Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2011
Risk factors of stroke and delirium after off-pump coronary artery bypass surgery.
Off-pump coronary artery bypass surgery (CABG) has not abolished the risk of postoperative stroke and delirium seen for on-pump CABG. Advanced arteriosclerotic changes are common in both on-pump and off-pump CABG. We sought to analyze if advanced arteriosclerotic changes are risk factors of stroke or transient ischemic attack (TIA), and delirium after off-pump CABG. ⋯ Carotid artery stenosis >50% was a significant risk factor of stroke or TIA (P=0.02) as well as delirium (P=0.04) after off-pump CABG. A history of atrial fibrillation (AF) (P=0.037) or diabetes mellitus (P=0.041) was a risk factors of postoperative stroke or TIA. In contrast, age over 75 years (P=0.006), creatinine >1.3 mg/dl (99 μmol/l) (P=0.011), a history of hypertension (P=0.001), past history of AF (P=0.024), and smoking (P=0.048) were significant risk factors of postoperative delirium.
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Interact Cardiovasc Thorac Surg · Mar 2011
Comparative StudyBeating heart versus conventional mitral valve surgery.
The present study aimed to compare the results of beating heart technique and conventional mitral valve surgery (MVS). ⋯ This study concluded that beating heart MVS can be performed successfully, particularly for patients at higher risk which will lead to increased morbidity and mortality in postoperative period.
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Interact Cardiovasc Thorac Surg · Mar 2011
Extracorporeal membrane oxygenation to support prolonged conventional cardiopulmonary resuscitation in adults with cardiac arrest from acute myocardial infarction at a very low-volume centre.
We aimed to analyse the outcomes of the deployment of extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation (E-CPR) 11 times for acute myocardial infarction (AMI) in 10 adult patients at a very low-volume (VLV) centre, where perfusionists or surgeons are not always available. We conducted a three-year retrospective chart review. E-CPR was performed 13 times in 12 adult patients who had cardiac arrest events and who underwent conventional CPR for longer than 10 min. ⋯ Three patients were successfully weaned off ECMO; however, they died subsequently of multiple organ dysfunction, unstable haemodynamic changes and septic shock from nosocomial infections, respectively. The outcome of E-CPR in adults with AMI was compared with previous studies at high-volume centres. Mortality or morbidity rates are not higher at a VLV centre.
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Interact Cardiovasc Thorac Surg · Mar 2011
Cerebral monitoring in patients undergoing carotid endarterectomy using a triple assessment technique.
Selective shunting during carotid endarterectomy (CEA) is advocated to reduce shunt related stroke. Cerebral monitoring is essential for temporary carotid shunting. Many techniques are available for cerebral monitoring, however, none is superior to monitoring the patient's neurological status (awake testing) while performing the procedure under local anaesthesia (LA). Cerebral oximetry (CO) and trans-cranial Doppler (TCD) has previously been used to show the adequacy of cerebral circulation in patients undergoing CEA. The aim of this study is to assess the reliability of CO and TCD in predicting the need for shunting compared to the awake testing. ⋯ TCD is less accurate than CO in predicting the need for carotid shunting during CEA. A combination of both methods does not add to the accuracy of detecting the need for carotid shunting.