Chapters authored
Coronary Artery Bypass Grafting in High-Risk Patients: On-Pump Beating-Heart CABG
The tailored surgical approach in high-risk patients undergoing coronary artery bypass graft (CABG) still remains debated. Each classic operative technique has strengths and limitations: on-pump CABG entails the use of cardiopulmonary bypass and cardioplegic arrest, while off-pump “beating heart” CABG is technically challenging and might pose problems in case of preoperative hemodynamic impairment or recent myocardial infarction. The hybrid approach of on-pump beating-heart CABG (OPBHC) has been proposed over the years as an acceptable trade-off in cases of severe complications caused by cardioplegic arrest or manipulation of the heart. This chapter intends to summarize the available literature about OPBHC, considering both original contributions and secondary research papers, trying to define operative indications and future perspectives. OPBHC, preventing hemodynamic deterioration while sustaining adequate end-organ perfusion, has been gradually recognized as an effective technique for performing surgical revascularization in high-risk patients, such as those presenting with acute coronary syndrome, cardiogenic shock, or severe left ventricular dysfunction. In selected cases, OPBHC reduces in-hospital mortality and decreases the risk of perioperative complications such as myocardial ischemia or stroke and should be considered a valid alternative to conventional off-pump and on-pump CABG techniques. OPBHC should be in the armamentarium of the next-generation cardiac surgeon.
Part of the book: Coronary Artery Bypass Surgery
Anatomic Completeness, Variations, Patency, and Functional Assessment of Circle of Willis: Implications for Chronic Aortic Dissection and Non-Emergent Arch Surgery
Circle of Willis (CoW) variations are present in a significant number of patients. In patients undergoing non-emergent surgery for aortic dissection (e.g., chronic dissection or planned complex aortic arch surgery), an extensive preoperative examination is warranted as anatomic completeness, variation, patency, and functional assessment of CoW is crucial to optimize neuroprotection strategies. In non-emergent clinical presentations, unilateral or bilateral selective cerebral perfusion should be tailored to patient’s anatomy to minimize intraoperative risk and improve outcomes. A new classification system provides a simple and comprehensive ontology of the described anatomical variations of the CoW. An accurate preoperative assessment might indicate the need for adjunctive perfusion in selected CoW configurations.
Part of the book: Advances in Vascular Surgery [Working title]