Complications in Cardiothoracic Surgery E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 976

Veröffentlichungsjahr: 2011

Beschreibung

Written to supplement standard textbooks and operative atlases, this updated reference concentrates on the issue of complication prevention and treatment. By challenging the contributors to address specific issues related to both intraoperative techniques and post-operative care that will reduce the incidence of complications, Drs. Little and Merrill present a book that reinforces the commitment to excellence in cardiothoracic surgery. The book opens with a section on general topics with regard to cardiothoracic surgical complications, including thoracic incisions, postoperative arrhythmias, and myocardial preservation. Then Drs. Little and Merrill draw on their expertise in thoracic and cardiac surgery, respectively. They have assembled a team of experts to address specific diseases encountered and operations performed by cardiac and general thoracic surgeons. With advice developed through years of experience by some of the most respected names in the field, Complications in Cardiothoracic Surgery: Avoidance and Treatment, 2nd Edition makes an ideal introduction for the new trainee and the perfect refresher for the practicing surgeon.

Leseprobe

Contents

List of Contributors

Acknowledgements

Preface

Chapter 1: Preventing Complications: New Frontiers of Safety Science in Cardiothoracic Surgery

Paul N Uhlig, William R Berry, Ellen W Raboin, Jeffrey Brown, Joel T Erskin, Ann Hendrich and Daniel B Raemer

Pausing the action

Back to our story

The system approach to safety and the safety pyramid

The missing term

Two types of problem solving

Reflective practice and organizational learning

Building capacity for reflective practice, organizational learning, and type II problem solving

Role-based differences in perception

The social construction of high reliability teamwork

Evidence supporting these approaches

Better outcomes, hidden in plain sight

What do I do tomorrow?

Chapter 2: Thoracic Incisions

Michael F Reed

Introduction

Thoracotomy incisions

Sternal incisions

Chapter 3: Arrhythmias following Cardiac and Thoracic Operations

Joseph LoCicero, III

Incidence and characteristics of postoperative arrhythmias

Supraventricular arrhythmias

Ventricular arrhythmias

Risk factors

Influence on outcome

Specific arrhythmias and their mechanisms

Antiarrhythmic drug prophylaxis

Treatment of new onset supraventricular arrhythmias

Postepisode management and discharge planning

Chapter 4: Complications of Cardiopulmonary Bypass and Cardioplegia

Lawrence L Creswell and Nicholas J Karis

Introduction

Mechanics of CPB and related complications

Monitoring for CPB and related complications

Anticoagulation for CPB and related complications

Pathophysiologic consequences of CPB

Complications of cardioplegia

Chapter 5: Myocardial Protection: Why and How

Constantine L Athanasuleas and Gerald D Buckberg

Cardioplegia: the basics

Multidose cardioplegia

Cardioplegia delivery

The “integrated method” of cardioplegia

Single period of aortic clamping

Cannulas and devices for cardioplegia delivery

Antegrade cannula

Retrograde cannula

Coronary sinus injury

Monitoring antegrade cardioplegia delivery pressure

Monitoring retrograde cardioplegia delivery pressure

Cardioplegia delivery system

Evolving myocardial infarction

Myocardial protection during aortic root replacement

Surgical ventricular restoration

Septal function

Conclusion

Chapter 6: Complications after Pulmonary Resection: Lobectomy and Pneumonectomy

Mark F Berry and Thomas A D’Amico

Introduction

Mortality

Morbidity

Risk assessment

Prevention of complications

Technical complications

Pulmonary complications

Cardiovascular complications

Complication by operative approach

Chapter 7: Complications of Tracheobronchial Resection

Michael C Coello and Douglas J Mathisen

Bronchoplasty

Indications for sleeve lobectomy

Evaluation of patients for bronchoplastic procedures

Tracheal resection and reconstruction

Chapter 8: Complications of Lung Volume Reduction Surgery

Nirmal K Veeramachaneni and Bryan Meyers

Introduction

Avoiding complications by proper patient selection

Preoperative medical management

Operative approach

Postoperative care and avoidance of specific complications

Results

Chapter 9: Complications of Lung Transplantation

Paul F Waters

Complications of thoracic surgery

Early complications

Late complications

Post-transplant lymphoproliferative disorder (PTLD)

