https://ccme.osu.edu/RSSeriesBrochure/27546-Regional%20Grand%20Rounds.pdf

The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the Perioperative Management of Patients with Implantable Defibrillators, Pacemakers and Arrhythmia Monitors: Facilities and Patient Management This document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS)

A plurality of embodiments of a distal perfusion device are disclosed, which device facilitates anastomosis constructions by maintaining a dry anastomosis site while simultaneously maintaining blood flow distally in the blood vessel to prevent ischemia and reduce overall patient trauma. The perfusion device is configured for installation into a blood vessel such as a left anterior descending coronary artery through an incision therein, to which is to be grafted a distal end of a blood vessel such as an internal mammary artery. The device includes a central member of selected configuration and material, terminating at either end thereof in respective selectively tapered end members. A lumen extending through the central member and end members, and selected perforations in the end members, maintain blood flow through the perfusion device. A selected portion or portions of the device's outer circumference fit snugly within the artery in the regions beyond and/or at the anastomosis site, to maintain the latter free of blood. Several methods for deploying and removing respective embodiments of the device also are illustrated.

A perfusion device for maintaining blood flow in a vessel while isolating an anastomosis

Hypoxic states of the cardiovascular system are undoubtedly associated with the most frequent diseases of modern times. They originate as a result of disproportion between the amount of oxygen supplied to the cardiac cell and the amount actually required by the cell. The degree of hypoxic injury depends not only on the intensity and duration of the hypoxic stimulus, but also on the level of cardiac tolerance to oxygen deprivation. This variable changes significantly during phylogenetic and ontogenetic development. The heart of an adult poikilotherm is significantly more resistant as compared with that of the homeotherms. Similarly, the immature homeothermic heart is more resistant than the adult, possibly as a consequence of its greater capability for anaerobic glycolysis. Tolerance of the adult myocardium to oxygen deprivation may be increased by pharmacological intervention, adaptation to chronic hypoxia, or preconditioning. Because the immature heart is significantly more dependent on transsarcolemmal calcium entry to support contraction, the pharmacological protection achieved with drugs that interfere with calcium handling is markedly altered. Developing hearts demonstrated a greater sensitivity to calcium channel antagonists; a dose that induces only a small negative inotropic effect in adult rats stops the neonatal heart completely. Adaptation to chronic hypoxia results in similarly enhanced cardiac resistance in animals exposed to hypoxia either immediately after birth or in adulthood. Moreover, decreasing tolerance to ischemia during early postnatal life is counteracted by the development of endogenous protection; preconditioning failed to improve ischemic tolerance just after birth, but it developed during the early postnatal period. Basic knowledge of the possible improvements of immature heart tolerance to oxygen deprivation may contribute to the design of therapeutic strategies for both pediatric cardiology and cardiac surgery.

https://www.physiology.org/doi/pdf/10.1152/physrev.1999.79.3.635

Development of Cardiac Sensitivity to Oxygen Deficiency: Comparative and Ontogenetic Aspects

An implantable medical device comprising a drug-loaded polymer overlaid with a fabric that promotes tissue ingrowth is useful in a wide variety of tissue engineering applications. The invention includes, for example, prosthetic heart valves, annuloplasty rings, and grafts, having enhanced biocompatibility and biostability. Methods of making and using the implantable medical devices of the invention are also included.

Implantable medical device with enhanced biocompatibility and biostability

Patients with implanted cardiac devices (generally of advanced age and with severe cardiovascular disease) often require diagnostic and therapeutic procedures that involve strong sources of EMI. It should be emphasized that with appropriate planning most of these procedures can be performed safely. Consultation regarding exposure to EMI in the medical environment constitutes a frequent clinical practice issue for physicians and nurses caring for patients with pacemakers and implantable cardioverter defibrillators (ICDs). The routine use of prepocedural checklists to identify patients with implanted cardiac devices in advance is strongly recommended.1 Likewise, all institutions (especially those with dedicated staff and clinics) should have written policies regarding evaluation and management of patients before, during, and after procedures involving sources of EMI. Continuous education of patients and colleagues in other specialties and avoidance of improvisation will go a long way in preventing bad outcomes and reducing legal liability.

/pdf/interference-in-implanted-cardiac-devices-part-ii-1db456q0ny.pdf

Interference in Implanted Cardiac Devices, Part II

https://www.annalsthoracicsurgery.org/article/S0003-4975(10)62658-6/pdf

Pacemaker backup-mode reversion and injury during cardiac surgery.

Considerations in the development of artificial heart valve substitutes for use in infants and small children

Ever since the first attempts to replace blood vessels with a fabric prosthesis, surgeons have tried to understand and control the host's reactions to this foreign object. The natural tendency of the host is to try to incorporate the graft into the body by encapsulating it in living tissue, thus eliminating the interface between the synthetic fibers and the blood. As a result of an increased understanding of the mechanisms involved in this process, continued improvements in materials and construction of grafts have been made in order to optimize the formation of the biologic linings that develop around the synthetic fibers in response to their presence. More recently, the principles applied to the construction of the tubular grafts used in peripheral vascular surgery have been extended to the fabrication of other foreign bodies that have direct contact with the blood stream when implanted. These include prosthetic heart valves, patches used

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=SURG&articleId=579413&pdfFileName=archsurg_109_3_002.pdf

Nina S. Braunwald

Papers

Pacemaker backup-mode reversion and injury during cardiac surgery.

Considerations in the development of artificial heart valve substitutes for use in infants and small children

Tissue Acceptance of Materials Implanted Within the Circulatory System

Local Cardiac Hypothermia for Myocardial Protection During Correction of Congenital Heart Disease

Acceleration of tissue ingrowth on materials implanted in the heart.