Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2006
Optimal myocardial protection strategy for coronary artery bypass grafting without cardioplegia: prospective randomised trial.
Although hypothermia and ischaemic preconditioning (IP) are independently recognised mechanisms of cardioprotection, interactions between myocardial temperature and preconditioning have not been investigated. Therefore, this study explored the possibility of inducing IP during hypothermia and quantifying its effects at two temperature regimens commonly used in clinical practice. One hundred and four patients undergoing coronary artery bypass grafting (CABG) with intermittent cross-clamping and ventricular fibrillation were randomised to four groups: N=normothermia (36.5+/-0.5 degrees C); NP=normothermia+preconditioning, H=hypothermia (31.5+/-0.5 degrees C), HP=hypothermia+preconditioning. ⋯ There were significant differences in cTnI release between all groups, as follows: N: 117+/-12 microg/l (P
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Interact Cardiovasc Thorac Surg · Jun 2006
Levosimendan for patients with impaired left ventricular function undergoing cardiac surgery.
The efficacy of levosimendan treatment for a low cardiac output status following cardiac surgery has not been established. Here, we review our initial experiences of the perioperative use of levosimendan. This study is a retrospective uncontrolled trial. ⋯ In the case of all but one of the patients, either the dose of the concomitant inotropic support or the balloon pumping could be weaned down within 24 h after completion of the levosimendan infusion. No withdrawal of levosimendan was required. Levosimendan could constitute a new therapeutic option for postoperative low cardiac output.
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Pericardial tamponade is a life-threatening emergency. Chyle is a rare cause of pericardial effusion and can lead to cardiac tamponade. This case illustrates the presentation, work-up and operative video of a patient in pericardial tamponade secondary to chylopericardium.
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Interact Cardiovasc Thorac Surg · Jun 2006
Complex off-pump coronary artery bypass surgery can be safely taught to cardiothoracic trainees.
Off-pump coronary revascularisation is demanding technically as the surgeon is faced with a beating heart and not a bloodless field. The potential clinical advantages of off-pump coronary revascularisation have made this procedure an essential part of a cardiothoracic training program. The aim of this study is to investigate the impact of teaching trainees complex off-pump coronary artery surgery (arterial grafting, 'Y' grafts, sequential grafting and minimally invasive direct coronary artery bypass) on clinical outcomes. ⋯ The results of this study suggest that trainees under supervision perform complex off-pump coronary artery surgery safely with low rate of mortality and complications. These findings are in agreement with previous literature reports. Trainees should be allowed to operate on sufficient number of patients undergoing off-pump surgery according to their skills and abilities. Patients should be reassured that safety is not compromised by the presence of a trainee as a primary surgeon.