Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2010
Who needs preoperative routine chest computed tomography for prevention of stroke in cardiac surgery?
Although chest computed tomography (CT) is useful for identifying ascending aortic calcification before surgery, the efficacy of routine preoperative CT in cardiac surgery is unknown. We sought to clarify the role of routine preoperative chest CT for the determination of ascending aortic calcification before cardiac surgery to aid in the prevention of stroke. Three hundred consecutive patients who underwent elective cardiac operations excluding thoracic aortic surgery had preoperative non-contrast CT. ⋯ The prevalence of severe ascending aortic calcification was 11.9% (10/84) in patients with aortic stenosis. Stroke occurred in two (0.67%) of the patients in the entire group but none in the 13 patients with surgical modification. For patients with aortic stenosis or hemodialysis, a low postoperative stroke rate can be achieved in elective cardiac surgery by use of routine preoperative chest CT to identify patients with ascending aortic calcification who require modification of the surgical technique.
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Interact Cardiovasc Thorac Surg · Jul 2010
Case ReportsTakotsubo cardiomyopathy after elective mitral valve replacement.
Takotsubo cardiomyopathy is a syndrome characterized by transient acute left ventricular dysfunction, electrocardiographic changes that can mimic acute myocardial infarction and minimal release of myocardial enzymes in the absence of obstructive coronary artery disease. Reports of Takotsubo syndrome after cardiac surgery are exceptional. We describe a case of Takotsubo cardiomyopathy in a 68-year-old woman after elective mitral valve replacement. Takotsubo syndrome should be considered in the differential diagnosis of patients presenting cardiogenic shock after cardiac surgery.
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Interact Cardiovasc Thorac Surg · Jul 2010
ReviewMight type A acute dissection repair with the addition of a frozen elephant trunk improve long-term survival compared to standard repair?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in patients with an acute type A dissection (TAAD) is a frozen elephant trunk in addition to standard aortic dissection repair advantageous in terms of improved long-term mortality and closure of the distal false lumen? Altogether more than 138 papers were found using the reported search, of which six 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. ⋯ However, this procedure can be performed safely without increase the operative mortality and morbidity but with an overall higher cardiopulmonary bypass and circulatory arrest time. Spinal cord ischemia and malperfusion syndrome represents the main complications associated with this procedure. Despite few studies, this procedure seems to allow early thrombosis of the false lumen and a reduction of late thoraco-abdominal aneurysm formation and reoperations rate.
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Interact Cardiovasc Thorac Surg · Jul 2010
Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery.
Ablation outcomes were investigated in patients with and without statin pretreatment before cardiac surgery with concomitant surgical ablation for atrial fibrillation (AF). A prospective cohort study was performed containing 149 patients (n=73 statin group vs. n=76 control group) undergoing on-pump cardiac procedures with surgical ablation for paroxysmal or persistent AF. Measured outcomes were freedom from AF in the intensive care unit, discharge and at three and six months follow-up and perioperative markers of inflammation (white blood cell count, C-reactive protein). ⋯ Subgroup analysis showed that statin pretreatment was associated with higher rates of freedom from AF for paroxysmal AF at three and six months and for persistent AF after six months (P<0.05). Importantly, statin-pretreatment was independently predictive for freedom from AF at discharge [odds ratio (OR): 3.21; 95% confidence interval (CI): 1.2-8.55; P=0.02] and at three months (OR: 2.91; 95% CI: 1.14-7.45; P=0.026). Statin therapy prior to ablation surgery improves postoperative freedom from AF for paroxysmal and persistent AF in cardiac surgery patients.