Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Apr 2009
Randomized Controlled TrialPrevention of atrial fibrillation after coronary artery bypass grafting via atrial electromechanical interval and use of amiodarone prophylaxis.
In our previous study, we defined a cut-off point of 120 ms for atrial electromechanical interval (AEMi) to determine the risk of atrial fibrillation (AF) occurrence. Accordingly, the present study sought to investigate whether or not a prophylactic perioperative administration of amiodarone could reduce the incidence of AF in a high-risk group (AEMi >120 ms) undergoing coronary artery bypass grafting (CABG). In this prospective, randomized study, 100 patients with AEMi >120 ms received either amiodarone (n=50) or placebo (n=50). ⋯ The incidence of postoperative AF was significantly higher in the placebo group than that of the amiodarone group (88% of patients in control group vs. 16% of patients in amiodarone group, P<0.0001). The prophylactic therapy with amiodarone significantly reduced the ICU length of stay (2.28+/-1.00 vs. 3.60+/-0.90 days, P<0.0001) and hospital length of stay (5.64+/-2.35 vs. 7.78+/-1.46 days, P<0.0001). The incidence of postoperative AF among patients with high AEMi was significantly reduced by a prophylactic amiodarone treatment, resulting in shorter ICU and hospital stays.
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Interact Cardiovasc Thorac Surg · Apr 2009
ReviewCan a mini-bypass circuit improve perfusion in cardiac surgery compared to conventional cardiopulmonary bypass?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the 'mini-bypass technique' can give a reduction in complications after cardiac surgery compared to the conventional cardiopulmonary bypass circuit. Altogether 144 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. ⋯ Six studies find significantly reduced inflammatory markers, and 5 measure superior myocardial protection. There are several anecdotal references to a 'learning curve' with this technique but no significant morbidity with complications arising from this were found. Mini-bypass seems to be a promising technique with many documented benefits in studies reporting as many as 1000 patients undergoing this technique.
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Interact Cardiovasc Thorac Surg · Apr 2009
ReviewCould atrial natriuretic peptide be a useful drug therapy for high-risk patients after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether atrial natriuretic peptide (ANP) or brain natriuretic peptide (BNP) could be a useful alternative diuretic for patients post cardiac surgery. Altogether more than 250 papers were found using the reported search, of which eight RCTs represented the best evidence to answer the clinical question. ⋯ Lower urea and creatinine levels were also found postoperatively and also reduced decreases in glomerular filtration rate compared to placebo, both in studies of patients with preoperatively normal renal function and those who had impaired function. In addition, two studies found a reduction in the incidence of AF, and renin/aldosterone levels were lower. The NAPA trial of 272 CABG patients with LV dysfunction was the only study to show a shorter ICU stay and reduced early mortality with nesiritide compared to placebo.
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Interact Cardiovasc Thorac Surg · Apr 2009
Case ReportsSwyer-James-MacLeod syndrome; repeated chest drainages in a patient misdiagnosed with pneumothorax.
Swyer-James-MacLeod Syndrome (SJMS) occurs as a result of childhood bronchiolitis obliterans. Typically, this disorder is diagnosed in childhood after evaluations for recurrent respiratory infections. ⋯ Here, we are presenting a 22-year-old female patient who was diagnosed with SJMS who was initially misdiagnosed with a pneumothorax and treated by multiple chest tube drainages. This case highlights the significance of taking a careful history, the application of computed tomography and scintigraphy in confirming the diagnosis of SJMS and in eliminating other diseases.
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Interact Cardiovasc Thorac Surg · Apr 2009
Case ReportsHeparin-induced thrombocytopenia with thrombosis syndrome managed with plasmapheresis.
Heparin-induced thrombocytopenia with thrombosis syndrome is an antibody-mediated disorder that has a high mortality in cardiac surgical patients in spite of early diagnosis and management with direct thrombin inhibitors. Plasmapheresis, an extracorporeal technique that has been designed for the removal of large molecular weight substances from the plasma, can remove the offending antibodies from these desperately ill patients. We describe a case of a postoperative cardiac surgery patient with heparin-induced thrombocytopenia with thrombosis syndrome and multi-system failure who was dependent upon a left ventricular assist device. ⋯ This patient survived because of plasmapheresis. Removing the antibodies to the heparin-platelet factor four complex with plasmapheresis is an effective strategy to treat these patients. We believe that the use of plasmapheresis as a bail-out procedure in these often desperately ill post-operative cardiac surgical patients who have heparin-induced thrombocytopenia with thrombosis syndrome could be lifesaving.