Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2019
Does bilateral versus single thoracic artery grafting provide survival benefit in female patients?
Bilateral internal thoracic artery (BITA) grafting is associated with improved survival, but this technique is reluctantly used in women due to an increased risk of sternal wound infection. The aim of this study was to compare the long-term survival of women who underwent BITA grafting and single internal thoracic artery (SITA) grafting. ⋯ The low early mortality and complication rate, and the long-term survival benefit of BITA compared to SITA grafting, support the use of BITA grafting in women.
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Interact Cardiovasc Thorac Surg · Jun 2019
Case ReportsBiostial iatrogenic coronary artery stenosis: a rare complication of aortic valve surgery successfully treated with percutaneous coronary stenting.
A 66-year-old woman presented 4 months after conventional surgical aortic valve replacement with an acute coronary syndrome resulting from rare iatrogenic biostial left main and right coronary artery stenoses, which were successfully treated with percutaneous coronary stenting, optimized by intracoronary imaging.
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Interact Cardiovasc Thorac Surg · Jun 2019
Custodiol-N™ cardioplegia lowers cerebral inflammation and activation of hypoxia-inducible factor-1α.
Cardioplegic solutions induce cardiac arrest and protect cardiac tissue from ischaemia-reperfusion injury. However, the effects on the brain, which is vulnerable to cardiopulmonary bypass (CPB) surgery and ischaemia-reperfusion injury, mostly remain unknown. We investigated if cardioplegic solutions differ in their effects in altered oxygen conditions and in their ability to induce cerebral inflammation. ⋯ HTK-N (Custodiol-N) induced fewer cerebral effects and less inflammation during CPB surgery than HTK and HTK/CsA cardioplegia. These data suggest that HTK-N exerts brain protective effects during and after CPB surgery.
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Interact Cardiovasc Thorac Surg · Jun 2019
Surgical revision of failed percutaneous edge-to-edge mitral valve repair: lessons learned.
Although percutaneous edge-to-edge mitral valve repair with the MitraClip system is becoming widely adopted in clinical practice, surgical experience on how to correct failed MitraClip therapy is limited. We aimed to analyse the surgical and pathological outcomes after surgical revision of the failed MitraClip therapy. ⋯ The surgical revision of failed MitraClip therapy is feasible but has high perioperative mortality, especially among patients with cardiogenic shock, septic shock or liver failure. Mitral regurgitation after the MitraClip therapy is mainly caused by mitral valve leaflet damage due to tear, degeneration or infection, all related to the MitraClip itself.
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Interact Cardiovasc Thorac Surg · May 2019
Discontinuation of dual antiplatelet therapy and bleeding in intensive care in patients undergoing urgent coronary artery bypass grafting: a retrospective analysis.
Our goal was to evaluate the impact of the discontinuation times of dual antiplatelet therapy with clopidogrel, prasugrel or ticagrelor on postoperative bleeding rates and the use of blood products in patients undergoing isolated urgent coronary artery bypass grafting (CABG). ⋯ Discontinuation of ticagrelor and prasugrel for more than 72 h before urgent CABG was not associated with higher bleeding rates compared to treatment with ASA monotherapy. In contrast, discontinuation for less than 24 h was associated with higher use of blood products. For ticagrelor, this study supports evidence and recent guidelines proposing a shorter discontinuation time of 3 days and raises the question of whether the same could be true for prasugrel.