swissknife spezial 06 12.06.2006 13:39 Uhr Seite 24 ally available systems (VASOVIEW ® Endoscopic Vessel Harvesting System (Guidant Corporation, St.Paul, Minnesota), and STORZ system (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany). Intraoperative conduit flow was measured using the „transit-time principle“ with the MediStim ASA system (Oslo, Norway) in all patients. Results: From 1/2002 to 3/2006, a total of 858 Isolated CABG (94% OPCAP) were performed. Mean age and Euroscore were 66+-10 years and 5.4+-0.2 respectively. Surgery was elective, urgent and emergent in 58, 32 and 10% of cases respectively. Conversion to open harvest technique occured in 10% of patients. Mean flows (pulsatility indexes) in SVG and RA were >30ml/min (20ml/min (
swissknife spezial 06 12.06.2006 13:39 Uhr Seite 25 Intra-operative insertion of intra-aortic balloon pump as circulatory support during off-pump coronary artery bypass surgery Objective: Hemodynamic <strong>der</strong>angements during mobilisation of the heart especially while trying to expose the posterior vessels during off-pump coronary artery bypass (OPCAB) surgery still remains of concern. The purpose of the study is to show the hemodynamic effects of intraoaortic balloon pump (IABP), when inserted intra-operatively. Methods: Between February 2002 and March 2005, we studied 12 consecutive patients (8 male, 4 female) with a mean age of 72.3±11.3 years, who un<strong>der</strong>went OPCAB surgery combined with intraoperative use of IABP. None of these patients required conversion to CPB. All these patients had a triple vessel disease with an average left ventricular ejection fraction (LVEF) of 55±10%. 6/12 patients (50%) of which presented with a main stem disease, 2/12 patients (16.7%) had mild to mo<strong>der</strong>ate mitral insufficiency, 5/12 patients (41.6%) were emergencies, 7/12 patients (58.3%) had myocardial infarction and the standard mean Euroscore was 7.0± 2.2. Results: There were no early mortality or neurological events recorded in these patients. The patients had received an average of 3.83±0.84 grafts each and an average amount of 233.3± 23<strong>4.</strong>5 mcg/min dobutamine and 13.9 ±9mcg/min of noradrenaline intraoperatively. Pre -IABP therapy mean arterial pressure (MAP) = 58±<strong>4.</strong>3mmHg and post IABP therapy MAP= 80 ±11.0mmHg; p= 0.002. Pre IABP therapy mean pulmonary arterial pressure (PAP) =34±16.6mmHg and post IABP therapy PAP= 22±10.6mmHg; p was not significant. Conclusion: Intraoperative IABP is a safe and an efficient mechanical supportive device for stabilizing fluctuant hemodynamics which occur during OPCAB surgery, in patients having triple vessel disease and normal left ventricular function. Intraoperative IABP insertion is able to reduce the number of conversion to CPB surgery. 14 1<strong>4.</strong>01 D. Dindo 1 , D. Hahnloser 2 , N. Demartines 1 , P. Clavien 3 , F.H. Hetzer 4 1 Dept. of Visceral and Transplant Surgery, University Hospital of Zurich, 8091 Zurich/CH, 2 Visceral and Transplantation Surgery, University Hospital Zurich, 8091 Zurich/CH, 3 Swiss Hpb Center, Dept. Visceral and Transplant Surgery, University Hospital of Zurich, 8091 Zurich/CH, 4 Viszeralsurgery, University Hospital, 8091 Zurich/CH Augmentation of the anal sphincter with bioplastique implants – a pilot study Objective: Surgical strategies for faecal incontinence such as sphincter repair, dynamic graciloplasty or artificial bowel sphincter have a high morbidity and failure rate. Recently, a minimal invasive technique using injectable silicone biomaterial implants was described with a promising success rate. In this pilot study, we present this new technique and first results. Methods: Between December 2005 and February 2006, three female patients median age 70 years (range 66-75) with faecal incontinence were treated by inter-sphincteric injections of silicone biomaterial (PTP-silicone). Injections were performed in an outpatient setting and un<strong>der</strong> anal 3-dimensional-ultrasound guidance. Each patient had 3 PTP-silicone injections at the 3, 7 and 11 o’clock position above the dental line. Before and after treatment, the validated Wexner’s incontinence score was determined. Results: There was no thirty days postoperative morbidity. Median Wexner’s faecal incontinence score improved from 14 (range 12-20) before to 4 (range 0-12) after silicone implant injections. Endoanal ultrasound scans did not show any migration of the bioplastique implants during median follow-up 1 month (range 1-3). Conclusion: The results of this pilot study are very promising. Injection of silicone biomaterial implants significantly improvement faecal continence with low morbidity. However, larger series are required to determine clinical efficacy, safety and cost-effectiveness. 1<strong>4.</strong>02 R.E. Vandoni 1 , A. Pelloni 2 , A. Krpo 3 , P. Gertsch 4 1 Surgery, Ospedale San Giovanni, 6500 Bellinzona/CH, 2 Surgery, Ospedale San Giovanni, 6500 Bellinzona/CH, 3 Anaesthsiology, Ospedale San Giovanni, Bellinzona/CH, 4 Chirurgia, Ospedale San Giovanni, 6500 Bellinzona/CH Localized hepatic ischemia after liver resection Objective: The segmental anatomy of the liver and the techniques of hepatectomy allow liver resections including one to several segments. A compromised blood supply to the remaining liver may result in ischemia of various extension and severity. Methods: Patients submitted to hepatectomy un<strong>der</strong>went enhanced CT-scan with arterial and venous phases within 48 hours after hepatectomy. Hepatic ischemia, characterized by reduced or absent contrast enhancement during the venous phase, was classified as hypoperfusion, non-perfusion or necrosis and its extension as marginal, partial or segmental. Uni and multivariate analysis of factors that might influence postoperative ischemia was performed. Results: 131 consecutive patients (79M/52F, 62 yrs) were included. We observed radiological signs of localized ischemia in 37 (26%) patients. Twenty-eight had hypoperfusion (14 marginal, 10 partial and 4 segmental) and three non-perfusion (1 marginal and 2 segmental). One had a partial and one a segmental necrosis. Only one patient un<strong>der</strong>went an early reoperation and evolution was favorable in all cases. Post-operative blood levels of ASAT and ALAT were significantly higher in patients with ischemia. Increased pre-operative blood level of bilirubin was the only factor significantly associated with ischemia. The incidence of biliary leak was higher in patients with localized ischemia (2% vs 21%, p
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