Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Jul 2010
Randomized Controlled TrialA lipopolysaccharide adsorber in adult cardiopulmonary bypass: a single centre randomised controlled pilot trial.
The aim of this study was to describe the biochemical effects and safety of selective removal of endotoxin from whole blood using a lipopolysaccharide adsorber during complex cardiac surgery. ⋯ There was no effect of the adsorber on endotoxin levels or inflammatory response in this study, we have demonstrated the device to be safe in a complex cardiac surgery setting.
-
Interact Cardiovasc Thorac Surg · Jul 2010
Comparative StudyOff-pump versus on-pump coronary artery revascularization: effects on pulmonary function.
Many studies have shown important changes in lung function tests after coronary artery surgeries. It is controversial if off-pump surgery can give a better and shorter recovery than the on-pump. A prospective study was conducted on 42 patients submitted to coronary artery surgery and divided into two groups: 21 off-pump using intraluminal shunt (G (I)) and 21 on-pump (G (II)), matched by the anatomical location of the coronary arteries lesions. ⋯ The blood gas measurements showed reduction in arterial oxygen pressure (PaO(2)) and carbon dioxide pressure (PaCO(2)), while there was an increase in A-aDO(2) at PO(4) and PO(10) in both groups. The results suggest that different changes occur in pulmonary function when the surgery is performed with or without cardiopulmonary bypass. The off-pump patients showed significantly greater improvement than the on-pump group.
-
Interact Cardiovasc Thorac Surg · Jul 2010
Transcatheter aortic valves inadequately relieve stenosis in small degenerated bioprostheses.
Transcatheter aortic valves (TAVs) are a promising treatment for high risk surgical patients suffering from degeneration of previously implanted bioprostheses (valve-in-valve therapy). However, unlike native stenosed aortic valves which have accommodated Edwards SAPIEN transcatheter valves after valvuloplasty, rigid bioprostheses may prevent full TAV stent expansion and disrupt leaflet function. We hypothesized that current 23 mm TAVs would not completely relieve severe stenosis in small bioprosthetic valves. The objective of this study was to study the hemodynamics of TAVs in degenerated bioprostheses. ⋯ The bioprosthetic annulus and stent posts offered a suitable landing zone for TAVs. However, oversized transcatheter valves were constrained by the rigid bioprostheses resulting in inadequate resolution of bioprosthetic stenosis. Hemodynamics of valve-in-valve intervention was worse than comparable size surgical valve replacements, particularly in 19 and 21 mm valves. Small degenerated bioprostheses require modification of current TAV design to yield acceptable hemodynamics.
-
Interact Cardiovasc Thorac Surg · Jul 2010
Systemic hyperkalemia and mild hypothermia for valve surgery in patients with patent internal mammary artery graft.
Myocardial protection is compromised in patients with a patent internal mammary artery (IMA) graft. We assessed the advantages of systemic hyperkalemia with mild hypothermia for valve surgery in patients with a patent IMA graft. Nine patients (mean age 71.5+/-7.0 years) with a patent IMA graft underwent valve surgery from May 2004 to July 2009. ⋯ Cardiac arrest was easily achieved in each patient without IMA or aortocoronary graft injury. The postoperative peak creatine kinase-MB level was 33+/-17 IU/l, with no ST changes seen in electrocardiogram findings or new asynergy seen in echocardiogram findings. Systemic hyperkalemia and mild hypothermia for valve surgery in patients with a patent IMA graft is a good option to reduce graft and myocardial injuries.
-
Interact Cardiovasc Thorac Surg · Jul 2010
Who needs preoperative routine chest computed tomography for prevention of stroke in cardiac surgery?
Although chest computed tomography (CT) is useful for identifying ascending aortic calcification before surgery, the efficacy of routine preoperative CT in cardiac surgery is unknown. We sought to clarify the role of routine preoperative chest CT for the determination of ascending aortic calcification before cardiac surgery to aid in the prevention of stroke. Three hundred consecutive patients who underwent elective cardiac operations excluding thoracic aortic surgery had preoperative non-contrast CT. ⋯ The prevalence of severe ascending aortic calcification was 11.9% (10/84) in patients with aortic stenosis. Stroke occurred in two (0.67%) of the patients in the entire group but none in the 13 patients with surgical modification. For patients with aortic stenosis or hemodialysis, a low postoperative stroke rate can be achieved in elective cardiac surgery by use of routine preoperative chest CT to identify patients with ascending aortic calcification who require modification of the surgical technique.