Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Sep 2009
Multi-modality blood conservation strategy in open-heart surgery: an audit.
The objective of this study was to perform an audit of the use of homologous blood and blood products in patients undergoing open-heart surgery by a single surgical team that follows an in-house protocol for blood conservation. The hospital records of 310 consecutive patients (age >15 years) undergoing open-heart surgery over a period of 8 months were retrospectively reviewed to assess the comprehensive blood conservation protocol. Homologous blood and blood product usage during and after surgery, in the intensive care unit and up to hospital discharge was analyzed. ⋯ Only 54 patients (17.4%) received one or more units of allogenic transfusion either intraoperatively or postoperatively until discharge. Mean hemoglobin at discharge was 9.8 Grams% (8.9-12 Grams%). A standardized multidisciplinary approach to blood conservation in cardiac surgery decreases bleeding and transfusion requirements in a safe and cost effective manner.
-
Interact Cardiovasc Thorac Surg · Sep 2009
Case ReportsSpontaneous coronary artery rupture in a young patient: a rare diagnosis for cardiac tamponade.
We report a case of spontaneous coronary artery rupture (SCAR) in a 43-year-old male who presented with symptoms of sudden onset of chest pain and hemodynamic collapse. There were no abnormal electrocardiogram changes and serum troponin was not detected. Acute aortic dissection was suspected but urgent contrast computed tomography (CT) showed a large pericardial effusion with cardiac tamponade. ⋯ The patient was successfully managed with direct repair under cardiopulmonary bypass. Postoperative multi-detector dual-source 64-slice CT coronary angiography revealed normal coronary arteries with absence of atherosclerotic plaque in all coronary arterial segments. It is concluded that, though rare, a differential diagnosis of SCAR should be considered in cases of acute chest pain with cardiac tamponade in adult patients of all ages.
-
Interact Cardiovasc Thorac Surg · Sep 2009
ReviewEndovascular versus open surgical repair for blunt thoracic aortic injury.
A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether patients with acute traumatic thoracic aortic injury have a better outcome with endovascular or open surgical repair. ⋯ We concluded that the peri-procedural mortality rate for patients with traumatic thoracic blunt aortic injury is lower for patients treated with an endovascular stent graft when compared to the open technique. This important benefit is at the cost of a high procedure complication rate, requirement for long-term surveillance of the stent and uncertain medium and longer-term outcome.
-
Interact Cardiovasc Thorac Surg · Sep 2009
ReviewDoes pulmonary valve replacement post repair of tetralogy of Fallot improve right ventricular function?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether pulmonary valve replacement (PVR) after repair of tetralogy of Fallot improved outcomes including right ventricular (RV) function. Altogether 730 relevant papers were identified using the below mentioned search, 19 papers represented the best evidence to answer the question. ⋯ We conclude that PVR after tetralogy of Fallot repair has been shown to improve RV function and to offer symptomatic benefit. Several retrospective reviews report consistent reductions in RV end diastolic and systolic volumes and improvement in RV stroke volume, with one study also finding improvement in left ventricular stroke volume. PVR in this population appears to result in improved clinical outcome and can be performed with low mortality.
-
Interact Cardiovasc Thorac Surg · Sep 2009
Microalbuminuria and short-term prognosis in patients undergoing cardiac surgery.
To examine if preoperative microalbuminuria (MA) is associated with in increased risk of adverse outcomes in patients undergoing elective cardiothoracic surgery, and if adding information on MA could improve the accuracy of the additive EuroSCORE. ⋯ Preoperative MA in patients undergoing elective cardiothoracic surgery was not associated with most early adverse outcomes. However, risk of septicaemia was higher and patients with MA also had a marginally longer length of ICU and hospital stay. Information on preoperative MA did not improve the accuracy of the additive EuroSCORE.