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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ECardiovascular surgery is becoming less invasive, more focused, and safer, according to speakers who presented new approaches to several traditional surgical procedures. This article discusses hybrid revascularization for coronary artery disease, transapical aortic valve replacement, and atrial fibrillation ablation.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003ECardiovascular surgery is becoming less invasive, more focused, and safer, according to speakers who presented new approaches to several traditional surgical procedures.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EHybrid Revascularization for Coronary Artery Disease\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EHybrid revascularization, which incorporates coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) in one intervention, offers clinical and cosmetic advantages over CABG alone, said Johannes Bonatti, FETCS, Medical University of Innsbruck, Innsbruck, Austria. Cumulative data from recent studies revealed 0% perioperative mortality, 2% stenosis of the left internal mammary artery, and 12% restenosis of PTCA\/stent lesions. One comparative study (de Canniere D et al. \u003Cem\u003EAHJ\u003C\/em\u003E 2001;142:563\u201370) found multiple advantages for the hybrid procedure versus CABG for double-vessel disease, including faster return-to-work time (22 vs 89 days).\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EEndoscopic robotics further enhances hybrid revascularization. Based on 51 cases (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E), Dr. Bonatti has found that the robotic approach offers better overview inside the chest, and produces a longer graft and a smaller scar than a full sternotomy. \u201cThis operation best preserves the patient\u0027s integrity,\u201d he observed.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/10935\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/10935\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10935\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EHybrid Revascularization Innsbruck (Robotics) 2001\u20132007.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ETransapical Aortic Valve Replacement\u003C\/h2\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EA new technique has been introduced for aortic valve replacement. In this case, the valve is replaced using a transapical approach.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThe transapical procedure involves a minithoracotomy, balloon valvuloplasty, and implantation of an investigational prosthesis. The lack of mortality and stroke was striking in a population of 89 elderly high-risk patients. Survival was \u0026gt;90% at 30 days and no new strokes occurred. Sixty-eight patients (76.4%) were operated off-pump, and perioperative conversion was required in only 4 (4.5%). Thirty-day mortality was 9%, predominantly from underlying disease.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ENoting these results, Dr. Walther commented, \u201cIt is important that the elderly patients not just survive, but survive without strokes.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAtrial Fibrillation Ablation\u003C\/h2\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EFinally, concomitant ablation of atrial fibrillation (AF) in patients undergoing cardiovascular surgery was discussed by Patrick M. McCarthy, MD, Northwestern University, Chicago, IL. Underlying AF raises the mortality risk in patients undergoing any cardiac surgery. In a study by Dr. McCarthy and colleagues (Quader MA et al. \u003Cem\u003EAnn Thorac Surg\u003C\/em\u003E 2004;77:1514\u20131524) survival was significantly compromised in patients with AF undergoing CABG: 23% at 15 years (CABG-related?), vs 46% for patients without AF.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EConcomitant ablation is therefore desirable to improve survival and to spare AF patients from additional ablation procedures. The goal of epicardial AF surgery is to reproduce the results achieved with the classic Cox-Maze procedure, using a minimally invasive technique and no cardiopulmonary bypass. In this procedure, surgeons can ablate the AF, close the left atrial appendage and ablate the ganglionated plexi.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EIn five prospective randomized trials of permanent AF ablation during mitral valve surgery, normal sinus rhythm was restored in 44\u201394% and the treatment arm was significantly improved over controls (p\u0026lt;0.001), he noted. During mitral valve repair, Dr. McCarthy uses bipolar radiofrequency ablation and cryoablation. During aortic valve replacement, CABG, and aneurysm, he uses pulmonary vein isolation and closes the left atrial appendage. Cryoablation is used during re-do mitral valve repair.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/7\/35.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm7op\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm7op\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}