Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2012
ReviewWhat do you do with the antiplatelet agents in patients with drug eluting stents who then receive a mechanical valve?
Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is a cornerstone of treatment during and after percutaneous coronary interventions with drug-eluting stent (DES) implantation. Oral anticoagulation (OAC) is the recommended treatment for patients with mechanical heart valves. When patients with DES need a mechanical heart valve or vice versa, we face the difficult choice of their antithrombotic therapy. ⋯ As per the long-term management, antithrombotic management with DAT alone in mechanical aortic valve replacement might be possible, but there is not enough evidence to support it. The available evidence suggests that triple anticoagulation (OAC + DAT) is associated with the best clinical outcome compared with all the other possible strategies. The duration of TT should be 3 months after sirolimus DES implantation, and 6 months after paclitaxel DES implantation, followed by long-term therapy with OAC plus clopidogrel or aspirin with either PPIs, or H2-receptor antagonists (Class IIa Level of Evidence C).
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Interact Cardiovasc Thorac Surg · Jul 2012
Case ReportsSuccessful surgical repair of platypnea-orthodeoxia syndrome in a patient with cerebral infarction.
Platypnea-orthodeoxia syndrome is a rare condition characterized by hypoxaemia in the upright position and arterial hypoxaemia induced by the upright position, and the syndrome is relieved by recumbency. We encountered a cerebral infarction patient who presented with low SpO(2) levels in the upright position. ⋯ The surgical closure of the foramen and shortening of the ascending aorta improved the patient's clinical condition. To our knowledge, there have been few reports of clinical conditions of this kind.
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Interact Cardiovasc Thorac Surg · Jul 2012
Randomized Controlled Trial Comparative StudyComparative evaluation of the effects of tranexamic acid and low-dose aprotinin on post-valvular heart surgery bleeding and allogenic transfusion.
Bleeding diathesis and allogenic transfusion after complex heart surgery, such as heart valve surgery, may result in complications such as transfusion reaction, viral infection, postoperative infection, haemodynamic disturbance, prolonged stay in the intensive care unit and hospital, renal and respiratory failure and mortality. In this prospective, double-blind, randomized, placebo-controlled clinical trial, 90 patients were randomly divided into three groups: aprotinin, tranexamic acid and control. Chest-tube drainage, transfusion requirements and renal and neurological complications were evaluated. ⋯ The quantity of transfused fresh frozen plasma (P = 0.034) was significantly lower in the aprotinin group only. We did not find any neurological complications or renal failure in the three groups. Our data suggest that in valvular heart surgery, low-dose aprotinin is significantly better than tranexamic acid or a placebo for reduction of postoperative bleeding and allogenic transfusion, without increasing adverse outcomes.
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Interact Cardiovasc Thorac Surg · Jul 2012
ReviewIs heparin needed for patients with an intra-aortic balloon pump?
We addressed the question of whether or not the currently available evidence base supports heparinization in the context of a patient requiring cardiovascular support with an intra-aortic balloon pump (IABP). A best evidence topic was written according to a previously defined structured protocol. A literature search returned 443 papers, 3 of which were deemed relevant. ⋯ Just one study specifically looked at surgical patients. However, the existing data suggest that it is safe to omit heparinization when using IABP counterpulsation. The decision to heparinize should be weighed in the context of other indications or contraindications rather than being an automatic response to the use of IABP.