Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Aug 2011
ReviewIdiopathic thrombocytopenic purpura and coronary artery disease: comparison between coronary artery bypass grafting and percutaneous coronary intervention.
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a low platelet count and an increased risk of bleeding. At the same time, ITP patients present an increased risk of thrombosis and atherosclerosis related to the high presence of haemostatic factors and chronic steroid therapy. ⋯ In particular, no recommendations exist regarding the best management approach. We reviewed the literature making a comparison between coronary artery bypass grafting and percutaneous coronary intervention.
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Interact Cardiovasc Thorac Surg · Aug 2011
Comparative StudyPlasma neutrophil gelatinase-associated lipocalin measured in consecutive patients after congenital heart surgery using point-of-care technology.
Neutrophil gelatinase-associated lipocalin (NGAL) is an early predictive biomarker of acute kidney injury. Plasma NGAL was measured in 218 consecutive patients aged three days to 21.1 years after admission to the intensive care unit after cardiopulmonary bypass surgery using a commercially available point-of-care test to evaluate its diagnostic value in daily practice. Plasma NGAL was between 60 and 644 ng/ml in all patients [median 134 (interquartile range 94-194) ng/ml]. ⋯ However, NGAL values were substantially scattered. Plasma NGAL levels early after congenital heart surgery are correlated to acute kidney injury, but the severity of kidney injury cannot be deduced from an individual NGAL value. Therefore, the value of one single plasma NGAL measurement performed early after cardiac bypass surgery for congenital heart disease is limited.
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Interact Cardiovasc Thorac Surg · Aug 2011
Comparative StudyOne-year follow-up of patients undergoing elective cardiac surgery assessed with the Comprehensive Assessment of Frailty test and its simplified form.
Assessment of perioperative risk of elderly patients in cardiac surgery is demanding. Most of the commonly used cardiac surgery risk scores over-or underestimate individual risk. Therefore, we recently developed a 'frailty score', the comprehensive assessment of frailty (CAF) score that showed a good prediction of 30-day mortality. ⋯ A new, easily applicable score ('Frailty predicts death One yeaR after Elective Cardiac Surgery Test') was built out of the basic score and showed a promising ability to predict one-year mortality. CAF is a new additional tool to assess prognosis of elderly patients before cardiac surgical interventions. The 'CAF' score facilitates prediction of mid-term outcome of high-risk elderly patients.
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Interact Cardiovasc Thorac Surg · Aug 2011
Case ReportsAortic valve-sparing operations in aortic root aneurysms: remodeling or reimplantation?
A best evidence topic was written according to a structured protocol. The question addressed was whether the reimplantation (David) technique or the remodeling (Yacoub) technique provides the optimum event free survival in patients with an aortic root aneurysm suitable for an aortic valve-sparing operation. In total, 392 papers were found using the reported search criteria, of which 14 papers provided the best evidence to answer the clinical question. ⋯ Although some authors merely preferred the Yacoub technique for a bicuspid aortic valve, the accumulated evidence in the current review indicates comparable results for both techniques in a bicuspid aortic valve. Current evidence is in favour of the David rather than the Yacoub technique in pathologies such as Marfan syndrome, acute type A aortic dissection, and excessive annular dilatation that may impair aortic root integrity. Careful selection of patients for each technique and successful restoration of normal cusp geometry are the keys to success in aortic valve-sparing operations.
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Interact Cardiovasc Thorac Surg · Aug 2011
Case ReportsThe Novalung interventional lung assist as bridge to lung transplantation for self-ventilating patients - initial experience.
We report the use of the Novalung pumpless device in self-ventilating patients awaiting a lung transplantation. Two patients developed carbon dioxide retention with respiratory acidosis that did not respond to maximum medical therapy. ⋯ The second patient was weaned off the Novalung after a short period. The Novalung is a valuable device for self-ventilating patients with carbon dioxide retention being bridged to lung transplantation.