CARDIAC SURGERY. Current Issues 1

CARDIAC SURGERY Current Issues 1

CARDIAC SURGERY Current Issues 1 Edited by Aurel C. Cernaianu and Anthony J. DelRossi University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School at Camden Camden, New Jersey SPTINGER SCIENCE+BUSINESS MEDIA, LLC

Librar y of Congres Cataloging in Publication Data Cardiac surgery: current issues / edited by Aurel C. Cernaianu and Anthony J. Del- Rossi. p. cm. Includes bibliographical references and index. ISBN 978-1-4613-6511-2 ISBN 978-1-4615-3418-1 (ebook) DOI 10.1007/978-1-4615-3418-1 1. Heart Surgery Congresses. 2. Heart Surgery Nursing Congresses. I. Cernaianu, Aurel C. II. DelRossi, Anthony J. [DNLM : 1. Heart Surgery congresses. WG 169 C26725] RD598.C346 1992 617.4'12059 dc2 0 DNLM/DL C 92-4945 for Librar y of Congres CIP Proceedings of a symposium entitled Cardiac Surgery: 1992, held November 7-10, 1991, in St. Thomas, U.S. Virgin Islands ISBN 978-1-4613-6511-2 1992 Springer Science+Business Media New York Softcover reprint of the hardcover 1st edition 1992 Originally published by Plenum Press, New York in 1992 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

PREFACE This monograph is intended to compile the lectures presented at the 4th Annual Symposium "Cardiac Surgery:1992" held at the Frenchman's Reef Beach Resort, St. Thomas, US Virgin Islands, November 7-10, 1991. This symposium was organized by the Division of Cardiothoracic Surgery and the School of Cardiovascular Perfusion, Cooper Hospital/University Medical Center, Camden, New Jersey and sponsored by the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Philadelphia Academy of Cardiovascular Perfusion and the American Society of Extracorporeal Technology - Region II. The symposium was devoted to cardiothoracic surgeons, cardiologists, cardiovascular perfusionists, and nurses involved in the management of the cardiac surgical patient. Therefore, the context of the book represents the multidisciplinary nature of cardiac surgery at its present level of development. The contributors to this book have critically examined their experience and discussed controversial issues regarding cardiac pathophysiology, surgical indications, operative techniques, and longterm care and outcome. The co-editors wish to express their gratitude for the contributors' efforts in the production of this manuscript. We would also like to thank the members of the Organizing Committee, Jane V. Stewart MSN, RN, CCRN, Roger A. Vertrees BA, CCP, Rosemary Volosin, MSN, RN, Rosemary Morrone and Paul R. Cappola BS, CCP, who have greatly contributed to the success of the symposium. We would also like to express our thanks for the valuable support and assistance provided by the exhibitors and sponsors of the symposium, and Ms. Mary Safford and the staff at Plenum Publishing Corporation. July 1992 Aurel C. Cernaianu, M.D. FICS Anthony J. DelRossi, M.D. FACS v

COURSE DIRECTOR Anthony J. DelRossi, M.D. Chairman, Department of Surgery Head. Division of Cardiothoracic Surgery Cooper Hospital/University Medical Center Associate Professor of Surgery University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School at Camden Camden. NJ ORGANIZING COMMITTEE Jane V. Stewart, MSN, RN. CCRN Nurse Manager, Coronary Care Unit Presbyterian University Medical Center Philadelphia. PA Rosemary Volosin, MSN, RN Clinical Nurse Specialist Division of Cardiothoracic Surgery Cooper Hospital/University Medical Center Camden. NJ Roger A. Vertrees. BA, CCP Program Director School of Cardiovascular PerfUSion Cooper Hospital/University Medical Center Camden. NJ Paul R. Cappola, BS. CCP President. AMSECT Region II President, Philadelphia Academy of Cardiovascular PerfUSion Director, Cardiovascular Perfusion Miriam Hospital Providence, Rl Rosemary Morrone Program Coordinator Division of Cardiothoracic Surgery Cooper Hospital/University Medical Center Camden. NJ vii

EXHIBITORS Avecor Cardiovascular. Inc. - Plymouth. MN Baxter. Bentley Laboratories Division - Irvine. CA BFW - Lexington. KT Cobe Laboratories - Arcada. CO Datascope Corporation - Montvale. NJ Deknatel. Inc. - Fall River. MA Electromedics. Inc. - Inglewood. CA Ethicon. Inc. - Somerville. NJ W. L. Gore and Associates. Inc. - Elkton. MD IMPRA - Tempe. AZ Luxtec Corporation - Sturbridge. MA Mallinckrodt Sensor Systems. Inc. - Ann Arbor. MI Medtronic. Inc. - Heart Valves - Minneapolis. MN Medtronic. Inc. - Cardiopulmonary Division - Anaheim. CA Hoffman LaRoche Laboratories - Nutley. NJ St. Jude Cardiac Assist - Shelmsford. MA St. Jude Medical. Inc. - St. Paul. MN Sarns/3M Health Care - Ann Arbor. MI SPONSORS We are grateful for the generous financial support received from the following: Abbott Laboratories. Hospital Products Division. Abbott Park. IL Bard Cardiopulmonary - Tewksbury. MA Glaxo Pharmaceuticals - Research Triangle Park. NC Minntech Corporation - Minneapolis. MN Shiley. Inc. - Irvine. CA State of the Art Medical Products. Inc. - Rahway. NJ rill

CONTENTS Mitral Valve Surgery................................. 1 James R. Pluth Myocardial Augmentation Using Skeletal Muscle Robert Fietsam. Jr. and Larry W. Stevenson 9 Thoracic Transplantation............................. 33 G. Michael Deeb. Steven F. Bolling. Edward L. Bove. Louis A. Brunsting. F. Mark Lupinetti and Mark B. Orringer Coronary Bypass Grafting in Conjunction with Carotid and Valvular Disease... 43 Anthony J. DelRossi and Aurel C. Cernaianu Cardiac AnestheSia and Oxygen Delivery and Uptake in the Critically III................................... 63 T. James Gallagher Complex Cardiac Surgery............................. 71 Denton A. Cooley Cardiac Surgery Without Transfusion: A Reappraisal Richard K. Spence 91 Physiology of Blood Flow During Cardiopulmonary Perfusion 101 Roger A. Vertrees and Louis Brownstein Postoperative Responses to Hypothermia: Nursing ConSiderations... 117 Jill A. Fikkert Cardiac Valve Replacement in the 1990's: The Nursing Perspective... 127 Susan Kiley Eckert Intraoperative Care of the CABG Patient: A Nursing Diagnosis Approach... 137 Gail Kaempf

ECMO: An Overview for Perfusionists Mark Kurusz 145 Biomaterials and the Development of Membrane Technology... 161 Jeffrey P. Sites The Physiologic Impact of Cardiac Surgery: The Nursing Perspective... 175 Bonnie R. Sakallaris The Automatic Implantable Cardioverter Defibrillator; Surgical Considerations and Pre- and Postoperative Nursing Care 183 Rosemary Volosin Thoracic Trauma and the Rupture of the Diaphragm Joan Perks 189 Nursing Research: The Key to Excellence in Nursing Practice 197 Elizabeth H. Winslow Contributors... 203 Index............................................ 207