Manual of Cardiac Surgery by Bradley J. Harlan MD, Albert Starr MD, Fredic M. Harwin BFA,

By Bradley J. Harlan MD, Albert Starr MD, Fredic M. Harwin BFA, MS, Alain Carpentier MD (auth.)

Originally released in 1980-1981 as a two-volume set, the Manual of Cardiac Surgery has been thoroughly revised and now contains new full-color illustrations in one handy quantity. This re-creation continues the excessive criteria verified within the first version: insightful descriptions of varied cardiac surgeries illuminated by means of transparent, fabulous illustrations.

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Refined techniques of cardiopulmonary bypass and improved oxygenators and other devices have markedly diminished the incidence of organ failure in the pulmonary, renal, gastrointestinal, and neurologic systems. Depressed postoperative myocardial performance has been decreased by the many advances in the operative management of the myocardium or the technique of myocardial preservation. This chapter analyzes the methods of operative myocardial preservation that have been used: (1) coronary perfusion, (2) ischemic arrest, normothermic and modified by topical hypothermia, and (3) cardioplegic arrest.

No instance of stone heart occurred with this method. They subsequently adopted cold cardioplegic arrest. Experimental Background A broad experimental background contributes to our knowledge of normothermic ischemia. Experiments have been conducted by surgeons interested in ischemia as it relates to the conduct and success of cardiac surgery, cardiologists studying acute myocardial infarction, and cellular pathologists seeking to define the subcellular pathophysiology of ischemia and the mechanisms of cell death.

Swain48 has shown, in studies on sheep, that flow rates as low as 10 ml/kg/min preserve brain high-energy phosphates and intracellular pH. 25 Llmin/m2 the brain remains well perfused and brain oxygen consumption is maintained. We use circulatory arrest only for short periods of less than 15 minutes when absolutely necessary for a completely dry operative field. Most repairs of congenital heart disease are possible without the use of any periods of circulatory arrest. The prime for infants is shown in Table 5-2.

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