Lung cancer

Disorders associated with long-term immmunosuppression

Chapter 10: Complications of Esophageal Resection

Subroto Paul and Nasser K Altorki

Hospital mortality

Patient selection

General complications

Complications associated with esophageal resection

Anastomotic leak

Anastomotic stricture

Diaphragmatic herniation

Delayed gastric emptying and dumping syndrome

Chapter 11: Complications of Minimally Invasive Esophagectomy

Arjun Pennathur and James D Luketich

Introduction

Minimally invasive surgical training and patient selection

Patient selection

Staging

Technique of minimally invasive esophagectomy

Recurrent nerve injury vocal cord palsy

Anastomotic leaks and gastric tube necrosis

Gastric tube necrosis

Diaphragmatic hernia

Redundant gastric conduit

Chylothorax

Airway injuries

Conclusion

Chapter 12: Operations for Benign Esophageal Disorders

Keith S Naunheim

Introduction

Preoperative testing

Patient selection

Preoperative preparation

Surgical approach

Postoperative management

Operative maneuvers

Paraesophageal hiatal hernia repair

Early complications

Long-term complications

Conclusions

Chapter 13: Complications of Mediastinal Procedures

Cameron D Wright

Mediastinoscopy

Thymectomy for myasthenia gravis

Thymomas

Mediastinal nonseminomatous germ cell tumors

Neurogenic tumors

Paraganglomas

Bronchogenic cysts

Esophageal duplication cysts

Chapter 14: Complications of Pleural Operations and Procedures

Alberto de Hoyos

Introduction

Diagnosis

Surgical evaluation of the pleural space

Tube thoracostomy

Pleuroscopy and thoracoscopy

Unexpandable lung and trapped lung

Thoracotomy for pleural disease

Thoracotomy for fibrothorax and mature empyema

Surgery for mesothelioma

Residual postoperative pleural space

Chapter 15: Complications from Chest Wall Procedures

Mark S Allen

Wound infection

Respiratory failure

Fluid collections

Cosmetic outcomes

Pain

Flap loss

Mortality

Chapter 16: On-Pump Coronary Artery Bypass Grafting

Jennifer S Lawton and William A Gay, Jr

Preoperative evaluation

Postoperative care

Summary

Acknowledgments

Chapter 17: Off-Pump Coronary Artery Surgery: A Safe Approach

Jain Bhaskara Pillai and John D Puskas

Introduction

Preoperative planning

Operative steps

Pericardial preparation

Guidelines for planning the sequence of distal anastomoses

Using suction-based cardiac positioners and coronary-stabilizing devices

Technique for placement of suction devices on the epicardium

Mechanisms underlying hemodynamic compromise and corrective actions

Other maneuvers for improved hemodynamic stability in OPCAB

Specific problems during OPCAB

Operative set-up for the distal anastomosis

Clampless beating heart surgery

Strategies for complex risk factors

Absolute contraindications to OPCAB

Postoperative care

Conclusion

Chapter 18: Valvular Operations

Frederick Y Chen, Lawrence S Lee and Lawrence H Cohn

Introduction and overview

Aortic valve

Mitral valve

Mitral valve replacement

Tricuspid valve

Conclusion

Chapter 19: Complications of Myocardial Reconstruction

Gorav Ailawadi and Irving L Kron

Background

Anatomy

Patient selection

Incisions and cardiopulmonary bypass

Concomitant CABG

Concomitant mitral valve procedure

Ventriculotomy

Defining neck of aneurysm

Sizing the ventricle

Closure of the ventricle

Inferior ventricular reconstruction

De-airing and arrythmias

Postoperative ventricular arrhythmias

Separation from bypass

Embolization

Bleeding

Future

Acknowledgment

Chapter 20: Complications after Atrial Fibrillation Surgery

Anson M Lee and Ralph J Damiano Jr

Intraoperative complications

Postoperative complications

Acknowledgments

Chapter 21: Heart Transplantation

William Stein, IV, Jeffrey B Velotta, Hari R Mallidi, Michael P Fischbein and Robert C Robbins

