Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Nov 2013
Review Meta AnalysisA meta-analysis of randomized trials for repeat revascularization following off-pump versus on-pump coronary artery bypass grafting.
To determine whether repeat revascularization rates are increased following off-pump coronary artery bypass grafting (CABG), we performed a meta-analysis of randomized controlled trials of off-pump vs on-pump CABG. Databases including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through March 2013 using web-based search engines (PubMed, OVID). Studies considered for inclusion met the following criteria: the design was a prospective randomized controlled clinical trial; the study population was patients undergoing CABG; patients were randomly assigned to off-pump vs on-pump CABG and outcomes included repeat revascularization rates at ≥1 year. ⋯ In general, exclusion of any single trial from the analysis did not substantively alter the overall result of our analysis. There was no evidence of significant publication bias. The results of our analysis suggest that off-pump CABG may increase repeat revascularization rates by 38% over on-pump CABG.
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Interact Cardiovasc Thorac Surg · Nov 2013
Randomized Controlled Trial Comparative StudyPulsatile flow decreases gaseous micro-bubble filtering properties of oxygenators without integrated arterial filters during cardiopulmonary bypass.
Cardiopulmonary bypass (CPB) has a risk of embolic injury with an important role of gaseous micro-bubbles (GMBs), coming from CPB-circuit. Pulsatile perfusion (PP) can provide specific conditions for supplementary GMB-activity with respect to non-pulsatile (NP). We aimed to test GMB-filtering properties of three modern oxygenators under pulsatile and non-pulsatile conditions. ⋯ Pulsatile flow decreases gaseous micro-bubble filtering properties of oxygenators without integrated arterial filters during CPB. PP requires specially designed circuit components to avoid the risk of additional GMB delivery.
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Interact Cardiovasc Thorac Surg · Nov 2013
Case ReportsFirst experience with the deltastream(R) DP3 in venovenous extracorporeal membrane oxygenation and air-supported inter-hospital transport.
Based on continuous technical innovations and recent research, extracorporeal membrane oxygenation (ECMO) has become a promising tool in the treatment of patients with acute (cardio)pulmonary failure. Nevertheless, any extracorporeal technique requires a high degree of experience and knowledge, so that a restriction to specialized centres seems to be reasonable. As a consequence of this demand, the need for inter-hospital transfer of patients with severely impaired (cardio)pulmonary function is rising. Unfortunately, most of the ECMO devices used in the clinical setting are not suitable for inter-hospital transport because of their size, weight or complexity. In this article, we describe our first experiences with the airborne transport of 6 patients on a new portable, miniaturized and lightweight extracorporeal circulation system, the Medos deltastream® DP3. ⋯ Our experience shows that the deltastream® DP3 is an absolutely reliable and safe ECMO device that could gain growing importance in the field of airborne transportation of patients on ECMO due to its unsophisticated, miniaturized and lightweight characteristics.
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Interact Cardiovasc Thorac Surg · Nov 2013
Delirium after cardiac surgery: incidence and risk factors.
Delirium after cardiac surgery is a problem with consequences for patients and healthcare. Preventive strategies from known risk factors may reduce the incidence and severity of delirium. The present aim was to explore risk factors behind delirium in older patients undergoing cardiac surgery with cardiopulmonary bypass. ⋯ Delirium was common among older patients undergoing cardiac surgery. Both predisposing and precipitating factors contributed to delirium. When combined, the predictive strength of the model improved. Preventive strategies may be considered, in particular among the precipitating factors. Of interest, delirium was strongly associated with an increased volume load during surgery.
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Interact Cardiovasc Thorac Surg · Nov 2013
Pre-existing cerebral infarcts as a risk factor for delirium after coronary artery bypass graft surgery.
Delirium is a common and critical clinical syndrome in older patients. We examined whether abnormalities in the brain that could be assessed by magnetic resonance imaging predisposed patients to develop delirium after coronary artery bypass graft surgery. We also analysed the association between delirium and cognitive dysfunction after coronary artery bypass graft surgery. ⋯ Our findings suggested that postoperative delirium was associated with pre-existing multiple cerebral infarctions on MRI, preoperative decline in global cognitive function and ascending aortic atherosclerosis in elderly patients undergoing coronary artery bypass graft surgery and increased risk of postoperative cognitive dysfunction.