Journal of cardiac surgery
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From a disease that just a few decades ago carried an ominous prognosis, aortic dissection has become a highly treatable condition. Similar development has occurred in regard to the treatment of thoracic aortic aneurysms. Treatment options are medical, surgical, or endovascular. ⋯ Treatment for hypertensive emergency begins in the intensive care unit and continues during and after surgery. Improved surgical techniques as well as newer, safer agents that reduce BP to acceptable levels have reduced the risk of mortality and improved prognosis in the postoperative period. Nevertheless, mortality rates remain high, and successful management of aortic dissection and aortic aneurysm still poses a clinical challenge.
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Comparative Study
A simple technique of distal limb perfusion during prolonged femoro-femoral cannulation.
Cannulation of the femoral vessels for cardiopulmonary support is a common approach for many cardiac procedures as well as access of choice for many emergency bypass systems such as extracorporeal membrane oxygenation. A serious complication of prolonged femoral cannulation remains the ischemic injury of the distal limb. ⋯ This technique of distal limb perfusion was found to be safe and effective in preventing lower limb ischemia for patients with prolonged femoral cannulation for extracorporeal circulatory support.
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An estimated 50% of patients undergoing routine cardiac surgery require intravenous antihypertensive therapy to manage life-threatening arterial bleeding, myocardial ischemia, or cardiac failure in the perioperative period. Managing hypertension in this setting can be challenging because of the need to reduce blood pressure while maintaining adequate end organ perfusion. Hypotensive episodes can increase the risk of cardiac complications and end organ hypoperfusion, particularly in patients whose underlying cardiovascular disease has altered autoregulation of blood flow. ⋯ The ideal agent for postoperative hypertension should have a rapid onset of action, be highly vascular selective, and be rapidly reversible. In addition, it should be safe, with little risk of overshoot hypotension or adverse drug reaction. Precise management of arterial pressure in the perioperative period has the potential to improve clinical outcome by avoiding hypotensive episodes, ensuring adequate end organ perfusion, decreasing the risk of adverse drug effects, and serving as a bridge to definitive long-term therapy for essential hypertension.
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Comparative Study
Predictors and outcomes of extended intensive care unit length of stay in patients undergoing coronary artery bypass graft surgery.
To assess risk predictors of increased intensive care unit (ICU) length of stay in patients undergoing isolated coronary artery bypass surgery (CABG) and assess outcomes associated with increased ICU length of stay. ⋯ In patients undergoing CABG surgery an increased age, increased pump time, COPD, and urgent surgical procedure significantly increased the risk of an increased ICU length of stay. Patients with an increased ICU length of stay also experienced more negative outcomes.
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Adverse neurologic outcomes after cardiac surgery can have devastating consequences, among them increased mortality risk and, among survivors, loss of independence and a diminished quality of life. They also represent a burden on the health-care system, requiring prolonged hospitalizations and additional aftercare and, therefore, greater costs. Adverse outcomes are classified by their severity. ⋯ The benefits of strategies such as using low or high mean arterial pressures and manipulating pump flow remain unclear. Off-pump coronary bypass surgery has been proposed as a means of reducing neurologic risk, but its effectiveness is unproved in this area. One pharmacologic strategy, the administration of aprotinin, has been shown to reduce the incidence of stroke in high-risk patients.