共查询到20条相似文献,搜索用时 15 毫秒
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LEVI WATKINS JR. M.D. THOMAS GUARNIERI M.D. LAWRENCE S.C. GRIFFITH M.D. JOSEPH H. LEVINE M.D. ENRICO P. VELTRI M.D. JUAN M. JUANTEGUY M.D. MORTON MOWER M.D. M. MIROWSKI M.D. 《Journal of cardiac surgery》1988,3(1):1-7
Since February 1980 the automatic implantable cardioverter defibrillator has been implanted in over 1,500 patients. Sudden death rates have been reduced to 2%-4% annually. This report reviews the implantation techniques, their indications, and our clinical experience in 200 patients. 相似文献
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RICHARD B. SHEPARD M.D. MARSHALL D. GOLDIN M.D. GERALD M. LAWRIE M.B. B.S. LEVI WATKINS M.D. JR.† ROGER A. WINKLE M.D. ‡ MORTON M. MOWER M.D. # RA C. THOMAS R.N. # SEAH NISAM B.S.E.E. # 《Journal of cardiac surgery》1992,7(3):208-224
Surgical approaches for implantation of the automatic cardioverter defibrillator are sternotomy, left thoracotomy, subxiphoid, and subcostal. Although any one of these may be combined with insertion of one or more of the electrodes transvenously, surgical entry into the chest is required for every noninvestigational defibrillator implantation operation. The approaches differ in exposure provided for selecting electrode sites and for handling untoward events, in amount and location of tissue that must be divided or dissected, and in average time required. The operation is an electrical one. Its purpose is to obtain reliable rhythm sensing so that defibrillation or cardioversion shocks will occur only when necessary, and to obtain low enough defibrillation thresholds for shocks of 30 joules or less to have a 10-joule defibrillation safety margin. Many of the patients have had previous cardiac operations. They usually have low or very low ejection fractions. Intraoperative electrophysiological testing with often multiple defibrillation episodes is required. The choice of approach varies with the state of the patient, the institutional experience, and the surgeon. This article describes technique, and the advantages and disadvantages of the four approaches as used by four surgeons in four different institutions. 相似文献
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《The Annals of thoracic surgery》1988,45(3):315-318
To evaluate the effect of repeated induction of ventricular tachycardia or ventricular fibrillation, or both, in patients with poor left ventricular function, we performed intraoperative two-dimensional echocardiography in 6 patients undergoing implantation of the automatic implantable cardioverter/defibrillator. Changes in left ventricular ejection fraction in sinus rhythm were assessed before the first inducible ventricular arrhythmia and after a mean of 6 ± 1.9 (SD) episodes of ventricular tachycardia or ventricular fibrillation. During the procedure no significant change in mean ejection fraction was observed (28 ± 14 versus 27 ± 17%). Only 1 of the 6 patients studied had a change in ejection fraction greater than 3% (a decrease from 20 to 11%). In an overall clinical series of 38 primary implants or generator changes (including electrophysiological testing) in 29 patients, 1 patient recovered after postoperative inotropic support and 1 died of acute postoperative ischemic heart failure. We conclude that ventricular arrhythmias induced during automatic implantable cardioverter/defibrillator implantation have no immediate deleterious effects on ejection fraction in most patients with compromised left ventricular function and without ongoing ischemia. 相似文献
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Sanjay Gupta M.D. Christopher D. Prevel M.D. Kenneth Shaheen M.D. Edwin Wilkens M.D. David J. Smith Jr. M.D. Marvin M. Kirsh M.D. Steven F. Bolling M.D. Riley S. Rees M.D. 《Journal of cardiac surgery》1993,8(6):671-677
A bstract Since 1980, the automatic implantable cardioverter defibrillator (ICD) has evolved as effective therapy for prevention of sudden cardiac death following documented sustained ventricular tachycardia or fibrillation. During a 5-year period, 412 ICD devices were implanted at the University of Michigan Hospitals with a wound complication rate of 4.1%. In this group, there were 13 infections, 3 erosions of the generator pocket, and 1 wound hematoma. Of the 16 patients with infection or erosion, 12 patients were treated with a rectus abdominis muscle flap closure and 4 with ICD generator removal. In 83% (n = 12) of the muscle flap patients, the wound healed uneventfully. Preoperative chest CT scanning was found to be helpful in identifying probable infection of the epicardial leads. In these cases, all hardware had to be removed to achieve resolution of the infection. We concluded that rectus abdominis muscle flaps were helpful in salvaging infected or exposed ICD generators in the absence of infected epicardial leads. 相似文献
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Levi Watkins M. Mirowski Morton M. Mower Philip R. Reid Paul Freund Andra Thomas Myron L. Weisfeldt Vincent L. Gott 《The Annals of thoracic surgery》1982,34(5):515-520
