Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jan 2010
Case ReportsStented within a stentless aortic valve. A simple surgical solution for the replacement of a stentless aortic bioprosthesis.
Stentless aortic bioprostheses are designed to offer better hemodynamics, less mechanical stress to the leaflets and as a result less degeneration. Although encouraging results are reported, little evidence has been published regarding reoperations of stentless valves. We are reporting a case of a structural valve dysfunction of an O'Brien-Angell stentless prosthesis, which could not be extracted during reoperation without damaging the aortic root. We are presenting a simple, quick and effective surgical solution, the surgical 'valve within a valve' technique for the avoidance of a redo complex root procedure.
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Interact Cardiovasc Thorac Surg · Jan 2010
Case ReportsMechanical prosthetic mitral valve thrombosis in a first trimester pregnant woman.
Pregnant women with a mechanical heart prosthesis are at a higher risk of thromboembolic complications. The optimal anticoagulation strategy in this setting remains unclear. When prosthesis thrombosis happens and cardiac surgery must be performed, the risk of fetal mortality is high. ⋯ She underwent a mitral valve replacement with CPB at 34 degrees C and a short cardiac arrest time. Both mother and fetus survived. We briefly review the different anticoagulation options during pregnancy and perfusion strategies on CPB to improve fetal outcomes.
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Interact Cardiovasc Thorac Surg · Jan 2010
Effect of clopidogrel on perioperative blood loss and transfusion in coronary artery bypass graft surgery.
The effect of antiplatelet therapy (APT) on postoperative bleeding, transfusion needs and re-exploration remains unclear. This study examines the influence of APT, as well as antiplatelet mono- and combined therapy, on haemorrhage and transfusion requirements in patients undergoing coronary artery bypass on cardiopulmonary bypass (CPB). Six hundred and fifty patients were reviewed retrospectively, 325 patients received APT within seven days and 325 control patients. ⋯ APT group (vs. control group) received significantly more units of blood (3.9+/-4.2 vs. 1.9+/-2.6; P<0.001), platelet units (1.0+/-1.4 vs. 0.1+/-0.3; P<0.001), and fresh frozen plasma (FFP) units (2.9+/-3.9 vs. 0.9+/-2.2; P<0.001), respectively. Combined and mono-therapy groups had no significant differences in bleeding and blood transfusion. Considerations should be given to delaying elective coronary surgery for patients received APT for seven days.