he learned the clinical potential and limitations of closed heart mitral commissurotomy (through a left thoracotomy on a beating heart). During the same journey, he also spent time with Dr Marceau Servel, then staff surgeon at St Joseph Hospital (France), whose major interests were in vascular, lymphatic and cardiac surgery. On his way home, he stopped in London, Great Britain, to observe Dr Russell Brock, a pioneer in pediatric cardiac surgery, performing (with the instrument named after him) congenital pulmonary stenosis corrections on the beating heart. Finally, in 1953, Dr Cartier was appointed the position of thoracic surgeon at Hotel-Dieu Hospital of Montreal. His long-lived career was then launched on three different fronts: pediatric cardiac surgery, adult thoracic and cardiac surgery, and peripheral vascular surgery. We will review these three aspects of his outstanding career and point out the distinguishing features that made Dr Paul Cartier a pioneer in the field of cardiovascular surgery.

Seal properties of TachoSil(R): in vitro hemodynamic measurements

Fibrin glue products and collagen patches are frequently used as a sealing product, preventing surgical side bleedings. This is especially true in the field of cardiovascular surgery, where increasing numbers of patients are being operated with antiplatelet and anticoagulation therapy. The aim of this report was, in an in vitro hemodynamic setting, to examine the sealant properties of the TachoSil (Nycomed Pharma, Linz, Austria) patch. Burst pressure and normal force of 15 TachoSil sealed defects were measured. This was determined in a closed hydraulic system. Mean burst pressure load for a 5-mm defect was 69+/-11.4 mmHg; for a 7-mm defect was 63+/-16 mmHg; and, 62+/-16 mmHg for the defect with a diameter of 10 mm (P>0.05). The mean calculated normal force was as follows: 0.91+/-0.15 N for the 5 mm defect, 6.5+/-1.6 N for the 7 mm, and 8.1+/-0.75 N for the 10 mm defect. The TachoSil patch has the capability to seal small defects. However, at the larger defects the seal character was significantly reduced. These results suggest that the device may be a good alternative for hemostasis for small defects. The capacity to curtail or stop hemorrhage at the larger defects is unlikely.

2P1-B16 医療画像と経験則に基づく大動脈瘤診断支援システム

Recently computer-aided diagnosis systems (CAD) have been used in a variety of medical fields. Even in the field of cardiovascular surgery, CAD system is effectively used in patient diagnosis. But for the patients suffering from aortic aneurysm, conventional CAD systems cannot provide adequate information cardiovascular surgeons, where it is difficult to estimate the statement of aortic aneurysm during operation even by using the latest CAD system and medical image. Because the posture of patient changes between in the scene of medical imaging room and in the operation theatre, the shape of aneurysm and/or aortic vessel issues deforms from 3-D image for diagnosis. And then we aim to make a new CAD system that can estimate the condition of aneurysm interactively deforms according to the posture of patient and the view point of surgeon. For the purpose of our study, this paper firstly introduces how to detect the volume data of aneurysm and/or aortic vessel issue from patient's computed tomography angiography (CTA) that is commonly used for diagnosing a patient with aortic aneurysm. Fuzzy based region growing method and various experimental results will be shown in this paper.

Novel Anti-Adhesive Pericardial Substitute for Multistage Cardiac Surgery

Dense adhesions in the retrosternal space make reoperations difficult in the field of cardiovascular surgery. Several substitutes for pericardium have been employed to prevent dense adhesions forming, but they have been unsatisfactory because of peel formation, calcification, and infection. To overcome these drawbacks, a novel biodegradable pericardial substitute was developed from gelatin obtained from specific-pathogen-free porcine skin and a bioabsorbable polyester mesh, which persists while the adhesion reaction occurs in the retrosternal space. A clinical pilot study of this gelatin sheet was carried out in patients scheduled to receive multistage cardiac surgery. From February 2003 to July 2004, the material was used in 5 patients aged 0.4 to 3.0 years. There were no complications related to the gelatin sheet. The effectiveness of the material was evaluated when the sternum was reopened 1.4 +/- 0.5 years later. It took 24.5 +/- 6.0 min for the resternotomy, and all surgeons who participated in the surgery rated the effectiveness of the gelatin sheet as "good". This anti-adhesive sheet prevented dense adhesions, suggesting that this material may be useful as a pericardial substitute for multistage pediatric cardiac surgery.

