The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Randomized Controlled TrialHigh lactate levels are predictors of major complications after cardiac surgery.
Although hyperlactatemia after cardiac surgery is common, the implications of raised levels remain controversial. The aim of this study was to evaluate whether high lactate levels after cardiac surgery are predictors of major complications including mortality. ⋯ Hyperlactatemia 6 hours after ICU admission is an independent risk factor for worse outcomes in adult patients after cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Randomized Controlled TrialTemporary biventricular pacing decreases the vasoactive-inotropic score after cardiac surgery: a substudy of a randomized clinical trial.
Vasoactive medications improve hemodynamics after cardiac surgery but are associated with high metabolic and arrhythmic burdens. The vasoactive-inotropic score was developed to quantify vasoactive and inotropic support after cardiac surgery in pediatric patients but may be useful in adults as well. Accordingly, we examined the time course of this score in a substudy of the Biventricular Pacing After Cardiac Surgery trial. We hypothesized that the score would be lower in patients randomized to biventricular pacing. ⋯ The vasoactive-inotropic score decreases in patients undergoing temporary biventricular pacing in the early postoperative period. Future studies are required to assess the impact of this effect on arrhythmogenesis, morbidity, mortality, and hospital costs.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Preoperative multidetector computed tomograpy angiography for planning of minimally invasive robotic mitral valve surgery: impact on decision making.
Minimally invasive mitral valve (MV) surgeries (ie, right thoracotomy and robotic approaches) are preferred for degenerative mitral regurgitation because these procedures result in reduced surgical trauma and recovery time. However, because of peripheral cardiopulmonary bypass, there is risk of embolic complications. We sought to use the strengths of 3-dimensional multidetector computed tomography (MDCT) in assessing aortoiliac atherosclerosis and mitral annular calcification (MAC) and its influence on decision for approach in MV surgery. ⋯ In patients undergoing minimally invasive MV surgery, there is a strong association between presence of significant aortoiliac atherosclerosis, as determined by MDCT and/or MAC and change in surgical approach.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Contractile mitral annular forces are reduced with ischemic mitral regurgitation.
Forces acting on mitral annular devices in the setting of ischemic mitral regurgitation are currently unknown. The aim of this study was to quantify the cyclic forces that result from mitral annular contraction in a chronic ischemic mitral regurgitation ovine model and compare them with forces measured previously in healthy animals. ⋯ Mitral annular forces were measured for the first time in a chronic ischemic mitral regurgitation animal model. Our findings demonstrated an inferior left ventricular infarct to decrease significantly cyclic septal-lateral forces while modestly lowering those in the transverse. The measurement of these forces and their variation with left ventricular pressure contributes significantly to the development of mitral annular ischemic mitral regurgitation devices.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Anatomic and flow dynamic considerations for safe right axillary artery cannulation.
Neuroprotection is of paramount interest in cardiac surgery. Right axillary artery cannulation is well established in aortic surgery because it significantly improves survival and outcome, but malperfusion of the right brain after direct cannulation has been reported. Anatomically, 4 vessel segments are potentially amenable for cannulation of the subclavian and axillary arteries. Clinical studies vary widely in dissection sites and cannulation techniques. We investigated critical flow dynamics in the right brain caused by arterial inflow after direct cannulation and specified cannulation positions that provide optimal cerebral perfusion. ⋯ Direct cannulation of the right axillary artery can lead to cerebral malperfusion, caused by an obstruction of the vertebral artery's orifice by the arterial cannula or a subclavian steal phenomenon due to flow reversal. The safety of direct axillary artery cannulation can be improved by a well-considered dissecting site and insertion length of the cannula.