Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2011
ReviewDoes a 'no-touch' technique result in better vein patency?
A best evidence topic was written according to a structured protocol. The question addressed was whether harvesting the saphenous vein (SV) as a conduit for coronary artery bypass grafting (CABG) using a no-touch technique would result in better patency rates. This technique involves the harvest of the SV with a pedicle of peri-vascular tissue left intact and the avoidance of distension of the vein prior to anastomosis. ⋯ These findings were supported by the demonstrated improvements in the cellular integrity of the vessels and the reduction in the mechanisms leading to graft failure seen in the no-touch harvested SV grafts. These morphological and cellular analyses were carried by five small comparative studies, demonstrating improved endothelial integrity and reduced injury, decelerated atherosclerotic processes, intact adventitial collagen layers, increase in the total area of vasa vasorum, elevated endothelial nitric oxide synthase expression and activity, and increased peri-vascular leptin levels and activity. We conclude that there are clear enhancements in vessel wall properties at a cellular level and angiographical evidence of superior graft patency when the no-touch SV harvesting technique is employed.
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Interact Cardiovasc Thorac Surg · Dec 2011
Multicenter StudyCharacteristics, management and outcomes of patients with acute coronary syndrome and prior coronary artery bypass surgery: findings from the second Gulf Registry of Acute Coronary Events.
To evaluate the baseline demographic/clinical characteristics, in-hospital treatment and outcomes among patients with or without prior coronary artery bypass graft surgery (CABG) presenting as acute coronary syndrome (ACS) from six Middle East countries. ⋯ ACS patients from Middle East countries with prior CABG have adverse baseline characteristics, reported higher GRACE risk score, multivessel disease, more severe LV dysfunction, cardiogenic shock, in-hospital major bleeding, but with less incidence of STEMI with less prominent surge of cardiac biomarkers. However, there was no significant difference in mortality during hospitalization, at 30 days and at one year between ACS patients with and without prior CABG. The reasons for this 'risk-mortality' paradox need to be further evaluated.
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Interact Cardiovasc Thorac Surg · Dec 2011
Case ReportsAortic valve regurgitation with aorto-right ventricular fistula following penetrating cardiac injury.
Aortic valve perforation due to a penetrating cardiac injury is extremely rare, especially with an associated shunt between the right ventricle and the aortic valve. We report here the case of an 18-year-old male, who after suffering a chest stab injury, was seen at another institution where he underwent an emergency left anterolateral thoracotomy and right ventricular suture. ⋯ Workup confirmed the presence of an acute aortic regurgitation due to perforation of the right coronary leaflet with an interventricular shunt. After implementing appropriate medical treatment, the valve was replaced with a mechanical prosthesis and the shunt was closed with an autologous pericardial patch.
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Interact Cardiovasc Thorac Surg · Dec 2011
Preliminary experience in the use of an extracellular matrix to repair congenital heart diseases.
Congenital heart diseases are corrected early in life, so the surgical procedure has to maintain the maximum potential for growth. The quest for the ideal material for cardiac tissue repair is still ongoing. Here, we describe our preliminary experience with an extracellular matrix for cardiac and vascular tissue repair. ⋯ In the last 25 months, we used an extracellular matrix for cardiac and vascular tissue repair. The patch is advocated to induce the patient's own tissue regeneration. The early results are encouraging, but a longer follow-up is needed to understand the real potential of this material.
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Interact Cardiovasc Thorac Surg · Dec 2011
Comparative StudyA comparison of external and internal jugular venous pressures to monitor pulmonary artery pressure after superior cavopulmonary anastomosis.
The internal jugular vein continues to be the preferred site for cannulation to monitor central venous pressure despite the reported evidence of the accuracy of external jugular venous pressure (EJVP) to reliably predict internal jugular venous pressure (IJVP). Internal jugular venous cannulation carries a risk of thrombosis that can be life-threatening in children undergoing superior cavopulmonary anastomosis and a subsequent Fontan procedure. The present study compared IJVP and EJVP in children undergoing superior cavopulmonary anastomosis and found no statistical and clinical difference between IJVP and EJVP. Thus, external jugular vein cannulation reliably predicts IJVP and pulmonary artery pressures in children undergoing superior cavopulmonary anastomosis, and may obviate the risk of life-threatening cavopulmonary thrombosis.