Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2011
Mid-term results of tricuspid annuloplasty using the MC3 ring for secondary tricuspid valve regurgitation.
We investigated mid-term outcomes after ring annuloplasty with the MC3 ring and aimed to identify factors associated with recurrent tricuspid regurgitation (TR). From October 2006 to October 2010, 136 patients (male:female 80:56, with a mean age 64.7±11.8 years) underwent tricuspid valve (TV) annuloplasty for functional TR. The indications for TV annuloplasty were (1) severe TR, or (2) mild or moderate TR with pulmonary hypertension (systolic pulmonary artery pressure >50 mmHg) or tricuspid annular (TA) dilatation, in patients undergoing mitral valve (MV) surgery. ⋯ Multivariate analysis revealed that residual TR was significantly associated with preoperative severe TR, left ventricular end-diastolic dimension >70 mm, right ventricular dimension >40 mm, dilated cardiomyopathy (DCM) and left ventriculoplasty. This MC3 ring corrects TR effectively, and provided good results. We must point out, however, that additional or alternative surgical options should still be considered for high-risk of repair failure, such as those with DCM or high pulmonary hypertension.
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Interact Cardiovasc Thorac Surg · Jul 2011
Comparative StudyContinuous cardiac output monitoring with an uncalibrated pulse contour method in patients supported with mechanical pulsatile assist device.
We evaluated the accuracy of an uncalibrated pulse contour method called Pressure Recording Analytical Method (PRAM) compared with continuous thermodilution for cardiac output (CO) monitoring in patients implanted with a pulsatile left ventricular assist device (LVAD). Twelve adult patients implanted with the HeartMate I-XVE device were studied. CO was simultaneously evaluated by PRAM and by continuous thermodilution. ⋯ A good correlation was found between LVAD-CO and either ThD-CCO (r=0.88) or PRAM-CO (r=0.86), but an overestimation of 10% was observed for both PRAM-CO (mean bias -0.44 l/min) and ThD-CCO (mean bias -0.40 l/min). Our results demonstrated good agreements between PRAM-CO, ThD-CCO and LVAD-CO. PRAM derives CO from a peripheral artery without calibration and may be a complementary tool in the hemodynamic assessment of patients supported with a VAD.
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Interact Cardiovasc Thorac Surg · Jul 2011
Feasibility of blood conservation strategies in pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.
Blood transfusion requirements were reviewed for a consecutive series of 25 patients undergoing elective pulmonary endarterectomy (PEA) between August 2005 and March 2009 in our institution. Patients were divided into two groups based on the implementation of a conservative blood transfusion algorithm that combined antifibrinolytic therapy, intraoperative blood sequestration, blood salvage and lack of correction of coagulation parameters in the absence of ongoing bleeding. ⋯ The international normalized ratio normalized within six to 12 hours after discontinuation of cardiopulmonary bypass without transfusion of fresh frozen plasma or platelets in 13 of the 16 patients. In conclusion, a conservative blood transfusion strategy allows PEA to be safely performed with no or minimal blood product transfusions in a majority of patients despite deep hypothermic circulatory arrest.
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Interact Cardiovasc Thorac Surg · Jul 2011
Case ReportsMalpositioning of the chest tube across the anterior mediastinum is risky in chronic obstructive pulmonary disease patients with pneumothorax.
Malpositioning is one of the most common complications of chest tube insertion and is associated with increased morbidity and mortality. We present two cases of patients with chronic obstructive pulmonary disorder (COPD) in whom malpositioned chest tubes penetrated through the anterior mediastinum to the contralateral pleural cavity, and were later removed without complications. Both patients had a relatively wide retrosternal airspace and received blunt dissection with a trocar for percutaneous chest tube insertion, which may have increased the risk of chest tube penetration through the anterior mediastinum during tube thoracostomy. Further, the precise location of the malpositioned chest tubes could not be confirmed by single-view anteroposterior portable chest radiography, and computed tomography (CT)-scan was more helpful in the diagnosis and management of the cases reported herein.
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Interact Cardiovasc Thorac Surg · Jul 2011
Randomized Controlled TrialResults of coronary artery bypass grafting alone and combined with surgical ventricular reconstruction for ischemic heart failure.
In this study, we included 236 patients with ischemic heart failure and ejection fraction (EF) <35% who underwent surgical treatment. Patients were randomized in two groups. There were 116 patients who underwent coronary artery bypass grafting (CABG) with surgical ventricular reconstruction (SVR) and 120 patients who underwent CABG alone. ⋯ However, after isolated CABG EF did not increase significantly (32±7 preoperatively and 34±11 postoperatively). One- and three-year rates were 95% and 78% after SVR with CABG and 83% and 78% after CABG alone. Despite the more aggressive surgical strategy, left ventricular reconstruction did not increase operative mortality and early results were significantly effective compared with coronary artery bypass grafting alone.