Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2012
Comparative StudyImpact of clopidogrel on bleeding complications and survival in off-pump coronary artery bypass grafting.
This study investigated the impact of preoperative clopidogrel on bleeding complications and survival during and after off-pump coronary artery bypass grafting (OPCABG) and assessed the possible role of the antifibrinolytic agent aprotinin for attenuating blood loss after clopidogrel exposure. Prospectively collected data of 753 consecutive adult patients undergoing OPCABG were retrospectively reviewed; 139 (18.5%) patients received clopidogrel preoperatively. Statistical methods used were student paired t-test, Mann-Whitney U, Kruskal-Wallis, chi-square analysis and Kaplan-Meier with log-rank analysis. ⋯ Preoperative clopidogrel exposure does increase perioperative blood loss and blood transfusion requirements in patients undergoing OPCABG but has an otherwise excellent safety profile with a 94% 5-year survival rate. Aprotinin attenuated this blood loss. Based on these results a recommendation to discontinue clopidogrel prior to coronary artery bypass grafting cannot be maintained, if OPCABG strategies are considered.
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Interact Cardiovasc Thorac Surg · Mar 2012
Histological and genetic studies in patients with bicuspid aortic valve and ascending aorta complications.
Aneurysm diameter and growing rate does not represent a definite parameter for operation in bicuspid aortic valve (BAV), ascending aortic aneurysm and normal root patients. Thus, we investigated histological and immunohistochemical aspects of different segments of ascending aorta (precisely, aortic root without dilatation, aneurysmatic tubular portion, dissected ascending aorta) and genetic features of patients with BAV and ascending aorta complication (aneurysm or dissection). ⋯ Based on our histological and genetic data, we underline that a surgical approach in patients with BAV, ascending aortic aneurysm and normal root, should consider not only the diameter of the aneurysmatic aortic portion but also the histological features of the whole ascending aorta and the genetic risk profile.
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Interact Cardiovasc Thorac Surg · Mar 2012
Case ReportsPost-traumatic left ventricular pseudoaneurysm.
Left ventricular pseudoaneurysms (LVPs) occur as a complication of myocardial infarction, cardiac surgery and, rarely, due to thoracic trauma, infective pericarditis or iatrogenisis due to accidental perforation of the myocardium. Ventricular pseudoaneurysms are acquired by blood-filled spaces outside the cardiac chambers communicating with the ventricle. We present a case of LVP presented after a blunt non-penetrating chest injury. The patient underwent successful aneurysmorrhaphy.
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Interact Cardiovasc Thorac Surg · Mar 2012
Case ReportsNeedlescopic video-assisted thoracic surgery for reversal of thoracic sympathectomy.
Thoracic sympathectomy is a commonly performed surgical procedure for the treatment of palmar hyperhidrosis. However, one major complication of such a procedure is compensatory truncal hyperhidrosis. ⋯ Bilateral reoperative needlescopic video-assisted thoracic surgery was performed for the reversal of thoracic sympathectomy with an interposition intercostal nerve graft. The patient's truncal hyperhidrosis resolved gradually over 1 month following the reversal procedure.
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Interact Cardiovasc Thorac Surg · Mar 2012
Case ReportsRepair of a penetrating aortic arch injury using deep hypothermic circulatory arrest and retrograde cerebral perfusion.
The traumatic rupture of the thoracic aorta is a severe and life-threatening entity. The incidence of penetrating trauma to the aortic arch is not known, because most patients die of haemorrhage even before they receive adequate treatment. Clinical signs of such injuries include external or internal haemorrhage, bruit, distal pulse deficit, neurological deficit and shock. We present a 42-year old female with a penetrating aortic arch injury successfully repaired using deep hypothermic circulatory arrest and retrograde cerebral perfusion.