Kardiol Pol
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Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion in patients with ST elevation myocardial infarction (STEMI). Abciximab is a well established adjunct to primary PCI. The proper timing of abciximab administration in STEMI patients has been investigated in randomised trials, registries and metanalysis, providing conflicting results. ⋯ Patients transferred for primary PCI in STEMI hospital networks showed lower rates of death in long-term one-year clinical follow-up when treatment with abciximab was started early.
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Diabetes type 2 (DM) or impaired glucose tolerance (IGT) are linked with a 3-fold increased risk of renal failure after heart valve surgery. The increase of proinflammatory cytokines is detected in patients with DM or IGT, moreover cardiac surgery promotes the proinflammatory response, which may be responsible for the development of postoperative kidney failure. ⋯ Postoperative kidney failure with the incidence of 27% is a frequent finding in patients with DM or IGT operated due to acquired heart valve disease. The postoperative proinflammatory response is not involved in the development of this complication. The correlation between postoperative decrease of creatinine clearance and duration of cardiopulmonary bypass was noted. The trend toward the link between postoperative kidney failure and preoperative proinflammatory status was seen.
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Aortic dissection is a sudden event when the intimal tear occurs, blood penetrates the aortic wall through and the dissection propagates. Acute aortic dissection presents with chest pain, hemodynamic instability, absent or unequal peripheral pulses, various neurologic complications and aortic regurgitation. ⋯ Ascending aortic dissection often require surgery or stent-grafts, depending on their size and location. We present a case of a 71 year-old woman with an asymptomatic chronic type "A" dissection of aorta of total length, incidentally detected during ultrasonographic imaging, qualified for surgery treatment.
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In up to 36% of patients undergoing cardiac surgery prolonged intensive care unit stay may be necessary. Mortality rates of these patients range from 11% to 94%, causing enormous clinical and ethical issues. ⋯ The present study found that the preoperative presence of diabetes mellitus, and postoperative multiorgan failure syndrome decreased the probability of survival in patients with prolonged intensive care unit stay after elective isolated on-pump coronary artery bypass surgery.