The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2011
Pericardial effusions in the cancer population: prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability.
In the cancer population, pericardial effusions are a common and potentially life-threatening occurrence. Although decompression benefits most patients, paradoxical hemodynamic instability (PHI) develops in some, with hypotension and shock in the immediate postoperative period. This study examines paradoxical hemodynamic instability after pericardial window and identifies prognostic factors in patients with cancer who are treated for pericardial effusion. ⋯ Postoperative hemodynamic instability after pericardial window portends a grave prognosis. Evidence of tamponade, larger effusion volumes, and positive cytologic findings may predict a higher risk of paradoxical hemodynamic instability and anticipate a need for invasive monitoring and intensive care postoperatively.
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J. Thorac. Cardiovasc. Surg. · Jan 2011
Does early surgical intervention improve left ventricular mass regression after mitral valve repair for leaflet prolapse?
Left ventricular hypertrophy is associated with adverse cardiovascular outcomes. It is unclear whether hypertrophy caused by severe chronic mitral regurgitation regresses after mitral valve repair and, if so, which factors promote reverse remodeling and influence its prognostic significance. ⋯ Performing mitral valve repair before a decrease in left ventricular ejection fraction and the development of significant secondary tricuspid valve regurgitation is associated with a greater likelihood of significant regression of left ventricular mass, possibly predicting improved recovery of normal left ventricular function after surgical intervention. These data provide additional support for early degenerative mitral valve repair.
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J. Thorac. Cardiovasc. Surg. · Jan 2011
Comparative StudyEffect of duration of red blood cell storage on early and late mortality after coronary artery bypass grafting.
Recently, concern has been expressed about the transfusion of older red blood cells after cardiac surgery. We tested the hypothesis that longer storage of transfused red blood cells increases the risk of early and late mortality in patients who undergo coronary artery bypass grafting. ⋯ The storage time of transfused red blood cells is not a risk factor for early or late mortality in patients who undergo coronary artery bypass grafting.
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J. Thorac. Cardiovasc. Surg. · Jan 2011
Comparative StudyIs off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians?
Selected patients appear to benefit from off-pump coronary artery bypass compared with conventional coronary artery bypass with cardiopulmonary bypass. It is unknown whether elderly patients undergoing isolated coronary artery bypass grafting operations derive any benefit when performed off-pump. We hypothesized that off-pump coronary bypass offers a greater operative benefit to elderly patients when compared with conventional coronary artery bypass. ⋯ Performance of coronary artery bypass grafting among octogenarian patients is safe and effective. Off-pump coronary artery bypass confers shorter postoperative ventilation but equivalent mortality to conventional coronary artery bypass. Off-pump coronary artery bypass was associated with a reduction in the composite incidence of major complications in unadjusted and adjusted analyses and should be considered an acceptable alternative to conventional bypass for myocardial revascularization in elderly patients.
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Limited exposure and visualization and technical complexity have affected resident training in mitral valve surgery. We propose simulation-based learning to improve skill acquisition in mitral valve surgery. ⋯ Simulation-based learning with formative feedback results in overall improved performance of simulated mitral annuloplasty. In complex surgical procedures, simulation may provide necessary early graduated training and practice. Importantly, a "passing" grade can be established for proficiency-based advancement.