Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2013
Multicenter Study Observational StudyImpact of occult renal impairment on early and late outcomes following coronary artery bypass grafting.
High serum creatinine is considered an independent risk factor for poor outcomes following coronary artery bypass grafting (CABG). However, the impact of occult renal impairment (ORI), defined as an impaired glomerular filtration rate (GFR) with a normal serum creatinine (SCr) level, remains unclear. Thus, we sought to investigate the impact of ORI on outcomes after CABG. ⋯ ORI was an independent risk factor for early and late death as well as cardiovascular events in patients undergoing CABG with normal SCr levels. A more accurate evaluation of renal function through a combination of SCr and estimated GFR is needed in patients with normal SCr levels.
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The occurrence of intra-abdominal hypertension (IAH), as well as its promoting factors in cardiac surgery, has been poorly explored. The aim of the present study was to characterize intra-abdominal pressure (IAP) variations in patients undergoing cardiac surgical procedures, and to identify the risk factors for IAH in this setting. ⋯ IAH develops in one-third of cardiac surgery patients and is strongly associated with higher baseline IAP values, higher central venous pressure, positive fluid balance, extracorporeal circulation, use of vasoactive drugs and AKI. Determinants of IAH should be accurately assessed before and after surgery, and patients presenting risk factors must be monitored properly during the perioperative period. In this context, the baseline value of IAP may be a valuable and early warning parameter for IAH occurrence.
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Interact Cardiovasc Thorac Surg · Oct 2013
St. Jude Medical Trifecta™ aortic valve perioperative performance in 200 patients.
The St. Jude Medical Trifecta aortic bioprosthesis (St. Jude Medical, Inc., St. Paul, MN, USA) is a new stented pericardial tissue heart valve. The aim of the study was to evaluate the clinical and haemodynamic performance of the Trifecta bioprosthesis in the early postoperative period. ⋯ The Trifecta valve offers good clinical results and excellent haemodynamic performance. Special care must be taken to avoid oversizing, which can lead to difficulty in implantation and can produce gradient increases due to an excess of prosthetic leaflet tissue.
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Interact Cardiovasc Thorac Surg · Oct 2013
Case ReportsTranscatheter valve used in a bailout technique during complicated open mitral valve surgery.
Here, we describe the case of a 62-year old woman who required aortic and mitral valve replacement plus coronary artery bypass grafting. Transoesophageal echocardiogram revealed stenosis of the aortic valve (Ao valve area, 0.9 cm(2); PG, 45 mmHg; MG, 25 mmHg) and a diseased calcified mitral valve with stenosis and regurgitation (mitral valve area, 1.1 cm(2); MG, 10 mmHg; RV, 25 ml; ERO, 12 mm(2)). The mitral annulus calcifications were very deep into the left atrium and the left ventricle muscle, around the full annulus circumference. ⋯ The left atrium was surgically exposed, and we deployed a 26-mm Edwards SAPIEN XT endovalve through the left atriotomy. To prevent paravalvular leakage, we then used a pericardial patch to close the gap between the endovalve and the calcified mitral annulus. The postoperative echocardiogram showed perfect anchoring of the endovalve in the mitral annulus without any paravalvular leakage.
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Interact Cardiovasc Thorac Surg · Oct 2013
Case ReportsTuberculous ascending aortic pseudoaneurysm.
Pseudoaneurysms of the ascending aorta due to infective organisms are a rare but challenging entity with a risk of high morbidity and mortality. Previous cardiac surgery is an attributing factor, but they can present without previous surgical interventions. Various micro-organisms are responsible for this pathology. ⋯ We report a case of a 25-year old man who presented to us with shortness of breath and recurrent haemoptysis. After preoperative evaluation including clinical and radiological assessment and echocardiography, he underwent successful repair of a pseudoaneurysm of the ascending aorta by excision and replacement of the diseased aorta with a Dacron tube graft using cardiopulmonary bypass. Postoperatively, he was started on antituberculous chemotherapy based on histological findings.