| Автор | Carrel, T. |
| Автор | Pasic, M. |
| Автор | Schmid, E.R. |
| Автор | Turina, M. |
| Дата выпуска | 1993 |
| dc.description | Coronary disease is the leading cause of early and late death after any type of vascular operation, but its immediate implications are more serious in patients who require abdominal aortic reconstruction. Infrarenal cross-clamping required during aortic replacement is generally well tolerated but may occasionally lead to severe hemodynamic disturbances in patients suffering from coronary artery disease (CAD).The authors performed prospective registration of hemodynamic and cardiac effects of infrarenal aortic clamping in three groups of 25 patients each who underwent infrarenal aortic aneurysm repair. Group I included patients without CAD, group II patients had manifest signs of CAD, whereas patients in group III underwent aortic repair immediately after coronary revascularization, as part of a combined approach.Patients with CAD demonstrated significant increase of central venous pressure, pulmonary arterial pressure, and pulmonary capillary wedge pressure after aortic clamping. Cardiac output measurements showed a significant decrease while systemic vascular resistance increased. A majority of patients presented ischemic ECG alterations and/or arrhythmia. Patients of group III presented an intermediate response to aortic clamping as compared with cardiac-healthy patients of group I and coronary patients from group II. However, there were no signs of ischemia after cross-clamping in this group of patients.The study demonstrates clearly the different tolerances to the stress of aortic cross-clamping in patients with and without CAD. Intraoperative transesophageal echocardiography allowed the authors to detect dilatation of the cardiac cavities following cross-clamping in patients with severe CAD; when this is not available, left ventricular filling pressure should be monitored in patients with CAD undergoing abdominal aortic repair. Registration of left ventricular pressure is a prerequisite for proper intraoperative application of vasodilators. |
| Издатель | Sage Publications |
| Название | Cardiac and Hemodynamic Effects of Infrarenal Aortic Clamping During Repair of Abdominal Aortic Aneurysms. A Reason for Combined Coronary Bypass and Aneurysm Repair in Patients with Severe Coronary Artery Disease |
| Тип | Journal Article |
| DOI | 10.1177/153857449302700502 |
| Print ISSN | 1538-5744 |
| Журнал | Vascular and Endovascular Surgery |
| Том | 27 |
| Первая страница | 337 |
| Последняя страница | 343 |
| Аффилиация | Carrel, T., Clinic for Cardiovascular Surgery and Institute of Anesthesiology, University Hospital Zürich, Switzerland |
| Аффилиация | Pasic, M., Clinic for Cardiovascular Surgery and Institute of Anesthesiology, University Hospital Zürich, Switzerland |
| Аффилиация | Schmid, E.R., Clinic for Cardiovascular Surgery and Institute of Anesthesiology, University Hospital Zürich, Switzerland |
| Аффилиация | Turina, M., Clinic for Cardiovascular Surgery and Institute of Anesthesiology, University Hospital Zürich, Switzerland |
| Выпуск | 5 |
| Библиографическая ссылка | Reul GJ, Cooley DA, Duncan JM, et al: The effect of coronary bypass on the outcome of peripheral vascular operations in 1093 patients. J Vasc Surg3:788-798, 1986. |
| Библиографическая ссылка | Brown OW, Hollier LH, Pairolero PC, et al: Abdominal aortic aneurysm and coronary artery disease: A re-assessment . Arch Surg 116:1484-1488, 1981 . |
| Библиографическая ссылка | Diehl JT, Cali RF, Hertzer NR, et al: Complications of abdominal aortic reconstruction: An analysis of perioperative risk factors. Ann Surg197:49-56, 1983. |
| Библиографическая ссылка | Foster ED, Davis KB, Carpenter JA, et al: Risk of non-cardiac operation in patients with defined coronary disease (CASS-Study). Ann Thorac Surg41:42-50, 1986. |
| Библиографическая ссылка | Hertzer NR, Avellone JC, Farrell CJ, et al: The risk of vascular surgery in a metropolitan community. J Vasc Surg1:13-21, 1984. |
| Библиографическая ссылка | Coopermann M. , Martin EW, Evans WE: Cardiovascular risk factors in patients with peripheral vascular disease. Surgery 84:505-509, 1978. |
| Библиографическая ссылка | Crawford ES, Bomberger RA, Glaeser DA, et al: Aorto-iliac occlusive disease: Factors influencing survival and function following reconstructive operation over a 25-year period. Surgery90:1055-1067, 1981. |
| Библиографическая ссылка | Hertzer NR: Fatal myocardial infarction following abdominal aortic aneurysm: 343 patients followed 6-11 years postoperatively. Ann Surg192:667-673, 1980. |
| Библиографическая ссылка | Attia RR, Murphy JD, Snider M., et al: Myocardial ischemia due to infrarenal aortic cross-clamping during aortic surgery in patients with severe coronary artery disease. Circulation53:961-965, 1976. |
| Библиографическая ссылка | White GH, Advani SM, Williams RA, et al: Cardiac risk index as a predictor of long term survival after repair of abdominal aortic aneurysms. Am J Surg156:103-107, 1988. |
| Библиографическая ссылка | Bush HL, LoGerfo FW, Weisel RD, et al: Assessment of myocardial performance and optimal volume loading during elective abdominal aortic aneurysm resection. Arch Surg112:1301-1306, 1977. |
| Библиографическая ссылка | Cohn LH, Powell MR, Seidlitz L., et al: Fluid requirements and shifts after reconstruction of the aorta . Am J Surg 120:182-186, 1970. |
| Библиографическая ссылка | Grindlinger GA, Vegas AM, Manny J., et al: Volume loading and vasodilators in abdominal aortic aneurysmectomy. Am J Surg139:480-486, 1980. |
