Abstracts 4. Gemeinsamer Jahreskongress der ... - SWISS KNIFE

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Intra-operative insertion of intra-aortic balloon pump as circulatory support during off-pump
coronary artery bypass surgery
Objective: Hemodynamic derangements 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 underwent 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 moderate 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± 234.5 mcg/min dobutamine and 13.9 ±9mcg/min of noradrenaline intraoperatively.
Pre -IABP therapy mean arterial pressure (MAP) = 58±4.3mmHg 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.
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14.01
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 under 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.
14.02
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 underwent 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 underwent 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