Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Apr 2009
Randomized Controlled Trial Comparative StudyProspective randomized evaluation of stentless vs. stented aortic biologic prosthetic valves in the elderly at five years.
Randomized trials comparing stentless to stented bioprostheses for aortic valve replacement in elderly are scarce. The aim of this study was early and mid-term evaluation of these bioprostheses, with regards to clinical outcome and hemodynamic performance. ⋯ At five years, stentless valves were not superior to the stented valves, with regards to hemodynamic performance, regression of left ventricular mass and clinical outcome.
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Interact Cardiovasc Thorac Surg · Apr 2009
ReviewCan a mini-bypass circuit improve perfusion in cardiac surgery compared to conventional cardiopulmonary bypass?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the 'mini-bypass technique' can give a reduction in complications after cardiac surgery compared to the conventional cardiopulmonary bypass circuit. Altogether 144 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. ⋯ Six studies find significantly reduced inflammatory markers, and 5 measure superior myocardial protection. There are several anecdotal references to a 'learning curve' with this technique but no significant morbidity with complications arising from this were found. Mini-bypass seems to be a promising technique with many documented benefits in studies reporting as many as 1000 patients undergoing this technique.
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Interact Cardiovasc Thorac Surg · Apr 2009
Case ReportsHeparin-induced thrombocytopenia with thrombosis syndrome managed with plasmapheresis.
Heparin-induced thrombocytopenia with thrombosis syndrome is an antibody-mediated disorder that has a high mortality in cardiac surgical patients in spite of early diagnosis and management with direct thrombin inhibitors. Plasmapheresis, an extracorporeal technique that has been designed for the removal of large molecular weight substances from the plasma, can remove the offending antibodies from these desperately ill patients. We describe a case of a postoperative cardiac surgery patient with heparin-induced thrombocytopenia with thrombosis syndrome and multi-system failure who was dependent upon a left ventricular assist device. ⋯ This patient survived because of plasmapheresis. Removing the antibodies to the heparin-platelet factor four complex with plasmapheresis is an effective strategy to treat these patients. We believe that the use of plasmapheresis as a bail-out procedure in these often desperately ill post-operative cardiac surgical patients who have heparin-induced thrombocytopenia with thrombosis syndrome could be lifesaving.