Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jan 2009
Factors affecting post minimally invasive direct coronary artery bypass grafting incidence of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting and mortality of cardiac origin.
In the present study we identify parameters which influence the incidence of myocardial infarction (MI), need for percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and cardiac mortality after minimal invasive coronary artery bypass grafting (MIDCABG). With a mean follow-up of 30+/-11.2 months, 390 patients were assessed with Wald test-corrected chi(2) analysis to identify preoperative factors which correlate with a higher incidence of post-MIDCABG MI, PCI, CABG and mortality from cardiac causes. We found an increased incidence of postoperative MI in patients with 2-vessel (8.7%) and 3-vessel (7.7%) vs. 1.3% 1-vessel coronary artery disease (CAD) (P=0.023), and in patients with preceding cardiac procedure (CABG and PCI: 8.4% vs. 2.0% without, P=0.023). ⋯ Preoperative low ejection fraction (EF) (multivariate, P<0.001), preoperative MI (P=0.007) and extent of CAD (P=0.001) were associated with a higher post-MIDCABG mortality. None of the parameters correlated with subsequent CABG MIDCABG. The extent and history of CAD, history of cardiac interventions and low EF seem to influence the outcome adversely and should be considered deciding pro or against the MIDCAB-option.
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Interact Cardiovasc Thorac Surg · Jan 2009
Randomized Controlled TrialClinical benefit of cardiac ischemic postconditioning in corrections of tetralogy of Fallot.
The postoperative course of cyanotic patients is generally more complicated than in acyanotic patients. The ischemic postconditioning provides protection from myocardial injury. We conducted a randomized trial to evaluate the clinical benefits of postconditioning in patients undergoing repair of tetralogy of Fallot. ⋯ The ventilation time was significantly reduced in postconditioned patients compared with control (14+/-15 h vs. 25+/-28 h, P=0.024). There was a significant decrease in the ICU stay in the postconditioned patients (P=0.048). The study suggests that ischemic postconditioning may provide clinical benefits with respect to the morbidity, ventilation time, ICU stay, requirement of inotrope in patients undergoing repair for tetralogy of Fallot.
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This study evaluates the clinical outcome following surgery of our patients for the last seven years. Between 2001 and 2008 we performed tracheal resections in 60 patients. There were 46 cases of postintubation stenosis and 14 tumors. ⋯ Basic releasing maneuvers allow a good length of the trachea to be resected with no complications. We consider that emergency tracheal resection can be performed with success. Squamous cell carcinoma was the most frequent histological type in our series.
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Interact Cardiovasc Thorac Surg · Jan 2009
Case ReportsChylopericardial tamponade complicating oesophago-gastrectomy.
Although unusual, chyle leak following oesophagectomy is a recognised complication affecting 2-4% of patients. We describe the hitherto unreported sequelae of a chyle leak causing cardiovascular compromise secondary to pericardial tamponade 13 days after Ivor-Lewis oesophago-gastrectomy.