J Cardiothorac Surg
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J Cardiothorac Surg · Jan 2013
Hemoglobin and B-type natriuretic peptide preoperative values but not inflammatory markers, are associated with postoperative morbidity in cardiac surgery: a prospective cohort analytic study.
Risk stratification in cardiac surgery significantly impacts outcome. This study seeks to define whether there is an independent association between the preoperative serum level of hemoglobin (Hb), leukocyte count (LEUCO), high sensitivity C-reactive protein (hsCRP), or B-type natriuretic peptide (BNP) and postoperative morbidity and mortality in cardiac surgery. ⋯ High preoperative BNP or low Hb shows an association of independent risk with postoperative outcomes, and their measurement could help to stratify surgical risk. The ability to predict the onset of atrial fibrillation or postoperative low cardiac output has important clinical implications. Our results open the possibility of designing studies that incorporate BNP measurement as a routine part of preoperative evaluation, and this strategy could improve upon the standard evaluation in terms of reducing adverse postoperative events.
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J Cardiothorac Surg · Jan 2013
Case ReportsSuccessful management of trachea stenosis with massive substernal goiter via thacheobronchial stent.
A case of 65 year-old Chinese male patient with severe tracheal stenosis due to a massive substernal goiter, is presented. MRI and CT scan revealed that the massive substernal goiter was 9.3 × 6.1 × 4.7 cm in size, displacing the trachea and adjacent large vessels to the patient's right contributing to severe intrathoracic trachea compression up to 6 cm in length and the narrowest caliber of the trachea only 3.0 mm in diameter. To the best of our knowledge, optimal airway management for the massive substernal goiter resection was considered to be temporary tracheobronchial stent placement pre-operation.
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J Cardiothorac Surg · Jan 2013
Case ReportsThrombosis during off pump LVAD placement in a patient with heparin induced thrombocytopenia using bivalirudin.
Here we present our attempt at off pump HeartMate II left ventricular assist device (LVAD) implantation using the anticoagulant bivalirudin in a patient with heparin induced thrombocytopenia, which resulted in thrombosis within the LVAD device. This required that our procedure be converted to on pump, and a new HeartMate II LVAD device to be implanted. In our view, this thrombotic event may have been caused by a number of factors that include bivalirudin's (1) short half-life of about 20 minutes, (2) decreased activity with blood stasis, (3) inability to prevent clot propagation, and (4) uncertainty with real-time monitoring of therapeutic levels. ⋯ In addition, a solution other than blood may be used for priming. If blood is used for priming of the LVAD device, the duration of blood stasis should not exceed 20 minutes when bivalirudin is being used for anticoagulation. Furthermore, this case emphasizes the importance of having a backup LVAD device available and ready to use during surgical procedures.
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J Cardiothorac Surg · Jan 2013
Clinical TrialMean platelet volume may predict early clinical outcome after coronary artery bypass grafting.
An elevated mean platelet volume is associated with increased platelet activation and thus may predict thrombotic events. The goal of this study was to investigate the association of the mean platelet volume and the major adverse events after coronary artery bypass surgery. ⋯ An elevated preoperative mean platelet volume is associated with an adverse outcome after coronary artery bypass grafting. In conclusion, we can say that mean platelet volume is an important, simple, readily available, and cost effective tool and can be useful in predicting the postoperative adverse events in patients undergoing coronary artery bypass grafting.
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J Cardiothorac Surg · Jan 2013
Observational StudyEpidural analgesia is not superior to systemic postoperative analgesia with regard to preventing chronic or neuropathic pain after thoracotomy.
To assess prospectively the incidence of chronic and neuropathic pain in patients undergoing anteroaxillary thoracotomy with postoperative epidural analgesia or controlled-release oxycodone pain regimen. ⋯ These pilot data indicate that epidural analgesia is not superior to systemic postoperative analgesia with regard to preventing chronic or neuropathic pain after thoracotomy.