European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2011
Outcomes, risks and complications of cardiac surgery for carcinoid heart disease.
The development of carcinoid heart disease causes significant valvular dysfunction, eventually leading to symptomatic right heart failure and impaired survival. Data regarding cardiovascular surgery are limited. We sought to identify outcomes, risks and complications of valve surgery for carcinoid heart disease. ⋯ Valve surgery for carcinoid heart disease is of higher risk compared with most other forms of valvular surgery. However, in those that survive the operation significant improvement in functional class occurs. Most long-term complications were related to the tumour itself rather than cardiac complications.
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Eur J Cardiothorac Surg · Jul 2011
Predictors of long intensive care unit stay following cardiac surgery in children.
Prolonged length of stay in intensive care units after congenital heart disease surgery is associated with poor outcome, places a considerable burden on the financial resources of hospitals, and is an organizational challenge as well. This research discusses the impact of perioperative factors on prolonged stay in intensive care units. ⋯ Some patients with a risk of prolonged hospitalization may be identified preoperatively, the others just after the operation. Optimizing preoperative status and aggressive treatment of complications may have significant influence on the duration of hospitalization in intensive care units. The knowledge of risk factors may facilitate organizational procedures and rational bed management.
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Eur J Cardiothorac Surg · Jul 2011
Randomized Controlled TrialIncreased systemic perfusion pressure during cardiopulmonary bypass is associated with less early postoperative cognitive dysfunction and delirium.
Patients undergoing cardiac surgery procedures are thought to be at risk of early neuropsychological deficits and delirium. Regional cerebral hypoperfusion may play a role in the etiology of this complication. We hypothesized that low systemic perfusion pressure during cardiopulmonary bypass (CPB) would correlate with early postoperative cognitive dysfunction in on-pump patients. ⋯ Maintaining perfusion pressure at physiologic levels during normothermic CPB (80-90 mm Hg) is associated with less early postoperative cognitive dysfunction and delirium. This perfusion strategy neither increases morbidity, nor does it impair organ function.
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Eur J Cardiothorac Surg · Jul 2011
Case ReportsSpontaneous expectoration of an obstructive fibrinous tracheal pseudomembrane after tracheal intubation.
We report a rare and potentially life-threatening complication related to tracheal intubation in the formation of obstructive tracheal pseudomembrane. In the present case, the pseudomembrane was spontaneously expectorated; this is very unusual and not been reported before. This condition was first misdiagnosed as edema subglottis. ⋯ Control at 1 and again 3 months later showed no further tracheal stenosis. The diagnosis of obstructive tracheal pseudomembrane should be considered in cases of post-extubation stridor. Flexible bronchoscopic guidance after extubation may allow to diagnose such a complication earlier, but rigid bronchoscopy remains the treatment of choice.
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Eur J Cardiothorac Surg · Jul 2011
Is off-pump superior to conventional coronary artery bypass grafting in diabetic patients with multivessel disease?
Diabetic patients often present with diffuse coronary disease than nondiabetic patients posing a greater surgical challenge during off-pump revascularization. In this study, the safety, feasibility, and completeness of revascularization for this subset of patients was assessed. ⋯ OPCAB offers a lower mortality and superior postoperative outcomes in diabetic patients with multivessel disease. Arterial grafts are used more frequently that may contribute to better long-term outcomes and the OPCAB approach does not come at the cost of less complete revascularization.