Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Nov 2009
Multicenter StudyAnomalous left coronary artery from the pulmonary artery: intermediate results of coronary elongation.
A two coronary system is preferred for correcting anomalous left coronary artery from the pulmonary artery (ALCAPA); however, translocation is not always possible. In countries where neonatal arterial switch operations have not been perfected coronary transfer can be difficult. The purpose of this report is to describe the intermediate results using the coronary elongation and translocation technique in developing countries. ⋯ Color Doppler showed a patent left coronary artery; echocardiography estimated a normal left ventricular ejection fraction and improved mitral regurgitation in all patients. The technique provides an alternative approach to translocation for ALCAPA in countries where routine neonatal coronary transfer techniques may not be perfected. Intermediate results are comparable to translocation.
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Interact Cardiovasc Thorac Surg · Nov 2009
Case ReportsA strategy for safe sternal reentry in patients with pseudoaneurysms of the ascending aorta using the PORT-ACCESS EndoCPB system.
Pseudoaneurysms of the ascending aorta developing after previous aortic or aortic valve surgery pose a high risk of exsanguination upon sternal reentry. In the past, femorofemoral bypass and hypothermic circulatory arrest before sternotomy was the preferred approach. Today, however, availability of the PORT-ACCESS EndoCPB system (Edwards Lifesciences, Irvine, CA, USA) allows for endovascular clamping and cardioplegia before sternotomy, avoiding circulatory arrest.
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Interact Cardiovasc Thorac Surg · Nov 2009
Case ReportsHeartmate XVE destination therapy for end-stage heart failure in a patient with human immunodeficiency virus.
Cardiac dysfunction is a known predictor of survival in patients with acquired immunodeficiency syndrome. In this report, we describe a human immunodeficiency virus (HIV)-infected patient with worsening heart failure who was managed successfully for 16 months with placement of a left ventricular assist device.
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Interact Cardiovasc Thorac Surg · Nov 2009
Postoperative administration of landiolol hydrochloride for patients with supraventricular arrhythmia: the efficacy of sustained intravenous infusion at a low dose.
The purpose of this study was to investigate the efficacy of landiolol hydrochloride, a short-acting beta(1) blocker, by initiating its administration at a low dose (5 microg kg(-1) min(-1)) in patients with postoperative supraventricular arrhythmia. The efficacy of landiolol was evaluated in 38 patients who, after developing postoperative atrial flutter or fibrillation, with sinus tachycardia and two patients who had a history of paroxysmal atrial fibrillation with frequent atrial extrasystole. The heart rate and blood pressure before and 2 h after the administration of landiolol were compared. ⋯ The heart rate was reduced from 137+/-26 bpm (before landiolol administration) to 93+/-18 bpm (2 h after the start of the medication, P<0.01). As an agent to correct an arrhythmic condition, landiolol successfully raised the systolic blood pressure from 108+/-24 mmHg (before medication) to 120+/-19 mmHg (2 h after the medication was started, P<0.05). Continuous intravenous infusion of landiolol at a low dose was found to be effective for postoperative supraventricular arrhythmia.
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Interact Cardiovasc Thorac Surg · Nov 2009
Comparative StudyAge >or=75 years is associated with greater resource utilization following coronary artery bypass grafting.
We examined whether complication rates and resource utilization among elderly patients undergoing coronary artery bypass grafting (CABG) differed from their younger counterparts. A retrospective review of prospectively collected data was conducted of 2936 patients undergoing first-time isolated CABG. Demographic and baseline clinical characteristics were collected, and patients grouped according to age into those <75 years (n=2424, younger) and >or=75 years (n=512, older). ⋯ Older patients incurred longer intensive care stays (2 days interquartile range (IQR) [1-3] vs. 1 day IQR [1-2]; P<0.0001) and a longer postoperative stay (8 days IQR [6-11] vs. 6 days IQR [5-8]; P<0.0001). Multivariate logistic regression analysis showed age >or=75 years was an independent predictor of postoperative LOS (OR=1.23, 95% CI [0.49-1.96]; P=0.001). Older patients aged >or=75 years undergoing CABG had significantly higher rates of postoperative complications and greater resource utilization than their younger counterparts.