Fibrin glue in coronary surgery

Adjunctive application of fibrin sealant in coronary artery bypass graft (CABG) surgery has been established over years for various indications, such as bleeding from distal or proximal anastomoses, fixation of the bypass course, diffuse epicardial bleeding, sealing of the IMA-bed, and intrasternal application for profound bone marrow bleeding. Moreover, fibrin sealant has been used in surgical fields with diffuse bleeding, e.g. in cardiac re-operations, for pre-clotting of Dacron prostheses, in thoracic organ transplantation, aortic aneurysm surgery, and in complex congenital heart surgery. The publications of Gorler et al. (1) and Lamm et al. (2) from distinguished heart centers are presenting data showing an unfavorable risk—benefit relation based on safety issues after the application of Tissucol W Duo S in CABG surgery. Both papers assess a significantly higher 30-day mortality in patients with intraoperative application of fibrin glue proven by a retrospective comparative analysis including more than 2000 patients each. According to the results of both retrospective analyses mortality in the fibrin glue group was about 7% and thus significantly higher compared the control patients with about 3%. Supported by profound statistical analysis fibrin glue had the most confounding effect on mortality in covariate analysis. In concordance with experimental data it has beenspeculated thatfibrin glue may induce transmural coagulation and thrombosis of venous grafts. The results presented in both studies, which were conducted independently, are considered to be consistent when analyzing risk factors, precondition of the patients and outcome. It became evident that pre-operative risk factors (according to the adapted EUROSCORE used in Hannover) cannot explain the increased mortality rate of the Tissucol group. Furthermore, surgical technique, cardiopulmonary bypass time and aortic cross clamp time did not significantly differ between those patients who received Tissucol during surgery compared to those who did not. However, considering the retrospective character of data acquisition the conclusiveness of these investigations is reduced. Specific information regarding the indication for the application offibrin glue is lacking.In addition,important background information concerning the hemostatic condition of the patient at the time before, during and after CABG was not routinely investigated and therefore a comprehensive evaluation of the hemostaseological risk factors was not available. Use of fibrin glue can be also a marker for problem cases. At least in our setting, we do not use fibrin glue in routine fashion. However, fibrin glue is used both preventively and correctively for patients with particularly fragile tissues, for patients at risk for bleeding, for patients with graft kinking, etc. Hence, the fact that fibrin glue is used, tells us, that there were some problems. In consideration of the presented results and the lack of detailed information on the indication and usage of fibrin sealant in both retrospective studies, it seems necessary to perform a prospective analysis, which may allow a more reliable evaluation of the risk of the use of fibrin glue in CABG surgery. Furthermore, any study in this respect needs to address not only the indication for fibrin glue application but also the investigation on those parameters in the coagulation system, which are state of the art to elucidate the hemostaseological pathomechanism of this severe complica- tion described in this situation. After discussing the results of both studies experts in the field of cardiovascular surgery and hemostaseology have concluded that the way of application of fibrin glue may have a considerable impact on the increased mortality of those patients. They emphasized the need of further investigation and, moreover, a clarification of the description of the preparation and use of fibrin sealant has been requested. However, until there are no more detailed data available, every surgeon has to define an individual strategy for the application of fibrin glue in coronary surgery based on the existing studies from the Hannover and Munich group.

Endovascular Repair of Traumatic Thoracic Aortic Disruption

In a patient with multiple trauma, blunt thoracic trauma with concomitant aortic disruption is often eminently lethal, ranking second to head injury as the most common cause of trauma-related deaths. Open surgical repair of the aortic lesion has morbidity and mortality rates that are among the highest in the field of cardiovascular surgery. Results with thoracic endovascular aortic repair for traumatic aortic disruption are promising. The facility requirements, technique, and early results of thoracic endovascular aortic repair for the treatment of this difficult aortic injury are presented.

