Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2013
Oxygen delivery during cardiopulmonary bypass (and renal outcome) using two systems of extracorporeal circulation: a retrospective review.
To investigate the combined influence of blood flow and haemodilution with either a miniaturized (Mini-CPB) or a conventional cardiopulmonary bypass (C-CPB) circuit on average oxygen delivery during bypass. The influence of this on clinical outcome, particularly renal dysfunction after routine coronary artery bypass surgery (CABG), was measured. ⋯ Despite aiming for the same target pump flow, periodic limitations of venous return to the pump resulted in a significant reduction in average flow delivered to the patient by Mini-CPB. Less haemodilution compensated for this reduction, so that the average oxygen delivery was the same. The association between oxygen delivery and postoperative change in plasma creatinine was evident in both groups. Further work to understand whether there is a particular cohort of patients who benefit (or are put at risk) by one method of CPB vs the other is warranted.
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Interact Cardiovasc Thorac Surg · Jun 2013
Comparative StudySternal closure after median sternotomy: a new technique using titanium hooks and wires applied parasternally.
Osteosynthetic closure of the chest after median sternotomy is usually performed with steel wires. We describe, for the first time, a case series in which titanium hooks were implanted from the sternal surface in patients who required secondary or additional stabilization. In comparison to the classic wires, the diameters of the hooks are approximately three times bigger and therefore reduce the risk of cutting through the bones. Additionally, there is no need to dissect retrosternal adhesions, which may reduce the risk of injuring mediastinal tissues. ⋯ This sternal closure system using titanium hooks inserted parasternally is an effective alternative to conventional techniques and may increase stability of the breastbone and reduce the risk of injury to retrosternal tissues.
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Interact Cardiovasc Thorac Surg · Jun 2013
Liberal use of axillary artery cannulation for aortic and complex cardiac surgery.
Axillary artery cannulation for cardiopulmonary bypass has been described previously as a safe and reliable technique, with a low risk of atheroemboli, avoidance of malperfusion in aortic dissection and facilitation of selective antegrade cerebral perfusion during hypothermic circulatory arrest. The aim of this study was to document the broad applicability of axillary cannulation and its associated morbidity and identify where it was not possible to use planned axillary cannulation. ⋯ Axillary artery cannulation is an ideal arterial inflow site in cases where the ascending aorta is unsuitable as it is safe, reliable and reduces the risks of atheroembolization and malperfusion. Major complications are rare with this meticulous technique and it is our standard practice in complex cardiac and aortic surgery.
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Interact Cardiovasc Thorac Surg · Jun 2013
Case ReportsPrimary repair of sternal cleft in infancy using combined periosteal flap and sliding osteochondroplasty.
Sternal clefts are rare congenital malformations of the chest wall. Immediate correction in neonates or in infancy is beneficial in terms of providing skeletal cover with little or no need for any prosthetic material for reconstruction. In the absence of internal midline defects, one should aim to provide complete correction when the chest wall is still compliant, and cardiorespiratory compromise is expected to be least after correction. We report on 2 children who underwent primary sternal-cleft repair using a periosteal advancement flap along with mobilization of lateral sternal bars after sliding osteotomy of corresponding ribs.