The heart surgery forum
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The heart surgery forum · Apr 2004
Multicenter StudyIs off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency?
Renal dysfunction is a well-recognized complication following coronary artery bypass grafting (CABG). Coronary revascularization without cardiopulmonary bypass (CPB) has been shown to minimize renal injury in patients with normal preoperative renal function who undergo elective procedures. The purpose of this study was to define the effect of an off-pump revascularization strategy on the incidence of postoperative renal failure and survival of patients with preexisting renal dysfunction. ⋯ The results of this study suggested that patients with preoperative non-dialysis-dependent renal insufficiency have more favorable outcome when revascularization is done off pump. Avoidance of CPB results in (1) a reduction in the incidence of postoperative renal failure; (2) a reduction in the need for new dialysis; and (3) improved in-hospital and midterm survival.
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The heart surgery forum · Jan 2004
Surgical management of infants with congenital lobar emphysema and concomitant congenital heart disease.
Congenital lobar emphysema (CLE) is an uncommon cause of infantile respiratory distress. It is diagnosed on the basis of evidence of lobar overaeration, mediastinal shift, and compression of the adjacent lobe. Concomitant congenital heart disease (CHD) and CLE is not uncommon. In the literature a 12% to 20% concomitance rate is given. The optimal treatment of respiratory symptoms associated with CLE and CHD is not clear; however, there has been a great deal of progress in the treatment of CLE and CHD. The aim of this study was to evaluate a clinical experience with and long-term follow-up of the surgical treatment of 13 patients with concomitant CLE and CHD. ⋯ The presence of CHD, especially in infants with unusual respiratory distress symptoms, should be kept in mind, and echocardiography and/or cardiac catheterization should be considered in the diagnosis. In patients with high pulmonary artery pressure, palliative or corrective surgery for CHD in addition to lobectomy can be considered. We believe that for lesions without high pulmonary artery pressure, such as small atrial septal defect and patent foramen ovale, clinical follow-up is sufficient treatment after lobectomy. If the cause of CLE is compression of large ductus arteriosus, only division of the patent ductus arteriosus may be considered before lobectomy and clinical and radiologic follow-up. The cardiac lesion should be assessed as to severity and ease of management. A corrective procedure can be carried out at lobectomy. Because of the technical ease with which the cardiac operation can be performed at the time of lobectomy, we suggest that in addition to lobectomy, operative treatment of cardiac lesions be performed.
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The heart surgery forum · Jan 2004
Randomized Controlled Trial Clinical TrialSpinal (subarachnoid) morphine for off-pump coronary artery bypass surgery.
To study the effects of 8 microg/kg preoperatively administered intrathecal morphine sulfate on extubation time, postoperative pulmonary function, and postoperative analgesia after off-pump coronary artery bypass grafting (OPCAB). ⋯ Intrathecal morphine provided superior quality of analgesia that translated into better maintenance of postoperative lung volume determined by spirometry. This analgesic method also facilitated earlier tracheal extubation without any major respiratory or neurologic complications.
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The heart surgery forum · Jan 2004
Case ReportsMinimally invasive aortic valve replacement under thoracic epidural anesthesia in a conscious patient: case report.
Cardiopulmonary bypass and full median sternotomy have been recognized as major morbidity factors in cardiac surgery. Additional morbidity factors are general anesthesia and endotracheal intubation. Over the past several years high-thoracic epidural anesthesia (hTEA) has emerged as a potentially beneficial supplement to general anesthesia in the care of patients undergoing cardiac surgery. ⋯ There were no complications within 30 days after surgery. This case demonstrates that thoracic epidural anesthesia without endotracheal intubation used for aortic valve replacement performed through ministernotomy is feasible. Further experience is necessary to determine the safety of this method and the effect on outcome.
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The heart surgery forum · Jan 2004
Immediate Extubation after Aortic Valve Surgery Using High Thoracic Epidural Anesthesia.
Abstract Purpose: Fast-track anesthesia has gained widespread use in cardiac centers around the world. No study has focused on immediate extubation after aortic valve surgery. This study examines the feasibility and hemodynamic stability of immediate extubation after simple or combined aortic valve surgery using thoracic epidural anesthesia. ⋯ There were no complications related to TEA. Conclusions: Immediate extubation is feasible after aortic valve surgery with high thoracic epidural analgesia and maintenance of hemodynamic stability throughout surgery. Immediate extubation after aortic valve surgery is a promising new path in cardiac anesthesia.