Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Oct 2013
Randomized Controlled TrialRemote ischaemic preconditioning down-regulates kinin receptor expression in neutrophils of patients undergoing heart surgery.
Remote ischaemic preconditioning (RIPC) may protect distant organs against ischaemia-reperfusion injury. We investigated the impact of RIPC on kinin receptor expression in neutrophils following RIPC in patients undergoing coronary artery bypass grafting (CABG). ⋯ RIPC down-regulated the expression of kinin B1 and B2 receptors in neutrophils of patients undergoing CABG.
-
Interact Cardiovasc Thorac Surg · Oct 2013
ReviewIs levosimendan effective in paediatric heart failure and post-cardiac surgeries?
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'do children with heart failure post-cardiac surgery undergoing treatment with levosimendan have an acceptable haemodynamic improvement?' The use of levosimendan as a vasoactive drug is an accepted intervention for patients with altered haemodynamics post-cardiac surgeries. However, the role of levosimendan and its efficacy have been debated. ⋯ Furthermore, it is best used as a rescue drug on a named-patient basis. A small sample size was indeed a limitation in all the above studies. Larger, well-designed trials are required to further evaluate the efficacy and feasibility of levosimendan in paediatric heart failure and post-cardiac surgeries.
-
Interact Cardiovasc Thorac Surg · Oct 2013
ReviewMight rapid implementation of cardiopulmonary bypass in patients who are failing to recover after a cardiac arrest potentially save lives?
The question addressed was whether it might be beneficial to have a rapid-response emergency cardiopulmonary bypass service for patients who suffer an in-hospital or an out-of-hospital cardiac arrest of any aetiology. Eighty-five papers were reviewed using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ However, no study has provided clear-cut evidence of the merits of ECPS in patients with out-of-hospital cardiac arrest, although many case reports and case series have concluded that it is an effective method. We conclude that institution of emergency cardiopulmonary bypass may save the lives of patients in whom routine attempts at resuscitation after a cardiac arrest fail, especially after >10 min. The likelihood of success is much higher for patients who have in-hospital witnessed cardiac arrest.
-
Interact Cardiovasc Thorac Surg · Oct 2013
Multicenter Study Observational StudyImpact of occult renal impairment on early and late outcomes following coronary artery bypass grafting.
High serum creatinine is considered an independent risk factor for poor outcomes following coronary artery bypass grafting (CABG). However, the impact of occult renal impairment (ORI), defined as an impaired glomerular filtration rate (GFR) with a normal serum creatinine (SCr) level, remains unclear. Thus, we sought to investigate the impact of ORI on outcomes after CABG. ⋯ ORI was an independent risk factor for early and late death as well as cardiovascular events in patients undergoing CABG with normal SCr levels. A more accurate evaluation of renal function through a combination of SCr and estimated GFR is needed in patients with normal SCr levels.
-
The occurrence of intra-abdominal hypertension (IAH), as well as its promoting factors in cardiac surgery, has been poorly explored. The aim of the present study was to characterize intra-abdominal pressure (IAP) variations in patients undergoing cardiac surgical procedures, and to identify the risk factors for IAH in this setting. ⋯ IAH develops in one-third of cardiac surgery patients and is strongly associated with higher baseline IAP values, higher central venous pressure, positive fluid balance, extracorporeal circulation, use of vasoactive drugs and AKI. Determinants of IAH should be accurately assessed before and after surgery, and patients presenting risk factors must be monitored properly during the perioperative period. In this context, the baseline value of IAP may be a valuable and early warning parameter for IAH occurrence.