Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2013
Impact of mitral annular calcification on early and late outcomes following mitral valve repair of myxomatous degeneration.
Mitral annular calcification is associated with significant morbidity and mortality at the time of mitral valve surgery. However, few data are available describing the impact of mitral annular calcification on early and late outcomes following mitral valve repair in the current era. ⋯ Risk factors for mitral annular calcification in patients with myxomatous degeneration and severe mitral regurgitation include older age, female gender, severe renal dysfunction and larger preoperative left atrial size. Nevertheless, favourable early and late results can be achieved with mitral valve repair in this population.
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Interact Cardiovasc Thorac Surg · Jul 2013
Outcomes in the current surgical era following operative repair of acute Type A aortic dissection in the elderly: a single-institutional experience.
We reviewed our single-centre experience with emergent operative repair of Stanford Type A aortic dissections, with particular attention to outcomes in the elderly. ⋯ Excellent operative outcomes can be achieved in elderly patients undergoing emergent repair of Type A aortic dissections. Advanced patient age should therefore not serve as an absolute contraindication to operative repair in this high-risk cohort.
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Interact Cardiovasc Thorac Surg · Jul 2013
Case ReportsLong-term membrane oxygenator use to support an infant with acute respiratory distress syndrome on biventricular assist device.
Ventricular assist devices (VADs) are used in children with severe heart failure as a bridge to heart transplantation or recovery. Severe pulmonary dysfunction may preclude their use, leaving extracorporeal membrane oxygenation (ECMO) as the most frequently used option for combined cardiac and respiratory failure. There are few case reports describing the use of an oxygenator in combination with VAD support, but none that describes long-term utilization. ⋯ An oxygenator used in conjunction with a VAD may be a life-saving therapy, allowing adequate oxygenation and ventilation in severe respiratory and cardiac failure. Extended use may facilitate the prevention of ventilator-associated lung injury and organ dysfunction. This therapy may be an attractive intermediate step in the transition from, or alternative to ECMO, in patients requiring VAD placement with associated acute lung injury.
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Interact Cardiovasc Thorac Surg · Jul 2013
Balancing the benefits and risks of blood transfusions in patients undergoing cardiac surgery: a propensity-matched analysis.
Prior studies have found that cardiac surgery patients receiving blood transfusions are at risk for increased mortality and morbidity following surgery. It is not clear whether this increased risk occurs across all haematocrit (HCT) levels. The goal of this study was to compare operative mortality in propensity-matched cardiac surgery patients based on stratification of the preoperative HCT levels. ⋯ Our study indicates that a broad application of blood products shows no discernible benefits. Furthermore, patients who receive blood at all HCT levels may be placed at an increased risk of operative mortality and/or other surgical complications. Paradoxically, even though patients with low HCTs theoretically should benefit the most, transfusion was still associated with a higher complication and mortality rate in these patients. Our results indicate that blood transfusion should be used judiciously in cardiac surgery patients.
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Interact Cardiovasc Thorac Surg · Jul 2013
Case ReportsCombined transection of the left common carotid artery and delayed left main bronchus disruption after blunt chest trauma.
A 26-year old female was hit in the cervical region by a large block of ice and admitted with stable vital signs and multiple fractures. Chest radiography demonstrated an enlarged mediastinum, and CT scan revealed a transection of the left common carotid artery at its origin, with a false aneurysm. The lesion was repaired using a median sternotomy, cardiopulmonary bypass, moderate hypothermia and cerebral antegrade perfusion through the right axillary artery. The bronchial lesion was diagnosed 2 days later and successfully treated with left posterolateral thoracotomy and the use of direct bronchial anastomosis.