Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2010
Case ReportsSafety of coronary artery bypass grafting in patients with bilateral total carotid occlusions.
The presence of bilateral carotid artery occlusions in patients that require coronary artery bypass surgery is rare. Here, we report the successful coronary revascularization of two patients with cardiopulmonary bypass under moderate hypothermia. ⋯ The vertebral blood flows of both patients were also found to be highly increased. Following successful surgery, the postoperative courses were uneventful and patients were discharged from the hospital on the seventh postoperative day.
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Interact Cardiovasc Thorac Surg · May 2010
Review Comparative StudyWhich cannulation (ascending aortic cannulation or peripheral arterial cannulation) is better for acute type A aortic dissection surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Which cannulation (ascending aortic cannulation or peripheral arterial cannulation) is better for acute type A aortic dissection surgery?' Altogether 393 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ Central cannulation has promising results with a lower mortality rate but a higher stroke rate. Direct cannulation of the true lumen is a promising method for quick and easy establishment of CPB. Axillary artery cannulation with a side graft, although it takes more time to construct, is proven to be safe and straightforward, with fewer local and systemic complications including lower mortality and neurological complications.
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Interact Cardiovasc Thorac Surg · May 2010
Case ReportsThree-dimensional transesophageal echocardiography in Ebstein's anomaly.
Three-dimensional (3D) transthoracic echocardiography has advantages over traditional two-dimensional (2D) echocardiography in visualizing tricuspid valve morphology in Ebstein's anomaly. We describe the application of intra-operative 3D transesophageal echocardiography during a tricuspid valve repair procedure in a patient with Ebstein's anomaly. ⋯ Analysis of the tricuspid valve, RVOT and pulmonary valve in the multi-planar review (MPR) mode revealed a bicuspid pulmonary valve, which had not been noticed on the preoperative 2D echocardiographic work-up. In this patient with Ebstein's anomaly, 3D TEE provided additional information on morphology and function of tricuspid valve, RVOT and pulmonary valve.
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Interact Cardiovasc Thorac Surg · May 2010
Comparative StudyImpact of clopidogrel use on mortality and major bleeding in patients undergoing coronary artery bypass surgery.
Patients who received clopidogrel prior to coronary bypass surgery are at increased risk for bleeding that must be balanced with risk of ongoing ischemia if coronary artery bypass grafting is delayed. This study aimed to evaluate the impact of clopidogrel on mortality and major bleeding in patients undergoing urgent coronary bypass surgery. We reviewed 451 consecutive patients who underwent urgent isolated coronary bypass surgery; 262 had not received clopidogrel, whereas 189 received clopidogrel < or = 5 days preoperative. ⋯ No difference was observed even after adjusting for the date of stopping clopidogrel preoperatively. Multivariate regression analysis showed that clopidogrel or the duration it was stopped preoperatively, did not predict adverse outcomes. Significant independent predictors included preoperative renal dysfunction, hemoglobin level and peripheral vascular disease. clopidogrel, or the time it was stopped prior to surgery, was not a risk factor for in-hospital death, massive bleeding, or other poor early outcomes in patients undergoing urgent coronary artery bypass surgery.
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Interact Cardiovasc Thorac Surg · May 2010
Comparative StudyDespite modern off-pump coronary artery bypass grafting women fare worse than men.
Female gender is an established risk factor for worse outcomes after cardiac surgery. Avoiding cardiopulmonary bypass (CPB) for coronary bypass grafting has an unknown effect on gender differences. Herein, we evaluate if gender has an impact on outcomes after modern off-pump coronary artery bypass grafting (OPCAB). ⋯ OPCAB offers low mortality and excellent clinical outcome. Women are more likely to experience postoperative complications. Even if partially neutralized by avoiding CPB, gender differences remain present with modern OPCAB strategies.