Cardiovascular surgeons

There seems to be a lack of collaboration between the in vitro investigator and the physician (cardiologist and/or cardiovascular surgeon). Therefore, there are very few articles that attempt to relate specific in vitro flow characteristics to clinical performance and complications. 

In the cardiovascular arena, hundreds of thousands of patients are treated by interventional cardiologists, whereas in the past these people would have been treated by surgeons. The surgeons, to offset the loss of some patients, take on more difficult procedures which over time become routine in nature. Thus, more patients can be successfully treated and the marketplace expands. 

One of the more intriguing cardiovascular developments is cardiomyoplasty where implantable technologies are blended with another part of the body to take over for a diseased heart. One company, Medtronic, in close collaboration with surgeons, has developed a cardiomyoplasty system to accompany a technique of wrapping back muscle around a diseased heart which can no longer adequately pump. A combination pacemaker and neurological device senses the electrical activity of the heart and correspondingly trains and stimulates the dorsal muscle to cause the defective heart to contract and pump blood. Over 50 implants have been performed to date. 

Implantable valves, particularly mechanical valves which continue to encroach on tissue valves, are unique. Methods such as valvuloplasty, mitral valve repair, or use of ultrasound are unlikely to reduce the number of valve replacements into the twenty-first century. Valve selection remains in the hands of the surgeon because of the critical nature of the procedure. If anything goes wrong, the result can be catastrophic to the patient. Cost of a valve, from 3000— 4000, is a relatively small part of the cost of open-heart surgery which can mn as high as 30,000. Growth of the cardiovascular valve market has slowed in the United States with the decline of the threat of rheumatic fever. 

Contemporary anesthetic management requires (1) rapid loss of consciousness, which eliminates awareness, memory of pain, anxiety, and stress throughout the surgical period (2) a level of analgesia sufficient to abohsh the reflex reactions to pain, such as muscular movement and cardiovascular stimulation (3) minimal and reversible influence on vital physiological functions, such as those performed by the cardiovascular and respiratory systems (4) relaxation of skeletal muscle to facilitate endotracheal intubation, provide the surgeon ready access to the operative field, and reduce the dose of anesthetic required to produce immobihty (5) lack of... 

Last but not least requirement, artificial arterial substitutes must be able to be connected to the host s vessels using sutures, the only reliable mean surgeons trust (Fig. 2). The connections performed must be stable and blood tight for as long as the prosthesis will remain patent. This last condition has supported the interest of surgeons for vascular prostheses made of woven or non-woven and knitted synthetic fabrics. The following sections give an outline of the different steps that line the evolution of materials for the cardiovascular system, and present some prospective solutions that have been proposed and supposed to improve the performances of these materials. 

This work was supported in part by National Institutes of Health (NIH) grants HL-47416 and HL-48743, by a Merit Review Award from the U.S. Veterans Administration, and by a grant from NitroMed, Inc. G.R.U. is the recipient of a National Research Service Award from NIH (HL-09124) and an American College of Surgeons Fellowship Award. G.N.W. is the recipient of a Cardiovascular Training Grant Fellowship from NIH (T32 HL-07224). J.L. is the recipient of a Research Career Development Award from NIH (HL-02273). We express our appreciation to Stephanie Tribuna for expert technical assistance. 

The actual capabilities of persons over age 60, and the ability to detect disease or 2748 a precipitous decline in their faculties, were the subject of conflicting medical testimony. Western s expert witness, a former FAA Deputy Federal Air Surgeon, was especially concerned about the possibility of a cardiovascular event such as a heart attack. He testified that with advancing age the likelihood of onset of disease increases and that in persons over age 60 it could not be predicted whether and when such diseases would occur. Id., at 389. 

Cardiovascular technician Cardiac catheterization nurse Anesthesiologist Radiology technician Heart team Cardiac surgeon... 

Cardiovascular technicians Radiology technicians Catheterization laboratory nurse Heart team/perfiisionist Cardiac surgeon Anesthesiologist Extraction coordinator ... 

Using medical devices such as catheters, angioplasty balloons, pacemaker leads, and cardiovascular stents usually involves insertion of such devices into urinal tracts or blood vessels. During insertion, high surface lubricity of Ihe devices helps to facilitate the insertion process and reduce insertion-associated tissue damage, which benefits both the patient and the surgeon. Early approaches to decrease insertion friction involve using lubricants such as olive oil and silicon oil, or low friction materials like polyethylene. Due to the superior mechanical properties, polyurethane is extensively used in catheters/baUoons and it is desirable to improve the lubricity of polyurethane materials. 

The Health Consequences of Smoking Cardiovascular Disease. A report of the Surgeon General U.S. Gov t Printing office, 1983. 

Decreased life expectancy is not the only medical disadvantage of overweight. Obese people are more likely to develop diabetes mellitus, gall-bladder disease, some forms of cardiovascular disease, and arthritis of weight-bearing joints. If they require surgery they present considerable problems to both the anaesthetist and surgeon. Since obesity is not one of the conditions coded in death certificates it is impossible to provide accurate data about the contribution of obesity to death and ill-health in the community, but there is no doubt that it is a major factor. 

Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. / Am Coll Cardiol, 2008. 52(23) p. el-121. 

Department of Health and Human Services (1983) The health consequences of smok ing cardiovascular disease. A report of the surgeon general. Rockville, MD... 

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