Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2011
Comparative StudyContinuous cardiac output monitoring with an uncalibrated pulse contour method in patients supported with mechanical pulsatile assist device.
We evaluated the accuracy of an uncalibrated pulse contour method called Pressure Recording Analytical Method (PRAM) compared with continuous thermodilution for cardiac output (CO) monitoring in patients implanted with a pulsatile left ventricular assist device (LVAD). Twelve adult patients implanted with the HeartMate I-XVE device were studied. CO was simultaneously evaluated by PRAM and by continuous thermodilution. ⋯ A good correlation was found between LVAD-CO and either ThD-CCO (r=0.88) or PRAM-CO (r=0.86), but an overestimation of 10% was observed for both PRAM-CO (mean bias -0.44 l/min) and ThD-CCO (mean bias -0.40 l/min). Our results demonstrated good agreements between PRAM-CO, ThD-CCO and LVAD-CO. PRAM derives CO from a peripheral artery without calibration and may be a complementary tool in the hemodynamic assessment of patients supported with a VAD.
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Interact Cardiovasc Thorac Surg · Jun 2011
Preoperative computed tomography is associated with lower risk of perioperative stroke in reoperative cardiac surgery.
Preoperative computed tomography (CT) use appears to be increasing among patients undergoing cardiac reoperations. We hypothesized that preoperative CT imaging reduces adverse outcomes and operative mortality for these patients. From July 2002 to February 2009, 373 patients underwent cardiac reoperations. ⋯ Importantly, perioperative stroke occurred only within the NCT group (5.6% vs. 0.0%, P=0.003), and emergent operative status [odds ratio (OR): 6.45, confidence interval (CI): 1.15-36.10, P=0.03] as an independent multivariate predictor of perioperative stroke. Thus, preoperative CT imaging is associated with lower rates of perioperative stroke in patients undergoing cardiac reoperations by optimizing cannulation and aortic clamping strategies. Routine use of preoperative CT should be considered for patients undergoing cardiac operations following prior sternotomy.
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Interact Cardiovasc Thorac Surg · Jun 2011
ReviewIn cardiac surgery patients does Voluven(R) impair coagulation less than other colloids?
Hydroxyethyl starch (HES) solutions are commonly used for volume replacement in cardiac surgery patients. The degree of impairment of the haemostatic system depends on the molecular weight and substitution degree of HES solutions. It is claimed that as HES 130/0.4 (Voluven(®)) exhibits a lower in vitro molecular weight and a lower degree of hydroxyethyl substitution than HES 200/0.5 (HAES-steril(®)) therefore it has less impact on haemostasis. ⋯ The in vitro studies suggest that HES 130/0.4 has no significant effect on platelet variables, shows a faster clot formation process and a better clot retraction as compared with the other HES solutions. On the other hand, current best available evidence (level 1b) from clinical studies, limited by heterogeneity predominantly in terms of dosage of HES 130/0.4 administered and the sample size of individual trials, overwhelmingly suggests that HES 130/0.4 compared with HES 200/0.5 or gelatin-based volume replacement fluid affects coagulation to the same extent resulting in similar degree of blood loss. It can be concluded that contrary to in vitro studies HES 130/0.4 in clinical practice has comparable effects on blood loss after cardiac surgery.