i Cardiac Surgery in the Adult Notice Medicine is an ever-changing science.As new research and responsibility for any errors or omissions or for the results clinical experience broaden our knowledge,changes in treat- obtained from use of the information contained in this ment and drug therapy are required. The authors and the work. 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This recommendation is of particular this work warrants that the information contained herein is importance in connection with new or infrequently used in every respect accurate or complete,and they disclaim all drugs. iii Cardiac Surgery in the Adult THIRD EDITION Lawrence H.Cohn,MD Virginia and James Hubbard Professor ofCardiac Surgery Harvard Medical School Division ofCardiac Surgery Brigham and Women’s Hospital Boston,Massachusetts New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2008, 2003, 1997 by The McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of America. 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Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. DOI: 10.1036/0071469133 v To the cardiac surgery team at Brigham and Women's Hospital, past,present,and future This page intentionally left blank For more information about this title, click here vii Contents Contributors / xi 12.Extracorporeal Circulation. . . . . . . . . . . . . . . . . . . . . . . . 349 Foreword / xxi A. Perfusion Systems Preface / xxiii B. The Response of Humoral and Cellular Elements of Blood to Extracorporeal Circulation PART I FUNDAMENTALS . . . . . . . . . . . . . . . . . . . . . . . . . . .1 C. Organ Damage John W.Hammon 1.History of Cardiac Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 3 13.Transfusion Therapy and Blood Conservation. . . . . . . 415 Larry W.Stephenson Leonard Y.Lee,William J.DeBois,Karl H.Krieger, 2.Surgical Anatomy of the Heart. . . . . . . . . . . . . . . . . . . . . 29 & O.Wayne Isom Michael R.Mill,Benson R.Wilcox,& Robert H.Anderson 14.Deep Hypothermic Circulatory Arrest. . . . . . . . . . . . . 431 3.Cardiac Surgical Physiology . . . . . . . . . . . . . . . . . . . . . . . 51 René Prêtre & Marko I.Turina Edward B.Savage,R.Saeid Farivar,& Eric J.Okum 15.Myocardial Protection. . . . . . . . . . . . . . . . . . . . . . . . . . . . 443 4.Cardiac Surgical Pharmacology . . . . . . . . . . . . . . . . . . . . 77 Robert M.Mentzer,Jr.,M.Salik Jahania, Jerrold H.Levy,Kenichi A.Tanaka,& James M.Bailey & Robert D.Lasley 5.Pathology of Cardiac Surgery. . . . . . . . . . . . . . . . . . . . . 111 16.Postoperative Care of Cardiac Surgery Patients. . . . . . 465 Robert F.Padera,Jr.& Frederick J.Schoen Zain I.Khalpey,Rose B.Ganim,& James D.Rawn 6.Cardiac Surgical Imaging. . . . . . . . . . . . . . . . . . . . . . . . . 179 17.Cardiopulmonary Resuscitation. . . . . . . . . . . . . . . . . . . 487 Frank J.Rybicki,Tarang Sheth,& Frederick Y.Chen Mark P.Anstadt & James E.Lowe 7.Risk Stratification and Comorbidity . . . . . . . . . . . . . . . 199 18.Temporary Mechanical Circulatory Support. . . . . . . 507 Victor A.Ferraris,Fred H.Edwards, Edwin C.McGee,Jr.,Patrick M.McCarthy, David M.Shahian,& Suellen P.Ferraris & Nader Moazami 8.Statistical Treatment of Surgical 19.Late Complications of Cardiac Surgery. . . . . . . . . . . . 535 Outcome Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 Samuel Jerome Durham & Jeffrey Philip Gold Ruyun Jin & Gary L.Grunkemeier PART III ISCHEMIC HEART DISEASE . . . . . . . . . . . . . . .549 PART II PERIOPERATIVE/INTRAOPERATIVE CARE . . .259 20.Indications for Revascularization. . . . . . . . . . . . . . . . . . 551 9.Preoperative Evaluation for Cardiac Surgery . . . . . . 