The automatic implantable defibrillator is an electronic device capable of diagnosing and correcting malignant venticular arrhythmias. While major thoracic surgery was required in the original 24 implants, a new technique for implanting the device has been developed. The first subxiphoid implantations have been accomplished with the defibrillatory function successfully tested intraoperatively. The advantages and indications of the subxiphoid technique are reviewed. 相似文献
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Kyriakos Anastasiadis Polychronis Antonitsis Christos Asteriou Helena Argiriadou Apostolos Deliopoulos Dimitrios Konstantinou Vassilios Grosomanidis Paschalis Tossios 《Artificial organs》2017,41(7):628-636
Minimal invasive extracorporeal circulation (MiECC) has initiated important new efforts within science and technology towards a more physiologic perfusion. In this study, we aim to investigate the learning curve of our center regarding MiECC. We studied a series of 150 consecutive patients who underwent elective coronary artery bypass grafting by the same surgical team during the initial phase of MiECC application. Patients were randomly assigned into two groups. Group A (n = 75) included patients operated on MiECC, while group B (n = 75) included patients operated with conventional cardiopulmonary bypass (cCPB). The primary end‐point of the study was to identify whether there is a learning curve when operating on MiECC. The following parameters were unrelated with increasing experience, even though the results favored MiECC use: reduced CPB duration (102.9 ± 25 vs. 122.2 ± 33 min, P <0.001), peak troponin release (0.07 ± 0.02 vs. 0.1 ± 0.04 ng/mL, P < 0.01), peak creatinine levels (0.97 ± 0.24 vs. 1.2 ± 0.3 mg/dL, P < 0.001), duration of mechanical ventilation (14.1 ± 7.2 vs. 36.9 ± 59.8 h, P < 0.01) and ICU stay (2.1 ± 0.7 vs. 4.4 ± 6.4 days, P < 0.01). However, need for intraoperative blood transfusion showed a trend towards a gradual decrease as experience with MiECC system was accumulating (R2 = 0.094, P = 0.007). Subsequently, operational learning applied to postoperative hematocrit and hemoglobin levels (R2 = 0.098, P = 0.006). We identified that advantages of MiECC technology in terms of reduced hemodilution and improved end‐organ protection and clinical outcome are evident from the first patient. Optimal results are obtained with 50 cases; this refers mainly to significant reduction in the need for intraoperative blood transfusion. Teamwork from surgeons, anesthesiologists, and perfusionists is of paramount importance in order to maximize the clinical benefits from this technology. 相似文献
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Mohamed A. Khalil Abdelhay A. Ebade Mohsen S. Abdel Azeem 《Egyptian Journal of Anaesthesia》2013,29(1):41-45
BackgroundInsertion of Internal Cardioverter Defibrillator in high risk cardiac patients can be performed by many anesthetic techniques including local anesthesia with moderate sedation or general anesthesia. Many studies have proved that intravenous paracetamol infusion is effective in reducing narcotic requirements in many surgical procedures.PurposeThe aim of this study was to assess the effect of paracetamol in reducing pain as well as apnea and upper airway obstruction during conscious sedation for Internal Cardioverter Defibrillator placement.Patients and methodsIn this prospective, randomized study, 100 patients undergoing elective transvenous placement of Internal Cardioverter Defibrillator (ICD) were enrolled in this study. Pain, respiratory events as apnea and airway obstruction in patients receiving intravenous paracetamol infusion 1 g over 30 min have been compared with those receiving fentanyl in a total dose of 1.5 μg/kg.ResultsThe incidence of airway obstruction was lower in the paracetamol group than in the fentanyl one (P < 0.05). There was also a significant difference between the two groups as regards arterial carbon dioxide tension (PCO2), which was significantly higher in Group F (48.9 ± 0.63) in comparison to Group P (45.6 ± 0.64) (P < 0.001) as well as the degree of sedation where the sedation score was 2.2 ± 0.3 in group P. Also, the Visual Analog Scale (VAS) was significantly lower in Group P than in Group F (P < 0.05).ConclusionIntravenous paracetamol infusion was effective in reducing pain as well as the incidence of intraoperative respiratory events as upper airway obstruction in high risk cardiac patients undergoing Internal Cardioverter Defibrillator insertion. 相似文献
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目的评估桡骨远端不稳定型骨折微创治疗的手术疗效。方法对64例桡骨远端不稳定型骨折患者进行回顾性研究,在手术后1~3年,测定腕关节的活动范围和影像学指标,对腕关节功能进行Gartland-Werley评分。结果患侧腕关节的背伸和尺偏活动范围显著小于正常腕关节(P〈0.05),掌曲、桡偏、旋前和旋后活动范围与正常腕关节无显著性差异(P〉0.05)。掌倾角显著小于正常腕关节(P〈0.01),桡骨高度和尺偏角无显著性差异(P〉0.05)。Gartland-Werley功能评分优良率为90.6%。结论闭合复位,外固定支架结合经皮克氏针固定能有效治疗桡骨远端不稳定型骨折。 相似文献
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