Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2013
Is single-unit blood transfusion bad post-coronary artery bypass surgery?
Publications in the surgical literature are very consistent in their conclusions that blood is dangerous with regard to in-hospital mortality, morbidity and long-term survival. Blood is frequently used as a volume expander while simultaneously increasing the haematocrit. We investigated the effects of a single-unit blood transfusion on long-term survival post-cardiac surgery in isolated coronary artery bypass grafting patients. ⋯ Cox regression and propensity matching both indicate that a single-unit transfusion is not a significant cause of reduced long-term survival. Preoperative anaemia is a significant confounding factor. Despite demonstrating the negligible risks of a single-unit blood transfusion, we are not advocating liberal transfusion and would recommend changing from a double-unit to a single-unit transfusion policy. We speculate that blood is not bad, but that the underlying reason that it is given might be.
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Interact Cardiovasc Thorac Surg · Jun 2013
Case ReportsSuccessful simultaneous repair of traumatic aortic and right atrium ruptures.
A 63-year old woman was transferred to our hospital due to a motor vehicle accident. Enhanced computed tomography showed aortic arch intramural haematoma and pericardial effusion. The patient lost consciousness, and we thought that the cardiac tamponade was indeed due to intrapericardial rupture of the aorta. ⋯ Next, total arch replacement with a four-branched knitted prosthetic graft was performed. Over two-thirds of the intima was circumferentially ruptured at the level of the aortic isthmus. Postoperative neurological complications did not arise.
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Interact Cardiovasc Thorac Surg · Jun 2013
Comparative StudySternal closure after median sternotomy: a new technique using titanium hooks and wires applied parasternally.
Osteosynthetic closure of the chest after median sternotomy is usually performed with steel wires. We describe, for the first time, a case series in which titanium hooks were implanted from the sternal surface in patients who required secondary or additional stabilization. In comparison to the classic wires, the diameters of the hooks are approximately three times bigger and therefore reduce the risk of cutting through the bones. Additionally, there is no need to dissect retrosternal adhesions, which may reduce the risk of injuring mediastinal tissues. ⋯ This sternal closure system using titanium hooks inserted parasternally is an effective alternative to conventional techniques and may increase stability of the breastbone and reduce the risk of injury to retrosternal tissues.
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Interact Cardiovasc Thorac Surg · Jun 2013
Aortic valve reconstruction with autologous pericardium for dialysis patients.
This study aimed to report on original aortic valve reconstruction for patients on dialysis. ⋯ Medium-term results are excellent. Since warfarin for dialysis patients becomes problematic, a postoperative warfarin-free status is desirable. Aortic valve reconstruction can provide patients with a better quality of life without warfarin.
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Interact Cardiovasc Thorac Surg · Jun 2013
Case ReportsStaged repair for aortic arch reconstruction and intracardiac repair following bilateral pulmonary artery banding in 3 critical patients.
Bilateral pulmonary artery banding has been performed as a first palliation for hypoplastic left heart syndrome with a poor preoperative condition. We report 3 patients with aortic arch reconstruction and intracardiac repair following bilateral pulmonary artery banding in moribund patients after birth. ⋯ More than 75% of cerebral oxygenation may provide higher urinary output due to higher renal blood flow through collateral circulation. This technique reduces the risk of perioperative neurological damage.