261 Morgan L.Brown,ThoralfM.Sundt,III,& Bernard J.Gersh Michelle A.Albert,Nitsan Halevy,& Elliott M.Antman 21.Myocardial Revascularization with Percutaneous 10.Cardiac Anesthesia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573 Joseph S.Savino & Albert T.Cheung James M.Wilson & James T.Willerson 11.Principles and Practice of Echocardiography 22.Myocardial Revascularization with in Cardiac Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 Cardiopulmonary Bypass. . . . . . . . . . . . . . . . . . . . . . . . . 599 Maurice Enriquez-Sarano,Vuyisile T.Nkomo,& Hector Michelena Enrique Góngora & ThoralfM.Sundt,III viii Contents 23.Myocardial Revascularization without 39.Minimally Invasive Aortic Valve Surgery. . . . . . . . . . . 957 Cardiopulmonary Bypass. . . . . . . . . . . . . . . . . . . . . . . . . 633 Prem S.Shekar & Lawrence H.Cohn Todd M.Dewey & Michael J.Mack 40.Percutaneous Aortic Valve Interventions . . . . . . . . . . 963 24.Myocardial Revascularization with Michael J.Davidson & Donald S.Baim Carotid Artery Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . 655 Cary W.Akins & Richard P.Cambria PART IVb VALVULAR HEART DISEASE (MITRAL) . . . . .971 25.Myocardial Revascularization after Acute Myocardial Infarction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 669 41.Pathophysiology of Mitral Valve Disease. . . . . . . . . . . 973 Isaac George & Mehmet C.Oz James I.Fann,Neil B.Ingels,Jr.,& D.Craig Miller 26.Minimally Invasive Myocardial Revascularization . . 697 42.Mitral Valve Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1013 Volkmar Falk & Friedrich W.Mohr Frederick Y.Chen & Lawrence H.Cohn 27.Coronary Artery Reoperations. . . . . . . . . . . . . . . . . . . . 711 43.Mitral Valve Replacement . . . . . . . . . . . . . . . . . . . . . . . 1031 G.V.Gonzalez-Stawinski & Bruce W.Lytle Tomas Gudbjartsson,Tarek Absi,& Sary Aranki 28.Transmyocardial Laser Revascularization and 44.Surgical Treatment of Mitral Valve Extravascular Angiogenetic Techniques to Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1069 Increase Myocardial Blood Flow. . . . . . . . . . . . . . . . . . . 733 Sotiris C.Stamou,Gosta Petterson,& A.Marc Gillinov Keith A.Horvath & Yifu Zhou 45.Minimally Invasive and Robotic Mitral 29.Surgical Treatment of Complications of Acute Valve Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1079 Myocardial Infarction:Postinfarction Ventricular W.Randolph Chitwood,Jr.& Evelio Rodriguez Septal Defect and Free Wall Rupture . . . . . . . . . . . . . . 753 46.Percutaneous Catheter–Based Mitral Arvind K.Agnihotri,Joren C.Madsen, Valve Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1101 & Willard M.Daggett,Jr. Michael J.Davidson & Donald S.Baim 30.Ischemic Mitral Regurgitation. . . . . . . . . . . . . . . . . . . . . 785 Wilson Y.Szeto,Robert C.Gorman, PART IVc VALVULAR HEART DISEASE (OTHER) . . . .1109 Joseph H.Gorman,III,& Michael A.Acker 31.Left Ventricular Aneurysm. . . . . . . . . . . . . . . . . . . . . . . . 803 47.Tricuspid Valve Disease. . . . . . . . . . . . . . . . . . . . . . . . . . 1111 Donald D.Glower & James E.Lowe Richard J.Shemin PART IVa VALVULAR HEART DISEASE (AORTIC) . . . .823 48.Multiple Valve Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . 1129 Hartzell V.Schaff& Rakesh M.Suri 32.Pathophysiology of Aortic Valve Disease . . . . . . . . . . 825 49.Reoperative Valve Surgery. . . . . . . . . . . . . . . . . . . . . . . 1159 Tomislav Mihaljevic,Mohammed R.Sayeed, James P.Greelish,Rashid M.Ahmad,Jorge M.Balaguer, Sotiris C.Stamou,& Subroto Paul Michael R.Petracek,& John G.Byrne 33.Aortic Valve Replacement with a Mechanical 50.Valvular and Ischemic Heart Disease. . . . . . . . . . . . . 1175 Cardiac Valve Prosthesis. . . . . . . . . . . . . . . . . . . . . . . . . . 