Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2010
Does the use of non-steroidal anti-inflammatory drugs after cardiac surgery increase the risk of renal failure?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief post-cardiac surgery increases the risk of renal failure. Altogether 53 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. ⋯ In contrast, one RCT assessing these COX-2 inhibitors detected a significant increase in the incidence of oliguria in this group compared to controls (parecoxib/valdecoxib: 14.5%, controls: 9.9%, P=0.187) as well as renal dysfunction (parecoxib/valdecoxib: 1.9%, controls: 0%, P=0.184). Three retrospective studies within paediatric populations, including one cohort study and two chart reviews, found various parameters of renal function, such as serum creatinine and blood urea nitrogen, to be similar between ketorolac and control groups. We conclude that NSAIDs are not associated with an increased risk of renal failure after cardiac surgery when administered at optimal 'renal' doses, within early postoperative settings, to patients at low-risk of renal dysfunction in whom NSAIDs are not contraindicated.
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Interact Cardiovasc Thorac Surg · Oct 2010
Case ReportsSuccessful support and separation from veno-venous extracorporeal membrane oxygenation support in a three-month-old patient following bidirectional Glenn procedure.
While extracorporeal membrane oxygenation (ECMO) is a useful mechanism of providing support in pediatric patients with cardiopulmonary dysfunction following surgery for congenital heart disease, outcomes have varied dramatically between distinct cardiac diagnoses. Reported outcomes of ECMO support following a bidirectional Glenn procedure in patients with single ventricle physiology are uniformly poor due in part to physiological and anatomical challenges inherent to cannulation in this population. We describe a unique veno-venous cannulation that can be applied to this patient population and has allowed for successful decannulation in our practice.
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Interact Cardiovasc Thorac Surg · Oct 2010
Does off-pump coronary artery revascularization improve the long-term survival in patients with ventricular dysfunction?
Coronary artery revascularization with cardiopulmonary bypass (ONCAB) has been reported to carry several risks for patients with poor left ventricular (LV) function (ejection fraction <30%). Off-pump CABG (OPCAB) has been proposed to result in a better outcome, but mid- and long-term survival rates have never been compared. The aim of this study is to assess the effect of cardiopulmonary bypass on this group of patients. ⋯ Despite the reported benefits of OPCAB, there was no significant influence on the in-hospital mortality, mid-term survival or long-term survival in patients with LV dysfunction. With adequate myocardial protection in ONCAB and complete revascularization in OPCAB, similar results are achievable.
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Interact Cardiovasc Thorac Surg · Oct 2010
Outcomes of airway stenting for advanced lung cancer with central airway obstruction.
Approximately 30% of lung cancer patients will develop central airway obstruction (CAO). Interventional therapeutic bronchoscopy including airway stenting (AS) providing immediate and effective palliation is therefore essential to improve quality of life (QoL). However, no report has demonstrated the survival benefit of AS. ⋯ AS followed by adjuvant therapy provided a four-month increase in MST, although overall survival was not significantly changed. This study represents a single-institution experience. Although an aggressive strategy of AS is justified in order to improve symptoms and QoL, AS itself did not contribute to survival benefit.
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Interact Cardiovasc Thorac Surg · Oct 2010
Case ReportsThrombosis of the ascending aorta during mechanical circulatory support in a patient with cardiogenic shock.
Cardiogenic shock after percutaneous coronary intervention (PCI) is a life-threatening complication and is most often related to abrupt vessel closure. We present the case of a patient who developed cardiogenic shock after PCI and was supported with intra-aortic balloon counterpulsation and the Levitronix CentriMag short-term mechanical circulatory support. ⋯ Preoperative transesophageal echocardiography revealed a massive thrombus of the aortic root and ascending aorta despite optimal anticoagulation regimen. The patient succumbed due to multiorgan failure.