Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Nov 2010
Venous obstruction and cerebral perfusion during experimental cardiopulmonary bypass.
To investigate the effects on cerebral perfusion by experimental venous congestion of the superior vena cava (SVC) during bicaval cardiopulmonary bypass (CPB) at 34 °C, pigs were subjected to SVC obstruction at levels of 75%, 50%, 25% and 0% of baseline SVC flow at two arterial flow levels (low, LQ, high, HQ). The cerebral perfusion was examined with near-infrared spectroscopy (NIRS), cerebral microdialysis and blood gas analysis. SVC obstruction caused significant decreases in the NIRS tissue oxygenation index (TOI) and in SVC oxygen saturations (P<0.05, both groups), while the mixed venous saturation was decreased only in the LQ group. ⋯ The total venous drainage remained stabile throughout the experiment, indicating increased flow in the inferior vena cava cannula. The results indicate that SVC congestion may impair cerebral perfusion especially in the case of compromised arterial flow during CPB. Reduced SVC cannula flow may pass undetected during bicaval CPB, if SVC flow is not specifically monitored.
-
Interact Cardiovasc Thorac Surg · Oct 2010
Does the use of non-steroidal anti-inflammatory drugs after cardiac surgery increase the risk of renal failure?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief post-cardiac surgery increases the risk of renal failure. Altogether 53 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. ⋯ In contrast, one RCT assessing these COX-2 inhibitors detected a significant increase in the incidence of oliguria in this group compared to controls (parecoxib/valdecoxib: 14.5%, controls: 9.9%, P=0.187) as well as renal dysfunction (parecoxib/valdecoxib: 1.9%, controls: 0%, P=0.184). Three retrospective studies within paediatric populations, including one cohort study and two chart reviews, found various parameters of renal function, such as serum creatinine and blood urea nitrogen, to be similar between ketorolac and control groups. We conclude that NSAIDs are not associated with an increased risk of renal failure after cardiac surgery when administered at optimal 'renal' doses, within early postoperative settings, to patients at low-risk of renal dysfunction in whom NSAIDs are not contraindicated.
-
Interact Cardiovasc Thorac Surg · Oct 2010
Case ReportsSuccessful support and separation from veno-venous extracorporeal membrane oxygenation support in a three-month-old patient following bidirectional Glenn procedure.
While extracorporeal membrane oxygenation (ECMO) is a useful mechanism of providing support in pediatric patients with cardiopulmonary dysfunction following surgery for congenital heart disease, outcomes have varied dramatically between distinct cardiac diagnoses. Reported outcomes of ECMO support following a bidirectional Glenn procedure in patients with single ventricle physiology are uniformly poor due in part to physiological and anatomical challenges inherent to cannulation in this population. We describe a unique veno-venous cannulation that can be applied to this patient population and has allowed for successful decannulation in our practice.