New Techniques and Innovative Technology: An Integrated Element of Our Cardiovascular and Thoracic Specialty

Ten years ago if you had a new idea in the field of cardio-vascular surgery and it did not fit the way the old guards were thinking, you would have had a hard time getting it presented at any of the existing thoracic surgical meetings. If a new idea was presented, it would be the odd thing, and definitely you would not see innovations in cardiac devices and technology occupying a visible portion of the event. This scenario was the premise for creating Cardiac Techniques and Technology (CTT), the meeting.

Re-evaluation of the reliability of cytochrome oxidase--signal study of cardiopulmonary bypass.

The monitoring of brain oxygen status using near-infrared spectroscopy (NIRS) has recently been applied to clinical practice in the field of cardiovascular surgery. Published studies have indicated that NIRS could be used as a continuous and noninvasive way of observing changes in the cerebral oxygenation state during hypoxia and ischemia, since changes occur in optical properties under these conditions. However, the interpretation of NIRS data, especially the cytochrome oxidase (cyt. ox.) signal, remains controversial. A possible source of error that might interfere with the accurate measurement of the redox state of cyt. ox. derives from an overlapping of the absorption spectra for hemoglobin and cyt. ox. in the near-infrared region, with the absorption coefficient for hemoglobin being an order of magnitude greater than that for cyt. ox.. Recently, it was reported that the cyt. ox. signal measured by near-infrared spectroscopy (NIRS) is highly contaminated with the hemoglobin signal [1]. However, the cyt. ox. signal measured by NIRS would be expected to be strongly dependent on the algorithm employed. We have developed a new approach to the measurement of the redox state of cyt. ox. in the brain involving the use of a new algorithm [2], which has already been employed in clinical medicine [3, 4]. Therefore, in this paper we looked for evidence of cross-talk between the cytochrome and hemoglobin (Hb) signals when our new algorithm was used under cardiopulmonary bypass (CPB) in a dog model. Furthermore, we retrospectively studied the relationship between data obtained concerning the redox behavior of cyt. ox. during surgery (again using our new algorithm) and neurological prognosis in 105 patients.

Historical Profiles of Mayo Clinic

Dr Giancarlo Rastelli’s life was shaped by a deep desire to do scientific research. Despite a premature death in 1970 at the age of 36, he was successful in his mission. More than 3 decades later, cardiac surgeons throughout the world still save lives using the Rastelli procedure, a surgical innovation for the treatment of congenital heart disease. It is also noteworthy that this and other developments in cardiovascular research were achieved while Dr Rastelli battled complications of Hodgkin disease in the last 5 years of his life. Dr Rastelli received his medical degree from the University of Parma in Italy. In 1960, he received a NATO scholarship for international study in the newly developing field of cardiovascular surgery. He chose to study at the Mayo Clinic under Dr John W. Kirklin who had performed many of the world’s first successful open heart operations to repair congenital heart abnormalities. Complex congenital heart diseases were almost always fatal when Dr Rastelli began his studies, but his research soon led to greatly improved outcomes. The American Medical Association awarded the Gold Medal to Dr Rastelli for his contributions to the treatment of congenital heart diseases for 2 consecutive years. The first was for a precise anatomical classification of atrioventricular canal defects that facilitated the development of new surgical strategies. The techniques were quickly adopted at the Mayo Clinic by Dr Kirklin and Dr Dwight McGoon and resulted in a dramatic reduction of surgical mortality rates—from 60% to 20%. The second AMA Gold Medal was awarded to Dr Rastelli for developing extracardiac outflow conduits used for surgical correction of truncus arteriosus. Subsequent studies of this concept led in 1967 to the development of the Rastelli procedure, a surgical technique to correct transposition of the great vessels associated with ventricular septal defect and pulmonary stenosis. In 1968, he was appointed head of cardiovascular surgical research at the Mayo Clinic, an unusual position for such a young investigator. He had left his native Parma because he wanted to pursue a high level of research. Rastelli’s emigration to the United States began an exchange that ultimately worked to Italy’s benefit. In the intervening years, hundreds of operations have been performed on Italian children at the Mayo Clinic. And many Italian physicians have followed in his footsteps by completing their postgraduate training at the Mayo Clinic. Most of them have returned to Italy to help raise the level of medicine practiced there and to expand intercultural links. His daughter Antonella, who was only 4 years old when her father died, graduated from medical school in Verona, Italy, and now works at Washington University, St Louis, Mo. Dr Rastelli was both scientist and humanist—an exceptional physician with a natural curiosity who displayed enthusiasm, sensitivity, compassion, intelligence, courage, and respect in dealing with personal, collegial, and patient relationships. His classifications and the procedure that was named after him have given the gift of life to numerous children all over the world.

