Interactive cardiovascular and thoracic surgery
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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.
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Interact Cardiovasc Thorac Surg · Mar 2011
Levels of N-terminal-pro-brain natriuretic peptide in congenital heart disease surgery and its value as a predictive biomarker.
To explore the value of N-terminal-pro-brain natriuretic peptide (NT-ProBNP) as a predictive biomarker of postoperative cardiovascular surgery. ⋯ NT-ProBNP concentration is dependent on time during the perioperative period, it peaks at 24 hours and depends on the preoperative value and CPB length. A high peptide level before surgery is an independent predictor of prolonged stay in intensive pediatric care.
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Interact Cardiovasc Thorac Surg · Mar 2011
Comparative StudyEffects of foam or gauze on sternum wound contraction, distension and heart and lung damage during negative-pressure wound therapy of porcine sternotomy wounds.
The study was performed to compare the effects of negative-pressure wound therapy (NPWT) using gauze and foam on wound edge movement and the macroscopic appearance of the heart and lungs after NPWT. Sternotomy wounds were created in 6×70 kg pigs. Negative pressures of -40, -70, -120 and -160 mmHg were applied and the following were evaluated: wound contraction, distension and the macroscopic appearance of the heart and lungs after NPWT. ⋯ The study shows that foam allows greater wound contraction and distension than gauze. This movement of the wound edges may cause damage to the underlying organs. There is less damage to the heart and lungs when using gauze than foam.