841 Martin LeBoutillier,III & Verdi J.DiSesa Robert W.Emery,Ann M.Emery,Amy Knutsen, & Goya V.Raikar PART V DISEASES OF THE GREAT VESSELS . . . . . . .1193 34.Bioprosthetic Aortic Valve Replacement:Stented Pericardial and Porcine Valves. . . . . . . . . . . . . . . . . . . . . 857 51.Aortic Dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1195 Nimesh D.Desai & George T.Christakis T.Brett Reece,G.Randall Green,& Irving L.Kron 35.Stentless Aortic Valve Replacement: 52.Ascending Aortic Aneurysms. . . . . . . . . . . . . . . . . . . . 1223 Autograft/Homograft . . . . . . . . . . . . . . . . . . . . . . . . . . . . 895 Derek R.Brinster,Robert J.Rizzo, Craig R.Hampton & Edward D.Verrier & R.Morton Bolman,III 36.Stentless Aortic Valve Replacement: 53.Aneurysms of the Aortic Arch . . . . . . . . . . . . . . . . . . . 1251 Porcine and Pericardial. . . . . . . . . . . . . . . . . . . . . . . . . . . 915 David Spielvogel,Manu N.Mathur,& Randall B.Griepp Paul Stelzer 54.Descending and Thoracoabdominal Aortic 37.Aortic Valve Repair and Aortic Valve–Sparing Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1277 Operations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 935 Joseph S.Coselli & Scott A.LeMaire Tirone E.David 55.Endovascular Therapy for the Treatment 38.Surgical Treatment of Aortic Valve Endocarditis . . . . . 949 of Thoracic Aortic Disease. . . . . . . . . . . . . . . . . . . . . . . 1299 Tirone E.David Susan D.Moffatt-Bruce & R.Scott Mitchell ix Contents 56.Pulmonary Embolism and Pulmonary PART VIII TRANSPLANT AND Thromboendarterectomy . . . . . . . . . . . . . . . . . . . . . . . 1309 CIRCULATORY SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . .1511 Michael M.Madani & Stuart W.Jamieson 64.Immunobiology of Heart and Heart-Lung 57.Trauma to the Great Vessels . . . . . . . . . . . . . . . . . . . . . 1333 Transplantation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1513 Thomas G.Gleason & Joseph E.Bavaria Bartley P.Griffith,Michel Haddad,& Robert S.Poston PART VI SURGERY FOR CARDIAC ARRHYTHMIAS .1355 65.Heart Transplantation. . . . . . . . . . . . . . . . . . . . . . . . . . . 1539 Lois U.Nwakanma,Ashish S.Shah,John V.Conte,& 58.Interventional Therapy for Atrial William A.Baumgartner and Ventricular Arrhythmias. . . . . . . . . . . . . . . . . . . . . 1357 66.Heart-Lung and Lung Transplantation . . . . . . . . . . . 1579 Robert E.Eckart & Laurence M.Epstein Ahmad Y.Sheikh,Marc P.Pelletier,& Robert C.Robbins 59.Surgical Treatment of Atrial Fibrillation. . . . . . . . . . . 1375 67.Long-Term Mechanical Circulatory Support. . . . . . 1609 Rochus K.Voeller,Richard B.Schuessler, Sanjeev Aggarwal,Faisal Cheema,Mehmet C.Oz, & Ralph J.Damiano,Jr. & Yoshifumi Naka 60.Surgical Implantation of Pacemakers 68.Total Artificial Heart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1629 and Automatic Defibrillators . . . . . . . . . . . . . . . . . . . . 1395 O.H.Frazier,Timothy J.Myers,& Igor Gregoric Henry M.Spotnitz & George H.Humphreys,II 69.Nontransplant Surgical Options for Heart Failure. 1639 PART VII OTHER CARDIAC OPERATIONS . . . . . . . . . .1429 Martinus T.Spoor & Steven F.Bolling 61.Adult Congenital Heart Disease. . . . . . . . . . . . . . . . . . 1431 70.Tissue Engineering for Cardiac Valve Surgery. . . . . 1649 Hillel Laks,Daniel Marelli,Mark Plunkett,& JeffMyers John E.Mayer 62.Pericardial Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1465 71.Stem Cell–Induced Regeneration Abeel A.Mangi & David F.Torchiana of Myocardium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1657 Robert P.Gallegos & R.Morton Bolman,III 63.Cardiac Neoplasms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1479 Jon-Cecil M.Walkes,W.Roy Smythe,& Michael J.Reardon Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1669