Introduction

Donor and recipient matching

Recipient operative technique

Recipient postoperative management

Complications

Immediate

Early postoperative complications

Antibody-mediated rejection

Late postoperative complications

Long-term results in cardiac transplantation

Summary

Chapter 22: Assist Devices

Sanjeev Aggarwal and Francis D Pagani

Introduction

Patient selection/risk stratification

Specific complications

Conclusions

Chapter 23: Aortic and Great Vessel Operations

William M Boedefeld and John A Kern

Neurologic complications

Cardiac complications

Pulmonary complications

Renal complications

Endovascular approaches

Conclusions

Index

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Library of Congress Cataloging-in-Publication Data

Complications in cardiothoracic surgery : avoidance and treatment / [edited by] Alex G. Little,Walter H. Merrill. – 2nd ed.p.; cm.Includes bibliographical references and index.ISBN 978-1-4051-8103-71. Heart–Surgery–Complications. 2. Chest–Surgery–Complications. I. Little, Alex G.II. Merrill, Walter H.[DNLM: 1. Thoracic Surgical Procedures–adverse effects. 2. IntraoperativeComplication–-prevention & control. 3. Postoperative Complications–prevention &control. WF 980 C73683 2009]RD597.C645 2009617.4’1201–dc22                                                     2009013400

ISBN 9781405181037

A catalogue record for this book is available from the British Library.

S

Set in 9.5/12pt Palatino by Aptara® Inc., New Delhi, IndiaPrinted and bound in Malaysia1 2010

