Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Apr 2010
Multicenter Study Comparative StudyIs advanced age a contraindication for emergent repair of acute type A aortic dissection?
With the general increase in human lifespan, cardiac surgeons are faced with treating an increasing number of elderly patients. The aim of our study was to investigate whether advanced age poses an increased risk for major morbidity and mortality with repair of acute type A aortic dissection. Between 2000 and 2008, 119 patients underwent emergency operation for acute type A aortic dissection at two institutions; 90 were younger than 70 years of age and 29 patients were 70 years or older. ⋯ No significant differences in operative mortality, major morbidity and actuarial 5-year survival were observed between patients >or=70 years and younger patients although there was a trend toward a lower actuarial 5-year survival in older patients. Surgery for type A acute aortic dissection in patients 70 years or older can be performed with acceptable outcomes. Hemodynamic instability portends a poor prognosis, regardless of age.
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Interact Cardiovasc Thorac Surg · Apr 2010
Biatrial reduction plasty with reef imbricate technique as an adjunct to maze procedure for permanent atrial fibrillation associated with giant left atria.
Success of the modified maze procedure after valvular operation with giant atria and permanent atrial fibrillation (AF) remains suboptimal. We report an aggressive approach for these patients utilizing biatrial reduction plasty with a reef imbricate suture technique concomitantly with valvular and maze procedure for AF. From January 1999 to December 2006, 122 consecutive Chinese patients with permanent AF and biatrial enlargement who required mitral valve+/-tricuspid valve (TV) surgery underwent aggressive left atrial reduction combined with radiofrequency bipolar full maze procedure. ⋯ Ninety-three of 122 (76%) patients were restored in normal sinus rhythm after one year clinical follow-up. Aggressive biatrial reduction plasty combined with full maze procedure is an effective treatment for patients with permanent AF undergoing concomitant valvular surgery. Further studies utilizing the reef imbricate suture technique for atrial reduction need to subsequently be evaluated.
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Interact Cardiovasc Thorac Surg · Apr 2010
Randomized Controlled Trial Comparative StudyLow postoperative dose of aprotinin reduces bleeding and is safe in patients receiving clopidogrel before coronary artery bypass surgery. A prospective randomized study.
Clopidogrel (Plavix) given before the operation increases bleeding complications following coronary artery bypass grafting (CABG). High perioperative doses of aprotinin (Trasylol) are known to reduce bleeding and transfusions after cardiac surgery, but may increase the risk of thrombosis, renal impairment, and mortality. The aim of the study was to evaluate the clinical effects of aprotinin given in high doses intra- and postoperatively vs. a low postoperative dose in patients on clopidogrel. ⋯ Renal impairment and need for inotropic drugs were more frequent in the high dose group. Thirty-day mortality was similar (high dose 2%, low dose 0.5%, P=0.22). A low postoperative dose of aprotinin in patients receiving clopidogrel is safe and has comparable effects regarding postoperative bleeding complications as a high dose.
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Interact Cardiovasc Thorac Surg · Apr 2010
ReviewIn hypoplastic left heart patients is Sano shunt compared with modified Blalock-Taussig shunt associated with deleterious effects on ventricular performance?
A best evidence topic in congenital cardiac surgery was written according to a structured protocol. The question addressed was: in hypoplastic left heart patients is Sano shunt compared with modified Blalock-Taussig (mBT) shunt associated with deleterious effects on ventricular performance? Sano shunt modification of Norwood procedure involves construction of a right ventricle to pulmonary artery (RV-PA) conduit as an alternative source of pulmonary blood flow. Compared with the mBT shunt, the RV-PA conduit provides a more stable haemodynamic state in the immediate postoperative period and is reported to be associated with lower interstage mortality. ⋯ We conclude that the current available evidence, although weak, does not show any adverse effects of ventriculotomy on ventricular performance in patients with Sano shunt in the short- and medium-term. However, all the existing studies are limited by small numbers, non-randomised design and retrospective nature with failure of correlation of echocardiographic indices to clinical outcomes. It is expected that the Pediatric Heart Network randomised controlled trial will address this important issue.
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Interact Cardiovasc Thorac Surg · Apr 2010
Case ReportsCalcifying fibrous pseudotumours: an unusual case with multiple pleural and mediastinal lesions.
Calcifying fibrous pseudotumour (CFPT) is a rare soft tissue lesion that has been reported in the pleura and mediastinum. The literature contains reports of multiple pleural lesions. ⋯ However, many lesions remain. We discuss the clinical behaviour of CFPTs and the dilemma of leaving remaining lesions in situ.