Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2007
Case ReportsAcute thrombosis of an abdominal aortic aneurysm following intra-aortic balloon pumping.
Acute thrombosis of an abdominal aortic aneurysm is a rare but devastating surgical emergency. We present the first case of a patient with sudden thrombosis of an AAA delayed (more than 24 h) after removal of an intra-aortic balloon pump. ⋯ The patient received an aorto-bifemoral graft. The associations between intra-aortic balloon pump counter-pulsation and abdominal aortic thrombosis are discussed.
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Interact Cardiovasc Thorac Surg · Oct 2007
Case ReportsReverse-remodeling after coronary artery bypass grafting in ischemic cardiomyopathy: assessment of myocardial viability by delayed-enhanced magnetic resonance imaging can help cardiac surgeons.
Preoperative delayed-enhanced magnetic resonance imaging (DE-MRI) was performed to estimate myocardial viability in a 57-year-old man with ischemic cardiomyopathy in order to decide the best course of treatment. The patient was diagnosed as having congestive heart failure with triple-vessel involvement (ejection fraction of 7%, end-diastolic volume index of 160 ml/m2, end-systolic volume index of 148 ml/m2). 99mTc-sestamibi single-photon emission computed tomography revealed severe reduction of the uptake at both stress and resting phases in the anterior, lateral and inferior segments. ⋯ Six months after the operation, catheterization demonstrated dramatic improvement in ventricular function, with the ejection fraction having increased to 36%. This case suggests that preoperative assessment of myocardial viability by DE-MRI could help cardiac surgeons to choose the best treatment for patients with ischemic cardiomyopathy.
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Interact Cardiovasc Thorac Surg · Oct 2007
Review Meta AnalysisIs a stentless aortic valve superior to conventional bioprosthetic valves for aortic valve replacement?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether a stentless valve is superior to conventional stented valves when tissue aortic valve replacement is performed. Altogether more than 515 papers were found using the reported search, of which 16 represented the best evidence to answer the clinical question. ⋯ At six months several studies and a meta-analysis have shown superior left ventricular mass regression in the stentless valve groups. However, by 12 months the stented valve groups catch up in terms of mass regression and this significance disappears. So the 'eminent speaker from the floor', was right with his statement, that there have been no definitively proven benefits for stentless valves.
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Interact Cardiovasc Thorac Surg · Oct 2007
Multicenter StudyTransfusion practice in coronary artery bypass surgery in Denmark: a multicenter audit.
Transfusion rates in coronary artery bypass grafting (CABG) continue to vary substantially, although guidelines for allogeneic transfusion have been developed. In order to evaluate ongoing transfusion practices, we performed a multicenter audit in four Danish hospitals regarding the use of allogeneic blood products among patients undergoing first-time CABG. Data on patient characteristics, peri- and postoperative factors were retrieved from 600 patient records (150 records per hospital). ⋯ The relative risk of receiving an allogeneic blood transfusion was 2.1 (95% CI: 1.6-2.7) in the hospital with the highest transfusion rate, after adjustment for patient-, drug-, and procedure-related factors. Interesting differences in transfusion rates exists in Danish hospitals and these differences may reflect true variations in transfusion practices. Audits create a basis for educational efforts among surgeons and anesthesiologists to standardize transfusion practices.
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Interact Cardiovasc Thorac Surg · Oct 2007
Predictive value of paediatric risk of mortality score and risk adjustment for congenital heart surgery score after paediatric open-heart surgery.
This study compared the performance of risk adjustment for congenital heart surgery (RACHS-1) score with paediatric risk of mortality (PRISM) score in operative risk prediction after open-heart surgery in children. This was a retrospective analysis of a non-selected patient population from the paediatric intensive care unit of Helsinki University Hospital. All consecutive congenital open-heart surgery patients operated in Finland between the years 2000 and 2004, who were under 18 years of age, were included in this retrospective analysis. ⋯ With only a moderate discriminating AUC, RACHS-1 failed to adequately predict death after paediatric open-heart surgery. The predictive power of PRISM in this patient group was poor. Both scores overestimated the actual mortality rate.