Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Nov 2009
The effect of diabetic medications on creatine kinase-myocardial band levels in patients undergoing coronary artery bypass surgery.
Ischemic preconditioning has been shown to attenuate the rise in creatine kinase-myocardial band levels that occur with coronary artery bypass surgery (CABG). Recently, concerns have been raised that some sulfonylureas particularly glibenclamide may block ischemic preconditioning. The purpose of this study was to determine the effect of various diabetic medicines on creatine kinase-myocardial band levels after CABG. ⋯ After univariable comparisons, linear regression was used to determine the statistically significant predictors of creatine kinase-myocardial band levels. After correction for other factors, none of the diabetic medicines was a statistically significant predictor of creatine kinase-myocardial band levels. We found that the use of glibenclamide or other diabetic medications had no effect on creatine kinase-myocardial band levels the morning after patients underwent CABG.
-
Interact Cardiovasc Thorac Surg · Nov 2009
Comparative StudyMinimal extracorporeal circulation and off-pump compared to conventional cardiopulmonary bypass in coronary surgery.
Although minimal extracorporeal circulation (MECC) and off-pump surgery are equal or better alternatives to conventional cardiopulmonary bypass (CCPB) regarding perioperative morbidity, use of blood and blood products and completeness of revascularization, CCPB is still being used in the majority of coronary artery bypass grafting (CABG) operations. ⋯ Perioperative morbidity of MECC and OPCAB is comparable to or even less in comparison to CCPB. MECC allows CABG surgery in cardiac arrest so that completeness of revascularization is being warranted and longer patency rates can be guaranteed. Furthermore, the use of blood and blood products is significantly less in MECC surgery so that MECC should be considered first choice in CABG surgery over CCPB and OPCAB.
-
Interact Cardiovasc Thorac Surg · Nov 2009
ReviewDoes intermittent cross-clamp fibrillation provide equivalent myocardial protection compared to cardioplegia in patients undergoing bypass graft revascularisation?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: does intermittent cross-clamp fibrillation provide equivalent myocardial protection compared to cardioplegia in patients undergoing bypass graft revascularisation? Altogether, 58 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ The ischaemic duration associated with intermittent cross-clamp fibrillation is invariably shorter than that associated with cardioplegic arrest, and this may be one explanation for the comparable outcomes. There may also be an element of preconditioning protection during the intermittent cross-clamp fibrillation method, as has been shown experimentally. During elective CABG in patients with no clinical evidence of aortic or cerebro-vascular disease, the incidence of peri-operative microemboli (ME) and postoperative neuropsychological disturbances are shown to be comparable with both techniques of myocardial preservation.
-
Interact Cardiovasc Thorac Surg · Nov 2009
ReviewIn patients with acute aortic intramural haematoma is open surgical repair superior to conservative management?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in patients with acute aortic intramural haematoma (IMH) is open surgical repair superior to conservative management. IMH is defined as a clinical condition related to but pathologically distinct from aortic dissection. ⋯ We conclude that surgical treatment of aortic IMH involving the ascending aorta with open distal replacement of ascending aorta results in lower mortality and longer survival compared to conservative management. IMH affecting the descending aorta can be managed with medical or endovascular interventional approach. In this latter group, serial imaging of the aorta is recommended, as aneurysm formation is not uncommon.
-
Interact Cardiovasc Thorac Surg · Nov 2009
Comparative StudyNeutrophil gelatinase-associated lipocalin levels after use of mini-cardiopulmonary bypass system.
Neutrophil gelatinase-associated lipocalin (NGAL) has been implicated as an early predictive urinary biomarker of ischemic acute kidney injury (AKI). The aim of this study was to compare the effects of miniaturized cardiopulmonary bypass system (MCPB) vs. standard cardiopulmonary bypass system (SCPB) system on kidney tissue in patients undergoing myocardial revascularization using urinary NGAL levels as an early marker for renal injury. Sixty consecutive patients who underwent myocardial revascularization were studied prospectively. ⋯ The MCPB system is safe in routine clinical use. Kidney function is better protected during MCPB as demonstrated by NGAL levels. NGAL represents an early biomarker of renal failure in patients undergoing cardiac surgery and the valuation of its concentration can aid in medical decision-making.