Ischemic preconditioning improves the survival of skin and myocutaneous flaps in a rat model.

Inadequate blood supply of pedicle flaps results in partial necrosis, and prolonged ischemia during free-tissue transfer can result in partial or complete flap necrosis. Recent research in the field of cardiovascular surgery has shown that ischemic preconditioning (repeated brief episodes of coronary artery occlusion followed by reperfusion) improves myocardial muscle survival when the heart is subsequently subjected to prolonged ischemia. Preconditioning of skin or myocutaneous flaps as either pedicle or free flap models has never been studied. The goal of this investigation was to measure the effect of ischemic preconditioning on myocutaneous and skin flap survival areas and total necrosis rates after variable periods of global ischemia. In 220 rats, 100 transverse rectus abdominis myocutaneous flaps and 120 dorsal cutaneous flaps were randomized into treatment and control groups. The treatment flaps underwent preconditioning by three cycles of 10 minutes of pedicle clamping followed by 10 minutes of reperfusion for a total preconditioning period of 1 hour. The control flaps were perfused without clamping for 1 hour. Both control and treatment flaps then underwent global ischemia for 0, 2, 4, 6, 10, or 14 hours by pedicle clamping. Flap survival area was measured on the fifth postoperative day. Statistical analysis was performed with analysis of variance, student's t tests, and probit analysis. Preconditioning improved survival areas of pedicle myocutaneous flaps (0-hour group) from 47 +/- 16 percent (mean percent area surviving +/- SD) to 63 +/- 5 percent. This difference was statistically significant (t test, p < 0.04). There was no statistically significant improvement in pedicle skin flap survival. For free flap models (flaps undergoing global ischemia), preconditioning increased the survival areas of skin and myocutaneous flaps (analysis of variance, p < 10(-5)). For the skin flap model, statistical significance of the survival area difference was reached at 6, 10, and 14 hours of ischemia (t test, p < 10(-4)). The magnitude of this effect was higher in the myocutaneous flap model and reached statistical significance at 2, 4, 6, and 10 hours of ischemia (p < 10(-3)). Preconditioned flap survival areas were increased by two to five times that of non-preconditioned flaps at these ischemia times. Preconditioning lowered total necrosis rates at all ischemia times for both flap models. The critical ischemia time when 50 percent of skin flaps became totally necrotic (CIT50) improved from 6.9 to 12.4 hours by preconditioning. Similarly, preconditioning improved the CIT50 of myocutaneous flaps from 3.6 to 9.2 hours. For the first time, statistically significant improvements of partial necrosis areas and total necrosis rates have been demonstrated through intraoperative ischemic preconditioning of skin and myocutaneous flaps. In clinical practice, application of this technique may lead to improved survival during pedicled or free transfer of myocutaneous flaps and free transfer of skin flaps.

Biomaterials and cardiovascular devices.

In the field of cardiovascular surgery there is presently a lack of biomaterials possessing essential characteristics of the native tissue or organ which is to be replaced. This paper describes various biomaterials that have been introduced into the circulatory system and the complex reactions that subsequently occur. The risk of infection is also discussed as well as prevention and treatment regimes that can be used. Examples of future biomaterial development are outlined in an attempt to achieve biocompatibility.

Advanced Laser Therapy. Modern Trends of Laser Application for Cardiovascular Diseases.

