Interactive cardiovascular and thoracic surgery
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Proximal thoracic aortic reconstruction performed with or without hypothermic circulatory arrest (HCA) is an effective surgical strategy for aortic pathology. In this study, the clinical outcomes of patients undergoing reoperative proximal thoracic aortic surgery were evaluated. A retrospective review was performed for reoperative proximal aortic surgery from 2004 to date. ⋯ Univariate and multivariate analyses of HCA patients showed cardiopulmonary bypass (CPB) time, preoperative renal failure and prior coronary revascularization as independent predictors of mortality. Reoperative proximal aortic surgery can be performed with acceptable morbidity and mortality. These data also suggest that HCA represents a safe operative strategy for this patient population.
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Interact Cardiovasc Thorac Surg · Jul 2012
Outcomes and predictors of prolonged ventilation in patients undergoing elective coronary surgery.
OBJECTIVES Despite the seriousness of prolonged mechanical ventilation (PMV) as a postoperative complication, previously proposed risk prediction models were met with limited success. The purpose of this study was to identify perioperative variables associated with PMV in elective primary coronary bypass surgery. PMV was defined as the need for intubation and mechanical ventilation for >72 h, after completion of the operation. ⋯ Kaplan-Meier survival curves showed reduced survival among PMV patients (P < 0.001) with an improved survival in the tracheostomy subgroup. CONCLUSIONS PMV after coronary bypass is associated with a reduction in early and mid-term survival. Risk modelling for PMV remains problematic even when examining a more homogenous lower risk group.
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Interact Cardiovasc Thorac Surg · Jul 2012
Case ReportsA successful third resection-anastomosis in a tracheal restenosis.
Reoperation due to recurrence after tracheal resection and reconstruction still seems challenging. Although recurrence may lead to serious morbidity, an appropriate surgical technique plays a significant role in the cure of these patients. ⋯ We believe that the number of previous operations is not a contraindication by itself against reoperating on a patient with restenosis. Also the success rate might be acceptably high if a sufficiently healthy tracheal length remains.
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Interact Cardiovasc Thorac Surg · Jul 2012
The impact of major perioperative renal insult on long-term renal function and survival after cardiac surgery.
Temporary renal replacement therapy (RRT) facilitates recovery from a major perioperative renal injury and, although RRT can improve the hospital outcome, it is not known as to whether it mitigates long-term renal sequelae. Therefore, we investigated the risk of long-term dialysis after RRT post-cardiac surgery. We analysed prospectively the data collected for all hospital survivors who received RRT following cardiac surgery between March 1996 and July 2010, excluding those on dialysis preoperatively or with a functioning renal transplant. ⋯ Only three patients with severe preoperative renal dysfunction received dialysis. The Kaplan-Meier 5- and 7-year survival rates for this patient cohort were 54% and 38%, respectively. In conclusion, a major renal insult requiring temporary RRT after cardiac surgery does not increase the risk for renal dialysis in the long term for patients with normal renal function preoperatively.
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Interact Cardiovasc Thorac Surg · Jul 2012
Case ReportsSuccessful surgical repair of platypnea-orthodeoxia syndrome in a patient with cerebral infarction.
Platypnea-orthodeoxia syndrome is a rare condition characterized by hypoxaemia in the upright position and arterial hypoxaemia induced by the upright position, and the syndrome is relieved by recumbency. We encountered a cerebral infarction patient who presented with low SpO(2) levels in the upright position. ⋯ The surgical closure of the foramen and shortening of the ascending aorta improved the patient's clinical condition. To our knowledge, there have been few reports of clinical conditions of this kind.