Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2007
Randomized Controlled TrialFibrinolysis in coronary artery surgery: detection by thromboelastography.
Sixty-five patients scheduled for coronary surgery were randomized into three groups: A - conventional coronary artery bypass grafting, B - off-pump surgery, C - coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of re-infusion of cardiotomy blood into the circuit. On the completion of peripheral bypass anastomoses, highly significant inter-group differences were found in the thromboelastographic parameter lysis of set time at 60 min of assessment (P=0.003) and at 150 min of assessment (P<0.001), the mean values of these parameters were significantly lower in group A as compared with both groups B and C, which were statistically indistinguishable. ⋯ In group A no significant correlations between lysis on set time, postoperative blood loss and D-dimer levels were found. Based on our results, thromboelastographic signs of fibrinolysis were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C.
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Interact Cardiovasc Thorac Surg · Dec 2007
Management of complicated postoperative air-leak - a new indication for the Asherman chest seal.
Postoperative air-leak is a problem which is frequently encountered in thoracic surgery. We describe the utility of the Asherman chest seal, a device used in primary trauma care in the successful management of a complicated postoperative air-leak. The Asherman Chest Seal is a sterile occlusive dressing with a one-way Heimlich valve for treating open pneumothorax in acute settings. ⋯ All six patients had satisfactory expansion of the lungs with cessation of the air-leak. This was achieved without the pain and morbidity of a chest drain and inpatient stay. The Asherman chest seal is a simple but very useful device that has a role in management of complex air-leaks.
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Interact Cardiovasc Thorac Surg · Dec 2007
Arginine vasopressin is an ideal drug after cardiac surgery for the management of low systemic vascular resistant hypotension concomitant with pulmonary hypertension.
Low systemic vascular resistance (SVR) hypotension concomitant with pulmonary hypertension (PH) is difficult to manage postoperatively because they are often catecholamine-resistant. So, we applied arginine vasopressin (AVP), which is a potent vasoconstrictor in a specific condition, for post-cardiotomy refractory low SVR hypotension concomitant with PH. We treated nine cases of postoperative refractory vasodilatory hypotension concomitant with PH even after conventional treatment that included nitric oxide inhalation and/or intraaortic balloon pump. ⋯ AVP improved systemic circulation (increased systemic blood pressure with maintaining cardiac output) without deterioration of pulmonary hypertension. AVP is an ideal drug for treating refractory low SVR hypotension concomitant with PH. But its indication must be limited.
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Interact Cardiovasc Thorac Surg · Dec 2007
Effect of preoperative mild renal dysfunction on mortality and morbidity following valve cardiac surgery.
The objective of this study was to investigate the effect of preoperative mild renal dysfunction (RD) not requiring dialysis on mortality and morbidity after valve cardiac surgery (VCS). We studied 681 consecutive patients (2002-2006) who underwent valve cardiac surgery with or without coronary artery bypass graft (CABG). Preoperative RD was calculated with the abbreviated Modification of Diet in Renal Disease formula and was defined as a glomerular filtration rate <60 ml/min/1.73 m(2). ⋯ Preoperative RD was significantly and independently associated with more red blood cell transfusions and longer hospital stay (median 9 vs. 8 days, P<0.001). Mortality was similar in both groups (3.4% vs. 2.3%, P=0.43). Preoperative mild renal dysfunction in patients undergoing cardiac valve surgery is an independent marker of postoperative morbidity.
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Interact Cardiovasc Thorac Surg · Dec 2007
Mid-term results of peripheric cannulation after port-access surgery.
Several minimally invasive approaches, avoiding median sternotomy, have been described within the last few years for cardiac surgery. Femoral arterial and venous cannulation for extracorporeal perfusion are required for many of these operations. The aim of this report is to assess the long-term outcomes of femoral cannulations in patients who underwent minimally invasive procedures. ⋯ We found a chronic recanalized thrombotic change in the common femoral vein (CFV) in one patient (0.63%). Our study demonstrates vessel patency and/or stenosis in patients without complaints. In conclusion, femoral artery and vein cannulation for port-access surgery with transthoracic clamping can be performed successfully with excellent results in the mid-term.