Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 2014
Randomized Controlled TrialLevosimendan increases bleeding risk after heart valve surgery: a retrospective analysis of a randomized trial.
To investigate whether levosimendan, an inotrope with cardioprotective properties, increases postoperative bleeding after cardiac surgery. ⋯ Levosimendan increased the risk of postoperative bleeding after cardiac valve surgery. In addition, the risk of postoperative cardiac tamponade was increased in patients who received levosimendan compared to placebo.
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J. Cardiothorac. Vasc. Anesth. · Oct 2014
Observational StudyA Novel Assessment of Peripheral Tissue Microcirculatory Vasoreactivity Using Vascular Occlusion Testing During Cardiopulmonary Bypass.
Cardiac surgery and cardiopulmonary bypass are associated with release of inflammatory mediators and microcirculatory alterations that result in organ dysfunction. Near-infrared spectroscopic measurement of tissue oxygen saturation (StO2) and the vascular occlusion test (VOT) were utilized in a study of elective cardiac surgical patients as a novel, noninvasive method of assessing microcirculatory vasoreactivity during nonpulsatile cardiopulmonary bypass (CPB). The objective of this pilot study was to determine whether differences in microcirculatory function and vasoreactivity could be measured in cardiac surgery using StO2 and VOT. ⋯ This pilot study demonstrates a significant difference in reperfusion slopes during cardiopulmonary bypass when compared to prebypass and postbypass, suggesting impaired peripheral microvascular reactivity. Reperfusion slopes also exhibited a successive decline with duration of CPB, implying worsening microcirculatory dysfunction that returned to baseline values in all patients within 1 hour of separation from CPB. This noninvasive technique has potential to optimize circulatory parameters during cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Oct 2014
Multicenter Study Observational StudyElevated Levels of Angiopoietin-2 as a Biomarker for Respiratory Failure After Cardiac Surgery.
Angiopoietin-1 and angiopoietin-2 are important factors in regulating endothelial vascular permeability. This study evaluated perioperative changes in serum levels of angiopoietin-1 and -2 in patients undergoing cardiac surgery. ⋯ Angiopoietin-2 serum levels were elevated after cardiac surgery. Elevated angiopoietin-2 had a good predictive performance for respiratory failure after cardiac surgery, perhaps reflecting the severity of lung dysfunction related to postoperative increases in vascular permeability.