List of Contributors

Sanjeev Aggarwal, MD

Assistant Professor

Department of Surgery

Division of Thoracic and Cardiovascular Surgery

University of Louisville

Louisville, KY, USA

Gorav Ailawadi, MD

Assistant Professor

Department of Surgery

Division of Thoracic and Cardiovascular Surgery

University of Virginia

Charlottesville, VA, USA

Mark S Allen, MD

Professor of Surgery

Mayo Clinic

Rochester, MN, USA

Nasser K Altorki, MD

Professor of Cardiothoracic Surgery

Chief, Division of Thoracic Surgery

New York Presbyterian Hospital

Weill Cornell Medical Center

New York, NY, USA

Constantine L Athanasuleas, MD

Professor of Surgery

Division of Cardiothoracic Surgery

University of Alabama,

Birmingham, AL, USA

Mark F Berry, MD

Resident, Cardiothoracic Surgery

Department of Surgery

Duke University Medical Center

Durham, NC, USA

William R Berry, MD

Research Associate

Department of Health Policy and Management

Harvard School of Public Health

Boston, MA, USA

Jain Bhaskara Pillai,FRCS(CTh)UK, FRCSC

Super-Fellow in Cardiac Surgery

Division of Cardiac Surgery

Emory Crawford Long Hospital

Atlanta, GA, USA

William M Boedefeld, MD

University of Virginia

Charlottesville, VA, USA

Jeffrey Brown, MEd

Principal Scientist

Skilled Performance and Expertise

Klein Associates Division

Applied Research Associates

Fairborn, OH, USA

Gerald D Buckberg, MD

David Geffen School of Medicine

University of California

Los Angeles, CA, USA

Frederick Y Chen, MD, PhD

Assistant Professor of Surgery

Harvard Medical School

Director, Cardiac Surgery Research

Laboratory

Division of Cardiac Surgery

Brigham and Women’s Hospital

Boston, MA, USA

Michael C Coello, MD

Resident, Cardiothoracic Surgery

Massachusetts General Hospital

Boston, MA, USA

Lawrence H Cohn, MD

Hubbard Professor of Cardiac Surgery

Harvard Medical School

Brigham and Women’s Hospital

Boston, MA, USA

Lawrence L Creswell, MD

Associate Professor of Surgery

University of Mississippi Medical Center

Jackson, MS, USA

Ralph J Damiano, MD

John M Schoenberg Professor of Surgery

Chief of Cardiac Surgery

Washington University School of Medicine

Barnes-Jewish Hospital

St. Louis, MO, USA

Thomas A D’Amico, MD

Professor of Surgery and Program Director

Division of Thoracic Surgery

Duke University Medical Center

Durham, NC, USA

Alberto de Hoyos, MD

Professor of Surgery

Assistant Professor of Surgery

Feinberg School of Medicine

Northwestern University

Chicago, IL, USA

Joel T Erskin, ScD, PA-C

Senior Instructor Pilot/Aerospace Physiologist

184MDG

184IW

United States Air Force/Kansas Air National

Guard

McConnell AFB, KS, USA

Michael P Fischbein, MD, PhD

Assistant Professor of Cardiothoracic Surgery

Department of Cardiothoracic Surgery

Stanford University School of Medicine

Stanford, CA, USA

William A Gay, Jr, MD

Professor of Surgery

Division of Cardiothoracic Surgery

Washington University School of Medicine

St. Louis, MO, USA

Ann Hendrich, RN, MSN, FAAN

Vice President, System Office

Clinical Excellence Operations

Ascension Health

St. Louis, MO, USA

Nicholas J Karis, MD

Instructor, Division of Cardiothoracic Surgery

University of Mississippi Medical Center

Jackson, MS, USA

John A Kern, MD

Associate Professor of Surgery

Department of Surgery

Division of Thoracic and Cardiovascular Surgery

University of Virginia

Charlottesville, VA, USA

Irving L Kron, MD

Professor and Chair of Surgery

University of Virginia Medical Center

Charlottesville, VA, USA

Jennifer S Lawton, MD

Associate Professor of Surgery

Department of Surgery

Division of Cardiothoracic Surgery

Washington University and Barnes Jewish

Hospital

St. Louis, MO, USA

Anson M Lee, MD

Research Fellow

Division of Cardiothoracic Surgery

Washington University School of Medicine

St. Louis, MO, USA

Lawrence S Lee, MD

Division of Cardiac Surgery

Department of Surgery

Brigham and Women’s Hospital

Harvard Medical School

Boston, MA, USA

Joseph LoCicero, III, MD

Professor of Surgery

SUNY Downstate

Director of Surgical Oncology

Chief of General Thoracic Surgery

Maimonides Medical Center

Brooklyn, NY, USA

James D Luketich, MD

Henry T Bahnson Professor of Cardiothoracic Surgery

Chief, Heart, Lung, and Esophageal Surgery Institute

University of Pittsburgh School of Medicine

Pittsburgh, PA, USA

Hari R Mallidi, MD, FRCSC

Instructor, Department of Cardiothoracic Surgery

Stanford University School of Medicine

Stanford, CA, USA

Douglas J Mathisen, MD

Chief, Cardiothoracic Surgery

Hermes C Grillo Professor of Surgery Visiting Surgeon

Massachusetts General Hospital Boston, MA, USA

Bryan F Meyers, MD, MPH

Professor of Surgery

Division of Cardiothoracic Surgery

Washington University School of Medicine

St. Louis, MO, USA

Keith S Naunheim, MD

The Vallee and Melba Willman Professor of Surgery

Chief, Division of Thoracic Surgery

St. Louis University Medical Center

St. Louis, MO, USA

Francis D Pagani, MD, PhD

Professor, Department of Surgery

Section of Cardiac Surgery

University of Michigan

Ann Arbor, MI, USA

Subroto Paul, MD

Assistant Professor of Cardiothoracic Surgery

New York Presbyterian Hospital

Weill Cornell Medical Center