Since 1980's we have investigated laser works concerning to 3 fields of cardiovascular surgery. These works are as follows. That is, (1) Transmyocardial revascularization, (2) Laser vascular anastomosis, (3) Laser angioplasty. (1) Transmyocardial revascularization (TMR): This method is applied only for the patient for whom coronary artery bypass grafting (CABG) can not be carried out, because of small and diffuse stenoses of the coronary arteries. By this procedure arterial blood from the left ventricular cavity is supplied into the ischemic myocardium through the newly created myocardial channel by CO2 laser (output more than 80W, irradiation time 0.2 sec ). The new channel in the myocardium was opened for 3 years. And then, clinical application was done in November 12, 1985. This is a first clinical successful case in Japan. (2) Laser vascular anastomosis: Low power CO2 laser was used for this study. Optimal conditions were 20-40mW in output and 6-12 sec/mm in irradiation. First clinical application in the world was successfully performed in January 21, 1985. (3) Laser angioplasty: Based on excellent experimental results clinical application by Argon laser was done for 98 patients with intermittent claudication and stenosis more than 75% angiographycally. Cumulative patency rate in the follow up to 96 months was 87% in the stenotic lesions and 71% in the occlusive lesions.

心臓血管とレーザー

Lasers have been recently utilized in the field of cardiovascular surgery through the world.Most of them are fundamental works concerning laser angioplasty.Since 1980 we have started three scientific studies as follows. That is, 1) myocardial revascularization by laser, 2) vascular anastomosis, 3) laser angioplasty.On the basis of excellent experimental studies in these fields. lasers were clinically applied with safety.The numbers of the patients for whom lasers were utilized reached to 185 cases.They consisted of one case with myocardial revascularization, 110 cases with laser vascular anastomosis including coronary artery bypass grafting of 13 cases and 74 cases with laser angioplasty including intraoperative coronary angioplasty of 10 cases.Twenty-four cases of them received laser applications, because of angina pectoris and myocardial infarction.Characteristics of lasers were clearly recognized even in our clinical experience. Indications, techniques and long-term results of laser applications in cardiovascular surgery were reported in detail.

Fibrin glue

Fibrin glue is a topical biological adhesive, the effect of which imitates the final stages of coagulation. The glue consists of a solution of concentrated human fibrinogen which is activated by the addition of bovine thrombin and calcium chloride. The resultant clot aids haemostasis and tissue sealing and is completely absorbed during wound healing without foreign body reaction or extensive fibrosis. The fibrinogen component of fibrin glue can be produced from fresh frozen plasma obtained from single unit donations thereby reducing the risks of transfusion transmitted infections encountered by exposure to pools from large numbers of donors. Methods involving precipitation of fibrinogen by cryoprecipitation, polyethylene glycol or ammonium sulphate have been described and evaluated. The risk of transmission of infection can be further reduced by using plasma from ‘accredited donors’ who are plasma donors regularly tested for ALT and markers of viral infection or by use of fibrinogen prepared in advance of surgery from autologous blood. The second component, a mixture of thrombin and CaCl 2, is quantitatively and qualitatively well defined and commercially available (Armour Pharmaceutical Co., Thrombinar (bovine thrombin)). Thrombin is applied to the operation site simultaneously and in equal volume to the fibrinogen but from a separate syringe. In the UK a commercial heat treated fibrin glue prepared from pooled plasma is available on a doctor/named patient basis (Tisseel, Immuno, Vienna). The haemostatic and adhesive properties of fibrin glue can be employed in virtually every surgical speciality. 1 The usefulness of the glue is particularly well documented in the fields of cardiovascular surgery, ENT and neurosurgery. Although widely used, fibrin glue is not a haemostatic panacea and its effectiveness relies on careful surgical technique.

Surgery of the Chest

The seven-year cycle of new editions of this major cardiovascular work— 1962, 1969, 1976, and 1983—is continued with the fifth edition. Aside from its cover change from blue to green, this two-volume set looks much like the previous one, but, sadly to this observer, the name Gibbon has been eliminated from the cover. This distinguished pioneer in the field of cardiovascular surgery is found only in the Library of Congress Cataloging-in-Publication Data on the back of the title page. A new edition of a standard work can be evaluated in two ways: comparing it with its previous edition or noting how it stacks up against other volumes in the field. Comparison with its earlier version is indeed very positive. This one has had more than minor updating revisions. The two volumes have been increased by 342 pages to 1978+ pages without increasing their thickness. The 58 chapters, an increase of

心臓血管外科領域におけるレーザー応用の評価 臨床例１１０例からの検討

心臓血管外科領域におけるレーザー応用の評価 臨床例１１０例からの検討

心臓血管外科へのレーザー応用-臨床98症例を中心として

心臓血管外科へのレーザー応用-臨床98症例を中心として