Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2010
ReviewThe Fontan circulation: who controls cardiac output?
In a Fontan circuit the mechanisms involved in control of cardiac output at rest and during exercise differ significantly from normal. The classical model presumes an unlimited preload which is not available in the Fontan circuit. This review critically analyses the role of contractility, heart rate, and afterload and highlights the importance of pulmonary vascular resistance (PVR) in determining adequate preload and, therefore, cardiac output in these patients. A conceptual model of the determinants of cardiac output in Fontan patients is presented.
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Interact Cardiovasc Thorac Surg · Mar 2010
Randomized Controlled Trial Comparative StudyClinical performance and biocompatibility of hyaluronan-based heparin-bonded extracorporeal circuits in different risk cohorts.
This prospective randomized study compares novel hyaluronan-based heparin-bonded circuits vs. uncoated controls across EuroSCORE patient risk strata including biomaterial evaluation. Over a two-year period, 90 patients undergoing coronary artery bypass grafting were prospectively randomized to one of the two perfusion protocols: Group 1 was treated with hyaluronan-based heparin-bonded preconnected circuits (Vision HFO-GBS, Gish, CA, USA) and Group 2 with identical uncoated controls. Each group was composed of three subgroups (n=15) with respect to preoperative evaluation of low (EuroSCORE 0-2), medium (3-5) and high (6+) risk patients. ⋯ C3a (ng x ml(-1)) levels were significantly lower at T3 (0.2+/-0.04 vs. 0.31+/-0.05), T4 (0.25+/-0.04 vs. 0.51+/-0.05), T5 (0.38+/-0.04 vs. 0.56+/-0.05) and interleukin-6 (pg x ml(-1)) at T4 (91+/-18 vs. 124+/-20), T5 (110+/-20 vs. 220+/-25) in coated group vs. control (P
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Interact Cardiovasc Thorac Surg · Mar 2010
Comparative Study Clinical TrialFive years follow-up after Y-graft arterial revascularization: on pump versus off pump; prospective clinical trial.
We report our comparative experience of on-pump and off-pump full arterial coronary artery bypass grafting (CABG) using both internal mammary arteries (IMAs) anastomosed as a Y-graft. ⋯ The use of a free RIMA as Y-graft from the LIMA performed off pump eradicates aortic manipulations and provides complete revascularization to high-risk patients with mortality similar to the one of a lower risk population operated on pump. The morbidity and cost was lower in the off-pump group. This advocates for the widespread usage of the technique in high-risk patients.
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Interact Cardiovasc Thorac Surg · Mar 2010
Traumatic fracture of nitinol thermoreactive sternal clips.
Median sternotomy can be associated with significant morbidity, including non-union, dehiscence and mediastinitis. The use of flexible thermoreactive sternal clips has been introduced recently as an alternative method of sternal closure and is advocated in patients at increased risk of sternal breakdown. It is associated with a decreased incidence of sternal complications as well as allowing faster sternal closure and easy removal on resternotomy. This report describes the case of a fractured thermoreactive clip following trauma, resulting in sternal dehiscence necessitating sternal rewiring.