New York, NY, USA

Arjun Pennathur, MD

Assistant Professor of Surgery

Heart, Lung, and Esophageal Surgery Institute

University of Pittsburgh School of Medicine

Pittsburgh, PA, USA

John D Puskas, MD, MSc, FACS

Professor of Surgery and Chief of Cardiac Surgery

Division of Cardiac Surgery

Emory Crawford Long Hospital

Atlanta, GA, USA

Ellen W Raboin, MBA, MSOD, MAHOS

Consultant

Human and Organization Systems

CareQuest Consulting

Danville, CA, USA

Daniel B Raemer, PhD

Associate Professor

Department of Anesthesia and Critical Care

Massachusetts General Hospital

Harvard University

Boston, MA, USA

Michael F Reed, MD

Associate Professor of Surgery

Division of Thoracic Surgery

University of Cincinnati College of Medicine

Cincinnati, OH, USA

Robert C Robbins, MD

Chairman and Professor of Cardiothoracic Surgery

Department of Cardiothoracic Surgery

Stanford University School of Medicine

Stanford, CA, USA

William Stein, IV, MD

Postdoctoral Research Fellow

Department of Cardiothoracic Surgery

Stanford University School of Medicine

Stanford, CA, USA

Paul N Uhlig, MD, MPA

Associate Professor

Department of Preventive Medicine and Public Health

University of Kansas School of Medicine-Wichita

Wichita, KS, USA

Nirmal K Veeramachaneni, MD

Assistant Professor of Surgery

Division of Cardiothoracic Surgery

University of North Carolina at Chapel Hill

Chapel Hill, NC, USA

Jeffrey B Velotta, MD

Postdoctoral Research Fellow

Department of Cardiothoracic Surgery

Stanford University School of Medicine

Stanford, CA, USA

Paul F Waters, MD

Professor of Surgery

Yale School of Medicine

New Haven, CT, USA

Cameron D Wright, MD

Professor of Surgery

Harvard Medical School

Attending Surgeon

Massachusetts General Hospital

Boston, MA, USA

Acknowledgements

I would like to extend my thanks, gratitude, and appreciation to both the faculty and colleagues at the University of Chicago who trained and molded me, and to the high quality and enthusiastic residents whom I have had the good fortune to work with and train over the years. The community of thoracic surgeons is very special and it is an honor to be a part of it.

Alex G Little, MD

Likewise, I am grateful for the many teachers, mentors, and colleagues who have instructed, guided, and supported me during the course of my journey in cardiothoracic surgery. Working with students and residents has been a particular joy and privilege. Finally, I wish to acknowledge my indebtedness to the many patients who have taught me so much.

Walter H Merrill, MD

Preface

The reception of the first edition of this book has encouraged us to proceed with the development of this second edition. As before, we think of our book as a complement to the standard cardiothoracic surgery textbooks that address operative techniques and postoperative care. Acquisition of the information gained from the careful study of these books helps to establish the basic fund of knowledge that the thoracic surgery trainee and practitioner builds upon to establish final surgical competence. This knowledge foundation is supplemented by the real world experience with patients in the operating room, hospital, and clinic. It is this combination of knowledge and experience that leads to the development of the fully mature and capable thoracic surgeon.

We all are aware that this real world learning process involves the recognition of complications and the ability to learn from them. This is expressed in the common observation that good results come from experience and experience is acquired by making mistakes and learning from them. As before, the goal of our book is to minimize the frequency of surgical complications and maximize the patients’ outcome when they do occur by allowing the reader to learn from the operative and clinical experience of those who have gone before. This means that each generation can learn and benefit from the experience already gained by others. There is no need for each of us to make our own mistakes or have our own complications if we can benefit from the experience and accumulated wisdom of others.

Therefore, this book and its chapters are focused on the issue of complication prevention and/or recognition and treatment. While the chapter authors have been asked to address the correct or standard way to perform operations and care for patients afterward, they have also been challenged to address and emphasize specific issues related to both intraoperative techniques and post-operative care that will reduce the incidence of complications. This is a slightly but importantly different focus from standard textbooks. As some complications are essentially inevitable, also addressed by the authors are the issues of timely recognition and appropriate treatment of complications when they do occur, despite best efforts to prevent them.

In summary, we hope that this book will serve as a useful supplement to, and not a replacement for, standard textbooks and operative atlases. We are confident that the readers will be representative of the proud tradition of a constant commitment to excellence in cardiothoracic surgery.

Alex G Little and Walter H Merrill