Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2012
Comparative StudyImpact of clopidogrel on bleeding complications and survival in off-pump coronary artery bypass grafting.
This study investigated the impact of preoperative clopidogrel on bleeding complications and survival during and after off-pump coronary artery bypass grafting (OPCABG) and assessed the possible role of the antifibrinolytic agent aprotinin for attenuating blood loss after clopidogrel exposure. Prospectively collected data of 753 consecutive adult patients undergoing OPCABG were retrospectively reviewed; 139 (18.5%) patients received clopidogrel preoperatively. Statistical methods used were student paired t-test, Mann-Whitney U, Kruskal-Wallis, chi-square analysis and Kaplan-Meier with log-rank analysis. ⋯ Preoperative clopidogrel exposure does increase perioperative blood loss and blood transfusion requirements in patients undergoing OPCABG but has an otherwise excellent safety profile with a 94% 5-year survival rate. Aprotinin attenuated this blood loss. Based on these results a recommendation to discontinue clopidogrel prior to coronary artery bypass grafting cannot be maintained, if OPCABG strategies are considered.
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Interact Cardiovasc Thorac Surg · Mar 2012
Case ReportsRepair of a penetrating aortic arch injury using deep hypothermic circulatory arrest and retrograde cerebral perfusion.
The traumatic rupture of the thoracic aorta is a severe and life-threatening entity. The incidence of penetrating trauma to the aortic arch is not known, because most patients die of haemorrhage even before they receive adequate treatment. Clinical signs of such injuries include external or internal haemorrhage, bruit, distal pulse deficit, neurological deficit and shock. We present a 42-year old female with a penetrating aortic arch injury successfully repaired using deep hypothermic circulatory arrest and retrograde cerebral perfusion.
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Interact Cardiovasc Thorac Surg · Mar 2012
Histological and genetic studies in patients with bicuspid aortic valve and ascending aorta complications.
Aneurysm diameter and growing rate does not represent a definite parameter for operation in bicuspid aortic valve (BAV), ascending aortic aneurysm and normal root patients. Thus, we investigated histological and immunohistochemical aspects of different segments of ascending aorta (precisely, aortic root without dilatation, aneurysmatic tubular portion, dissected ascending aorta) and genetic features of patients with BAV and ascending aorta complication (aneurysm or dissection). ⋯ Based on our histological and genetic data, we underline that a surgical approach in patients with BAV, ascending aortic aneurysm and normal root, should consider not only the diameter of the aneurysmatic aortic portion but also the histological features of the whole ascending aorta and the genetic risk profile.
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Interact Cardiovasc Thorac Surg · Mar 2012
Case ReportsA right-sided aortic arch and aberrant left subclavian artery with proximal segment hypoplasia.
The right-sided thoracic aortic arch is a rare congenital malformation occurring during embryologic development. A majority of the cases present with two anatomic variations, one of which is an aberrant left subclavian artery (LSA) originating off the distal descending aortic arch. ⋯ This thoracic aneurysm is commonly known as Kommerell's diverticulum. This paper presents a case of an aberrant LSA originating off Kommerell's diverticulum with a proximal long-segment hypoplasia, a very rare anatomic variation.
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Interact Cardiovasc Thorac Surg · Mar 2012
Multicenter Study Comparative StudyPolicies of withholding and withdrawal of life-sustaining treatment in critically ill patients on cardiac intensive care units in Germany: a national survey.
To determine the decision-making process of withholding and/or withdrawal (WH/WD) of life-sustaining treatment in cardiac intensive care units (ICUs) in Germany. ⋯ This survey is a step towards creating standards of end-of-life care in cardiac ICUs, which may contribute to build consensus and avoid conflicts among caregivers, patients and families at each step of the decision-making process.