Journal of cardiac surgery
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We report our experience in use of Vacuum-assisted closure therapy (VAC) in the treatment of poststernotomy wound infection with emphasis on recurrent wound-related problems after use of VAC and their treatment. ⋯ VAC therapy is a safe and reliable option in the treatment of sternal wound infection. However, prolonged use of VAC system as a replacement for surgical closure of sternal wound appears to be associated with recurrent problems of the sternal wound. Strategy of use of VAC for a short duration followed by early surgical closure appears favorable.
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Recent studies suggest the development of a procoagulant state with hemodilution. We conducted this study to investigate the effect of hemodilution, by the priming solution in a cardiopulmonary bypass (CPB) circuit, on "point of care" coagulation assays (activated clotting time [ACT] and thromboelastography [TEG]). ⋯ The study suggests that hemodilution by crystalloid priming solution may impair the efficacy of anticoagulation during CPB. The mechanism for this phenomenon remains to be elucidated.
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Randomized Controlled Trial Clinical Trial
Postoperative effects of low-dose intrathecal morphine in coronary artery bypass surgery.
Intrathecal morphine has been used in hopes of providing long-lasting postoperative analgesia in patients after cardiac surgery. The aim of this study was to evaluate the effects of 7 micro/kg intrathecal morphine administration in coronary bypass surgery in the postoperative period. ⋯ Intrathecal morphine provided effective analgesia, earlier tracheal extubation and less ICU length stay after on-pump coronary bypass surgery. The influence on ICU length of stay requires further evaluations.
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Clinical Trial
Risk factors for prolonged stay in the intensive care unit and on the ward after cardiac surgery.
Prolonged length of stay (LOS) after cardiac surgery has been associated with poor outcome and a considerable expenditure of health care resources. As our patient's demographics are changing, a continuing evaluation of the preoperative and intraoperative variables affecting LOS in the intensive care unit (ICU) and on the floor remains important. ⋯ In this series of 426 consecutive patients, we have identified several perioperative risk factors associated with prolonged hospitalization that can help clinicians in their preoperative patient counseling, risk stratification, and selection. However, the most obvious use of these results is in allowing decision makers to implement specific strategies that would best allocate resources depending on the risk profile of cardiac patients.
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We present a rare case of bullet embolism from the left brachiocephalic vein to the right ventricle, following a chest gunshot wound, in a 56-year-old soldier. The bullet was accidentally discovered on a systematic chest X-ray. The bullet was very close to the tricuspid subvalvular apparatus and was about to come out from the ventricle. We removed it under cardiopulmonary bypass.