Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2009
ReviewIs reduction aortoplasty (with or without external wrap) an acceptable alternative to replacement of the dilated ascending aorta?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether reduction aortoplasty is an acceptable alternative to ascending aorta replacement. From 925 potential papers, 13 papers represented the best evidence to answer the clinical question. ⋯ In particular, an aortoplasty in elderly patients with post-stenotic dilatation, or in patients with significant co-morbidities is attractive. It should be acknowledged that only one study directly compares the technique with conventional replacement and that replacement remains the 'gold standard' technique. It should also be acknowledged that the external wrap is not without risk and wrap dislocation, erosion or fistula formation are recognised complications.
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Interact Cardiovasc Thorac Surg · Oct 2009
Comparative StudyAortic valve replacement with minimal extracorporeal circulation versus standard cardiopulmonary bypass.
The purpose of this study was to evaluate the safety and the clinical outcomes of aortic valve replacement (AVR) performed with minimally invasive extracorporeal circulation (miniECC) technique vs. standard cardiopulmonary bypass (CPB). From February 2006 to December 2007 a total of 181 isolated AVR were performed, of these 53 patients were operated using minimal extracorporeal circulation system and 128 patients were operated using the standard CPB. Demographic characteristics and operative data were similar in both groups except for EuroSCORE (P<0.0001). ⋯ The number of transfused blood bank products was higher in patients with a body surface area >1.7 m(2) and who underwent traditional CPB in respect to miniECC system. Postoperatively renal injury, atrial fibrillation episodes, neurologic event rate, ICU and hospital stay length were similar in both groups. The miniECC is suitable for AVR providing good clinical results but the present results should not identify the miniECC system to be superior to the conventional CPB.
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Interact Cardiovasc Thorac Surg · Oct 2009
Predicting prolonged intensive care unit length of stay in patients undergoing coronary artery bypass surgery--development of an entirely preoperative scorecard.
We sought to develop a predictive model based exclusively on preoperative factors to identify patients at risk for PrlICULOS following coronary artery bypass grafting (CABG). Retrospective analysis was performed on patients undergoing isolated CABG at a single center between June 1998 and December 2002. PrlICULOS was defined as initial admission to ICU exceeding 72 h. ⋯ Subsequent validation of this model demonstrated a c-statistic of 78%. An internally-validated, risk predictive model of PrlICULOS in patients undergoing CABG was constructed. Based on preoperative clinical factors, a scorecard was developed allowing identification of these patients prior to surgery and allowing for strategies aimed at optimizing hospital resources.
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Interact Cardiovasc Thorac Surg · Oct 2009
A retrospective analysis of terlipressin in bolus for the management of refractory vasoplegic hypotension after cardiac surgery.
Cardiac surgery performed with cardiopulmonary bypass (CPB) may be complicated by hypotension due to low systemic vascular resistance (SVR). Often in those cases, hypotension is resistant to pressor catecholamines. We report six cases of norepinephrine-resistant postcardiotomy hypotension, treated by terlipressin (TP), a potent vasopressor agent. ⋯ Subsequently, the effect on systemic blood pressure enhanced urine output. No major collateral effects were observed. The administration of TP in bolus may result as a useful alternative for treating refractory low SVR hypotension post CPB.