Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Jul 2010
Case ReportsTakotsubo cardiomyopathy after elective mitral valve replacement.
Takotsubo cardiomyopathy is a syndrome characterized by transient acute left ventricular dysfunction, electrocardiographic changes that can mimic acute myocardial infarction and minimal release of myocardial enzymes in the absence of obstructive coronary artery disease. Reports of Takotsubo syndrome after cardiac surgery are exceptional. We describe a case of Takotsubo cardiomyopathy in a 68-year-old woman after elective mitral valve replacement. Takotsubo syndrome should be considered in the differential diagnosis of patients presenting cardiogenic shock after cardiac surgery.
-
Interact Cardiovasc Thorac Surg · Jul 2010
ReviewMight type A acute dissection repair with the addition of a frozen elephant trunk improve long-term survival compared to standard repair?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in patients with an acute type A dissection (TAAD) is a frozen elephant trunk in addition to standard aortic dissection repair advantageous in terms of improved long-term mortality and closure of the distal false lumen? Altogether more than 138 papers were found using the reported search, of which six represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ However, this procedure can be performed safely without increase the operative mortality and morbidity but with an overall higher cardiopulmonary bypass and circulatory arrest time. Spinal cord ischemia and malperfusion syndrome represents the main complications associated with this procedure. Despite few studies, this procedure seems to allow early thrombosis of the false lumen and a reduction of late thoraco-abdominal aneurysm formation and reoperations rate.
-
Interact Cardiovasc Thorac Surg · Jul 2010
Multicenter StudySurgical resection for oral tongue cancer pulmonary metastases.
The aim of this study was to evaluate the efficacy of surgical resection of oral tongue cancer (OTC) pulmonary metastases. Between 1977 and 2003, 23 OTC patients who developed 1-3 pulmonary metastases underwent metastasectomy. There were 14 men and nine women with a median age at the time of first metastasectomy of 56 years. ⋯ The median interval to systemic recurrence after lung resection was 4.1 months, and 21 out of 23 patients died of OTC (median, 9.5 months) after metastasectomy. Most patients who underwent pulmonary metastasectomy died of the disease within two years of metastasectomy. Even for patients with a solitary metastasis, surgical metastasectomy is not a recommended treatment option.
-
Interact Cardiovasc Thorac Surg · Jul 2010
Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery.
Ablation outcomes were investigated in patients with and without statin pretreatment before cardiac surgery with concomitant surgical ablation for atrial fibrillation (AF). A prospective cohort study was performed containing 149 patients (n=73 statin group vs. n=76 control group) undergoing on-pump cardiac procedures with surgical ablation for paroxysmal or persistent AF. Measured outcomes were freedom from AF in the intensive care unit, discharge and at three and six months follow-up and perioperative markers of inflammation (white blood cell count, C-reactive protein). ⋯ Subgroup analysis showed that statin pretreatment was associated with higher rates of freedom from AF for paroxysmal AF at three and six months and for persistent AF after six months (P<0.05). Importantly, statin-pretreatment was independently predictive for freedom from AF at discharge [odds ratio (OR): 3.21; 95% confidence interval (CI): 1.2-8.55; P=0.02] and at three months (OR: 2.91; 95% CI: 1.14-7.45; P=0.026). Statin therapy prior to ablation surgery improves postoperative freedom from AF for paroxysmal and persistent AF in cardiac surgery patients.