Interactive cardiovascular and thoracic surgery
-
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.
-
Interact Cardiovasc Thorac Surg · Jan 2009
ReviewCould we use abdominal compressions rather than chest compression in patients who arrest after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether abdominal cardiopulmonary resuscitation (CPR) could be used instead of external cardiac massage either to protect the recent sternotomy or while chest compressions are not possible whilst a sternotomy is being performed. Altogether 386 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. ⋯ We found only one paper in a porcine model that looked at the effectiveness of abdominal only CPR although it did show that abdominal CPR was actually 60% better than chest CPR. Interposed abdominal and chest compressions has been much more extensively studied and has been shown to be significantly better in return of spontaneous circulation than chest compressions alone. We conclude that currently there is very little evidence to support abdominal only CPR although these studies may support the concept that it may potentially increase the coronary and cerebral perfusion pressure.
-
Interact Cardiovasc Thorac Surg · Jan 2009
Randomized Controlled Trial Comparative StudyThe impact of allogenic red cell transfusion and coated bypass circuit on the inflammatory response during cardiopulmonary bypass: a randomized study.
This study is designed to determine and compare the effects of transfusion and coated circuits on the inflammatory response during cardiopulmonary bypass. ⋯ Allogenic red cell transfusion enhances inflammatory response during CPB; coated circuit systems have a limiting effect on this inflammatory reaction.
-
Interact Cardiovasc Thorac Surg · Jan 2009
ReviewDoes surgical correction of coarctation of the aorta in adults reduce established hypertension?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether surgical correction of coarctation of the aorta in adults (>16 years) results in reduction in established hypertension. Altogether 484 relevant papers were identified using the below mentioned search, 11 papers represented the best evidence to answer the question. ⋯ The reduction in blood pressure postoperatively has been demonstrated consistently, with most patients reported as normotensive without medication and the remainder having reduced requirements for antihypertensive medications. In all the papers included here (except one), there was no early mortality and no procedure-related late mortality during mean follow-up ranging from 2 to 14 years. Thus, surgical correction of aortic coarctation is a relatively safe procedure.
-
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.