RESUMEN
The problem of haemostasis in cardiovascular surgery is of current concern. Recent trends are towards increased use of topical haemostatic agents. Tachocomb has been used for more than 30 years in abdominal surgery and oncology. The purpose of the present publication is to analyse the literature data and formulate the indications for the use of Tachocomb in cardiovascular surgery. Multicenter randomized and local studies have demonstrated efficacy of Tachocomb in treatment of surgical haemorrhage in operations on the heart, thoracic aorta, carotid arteries and lower-limb arteries, resulting in significantly decreased time to achieve haemostasis, decreased volume of blood loss and haemotrasfusion, as well as reduced frequency of complications. Also shown was economic efficacy, including a shortened length of patients' hospital stay. This is followed by describing a wide spectrum of examples of alternative use of Tachocomb, including its use for seamless closure of defects of cardiac chamber walls, aero- and lymphostasis, prevention of formation of commissures. Convincing experimental and clinical results make it possible to formulate a series of indications for the use of Tachocomb in cardiovascular surgery.
Asunto(s)
Procedimientos Quirúrgicos Cardiovasculares , Hemostáticos , Trombina , Pérdida de Sangre Quirúrgica , Hemostasis , Hemostasis Quirúrgica , Hemostáticos/uso terapéutico , HumanosRESUMEN
The frequency of use of assist blood device as the "bridge" to the heart transplantation increased in last years. An assessment of results of first 7 implantations of assist circulation device using biventricular type "Excor" was made. The implantations were performed in Federal Almazov centre of the heart, blood and endocrinology. An observation period after implantation was since 11 till 301 days. The heart transplantation of 4 patients was carried out in different terms after implantation. One of the patients passed away on the fifth day due to the pulmonary embolism. Another patient died on the eleventh day after the implantation because of multiple organ failure against the background of severe chronic cardiac failure. The waiting list of heart transplantation includes 2 patients.
Asunto(s)
Circulación Asistida , Insuficiencia Cardíaca , Trasplante de Corazón/métodos , Corazón Auxiliar , Adolescente , Adulto , Circulación Asistida/instrumentación , Circulación Asistida/métodos , Diseño de Equipo , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/cirugía , Humanos , Inmunosupresores/uso terapéutico , Masculino , Periodo Posoperatorio , Cuidados Preoperatorios/métodos , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Resultado del Tratamiento , Listas de EsperaRESUMEN
At the present time heart transplantation is considered to be the operation of choice in treatment of patients with terminal stage of chronic heart failure. Results of the first 5 heart transplantations made in the Federal Center of the heart, blood and endocrinology named after V. A. Almazov are assessed. There were no perioperational lethality and complications at the hospital stage. An analysis of the long-term results has shown effectiveness of heart transplantations in treatment of severe heart pathology.
Asunto(s)
Rechazo de Injerto , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/métodos , Monitoreo Fisiológico/métodos , Atención Perioperativa/métodos , Recolección de Tejidos y Órganos/métodos , Adulto , Biopsia , Enfermedad Crónica , Rechazo de Injerto/inmunología , Rechazo de Injerto/prevención & control , Insuficiencia Cardíaca/patología , Insuficiencia Cardíaca/fisiopatología , Trasplante de Corazón/inmunología , Trasplante de Corazón/mortalidad , Trasplante de Corazón/patología , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/normas , Atención Perioperativa/normas , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/prevención & control , Índice de Severidad de la Enfermedad , Recolección de Tejidos y Órganos/normas , Resultado del TratamientoRESUMEN
The authors discuss results of more than 300 operations of the aorto-coronary bypass using the radial artery as a shunt. An analysis of the initial state of the patients, the intraoperative, early postoperative and intrahospital periods was made. Special attention was given to specific features of the isolating and using the radial artery grafts. Specific complications resulting from the application of them were analyzed and recommendations are given for prophylactics of such complications. The experiences with using the radial arteries allow to recommend it in revascularization of the myocardium. It is one of the ways of improving immediate and long-term results of operations on patients with ischemic heart disease.
Asunto(s)
Puente de Arteria Coronaria/métodos , Arteria Radial/trasplante , Adulto , Anciano , Puente de Arteria Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/cirugía , Complicaciones Posoperatorias , Factores de TiempoRESUMEN
The authors describe a technique of the isolation, preparation and use of the radial artery for the aortocoronary shunting for ischemic heart disease. The method is anatomically valid and approbated in 300 operations on the open heart. Safety and efficiency of using the radial artery is due to its not traumatic isolation, original preparing for shunting and medicamental prevention of its spasm.