Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2010
Case ReportsTakotsubo cardiomyopathy after elective mitral valve replacement.
Takotsubo cardiomyopathy is a syndrome characterized by transient acute left ventricular dysfunction, electrocardiographic changes that can mimic acute myocardial infarction and minimal release of myocardial enzymes in the absence of obstructive coronary artery disease. Reports of Takotsubo syndrome after cardiac surgery are exceptional. We describe a case of Takotsubo cardiomyopathy in a 68-year-old woman after elective mitral valve replacement. Takotsubo syndrome should be considered in the differential diagnosis of patients presenting cardiogenic shock after cardiac surgery.
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Interact Cardiovasc Thorac Surg · Jul 2010
Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery.
Ablation outcomes were investigated in patients with and without statin pretreatment before cardiac surgery with concomitant surgical ablation for atrial fibrillation (AF). A prospective cohort study was performed containing 149 patients (n=73 statin group vs. n=76 control group) undergoing on-pump cardiac procedures with surgical ablation for paroxysmal or persistent AF. Measured outcomes were freedom from AF in the intensive care unit, discharge and at three and six months follow-up and perioperative markers of inflammation (white blood cell count, C-reactive protein). ⋯ Subgroup analysis showed that statin pretreatment was associated with higher rates of freedom from AF for paroxysmal AF at three and six months and for persistent AF after six months (P<0.05). Importantly, statin-pretreatment was independently predictive for freedom from AF at discharge [odds ratio (OR): 3.21; 95% confidence interval (CI): 1.2-8.55; P=0.02] and at three months (OR: 2.91; 95% CI: 1.14-7.45; P=0.026). Statin therapy prior to ablation surgery improves postoperative freedom from AF for paroxysmal and persistent AF in cardiac surgery patients.
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Interact Cardiovasc Thorac Surg · Jul 2010
Influence of lung mechanical properties and alveolar architecture on the pathogenesis of ischemia-reperfusion injury.
We tested the hypothesis that lung preservation techniques disarrange lung architecture, increase pulmonary impedance and lead to ischemia-reperfusion injury, which can be prevented by re-establishment of optimal lung geometry. In the first phase, fresh, cold ischemic, preserved lungs insufflated to total lung capacity (TLC) and preserved lungs ventilated with tidal volume prior to reperfusion were submitted to a 60-min ex-vivo reperfusion to evaluate the gas exchange, pulmonary hemodynamic and lung mechanics' properties. In the second phase, we evaluated the mechanical properties of lungs submitted to the same conditions of the first phase. ⋯ After the pulmonary vascular flush pulmonary impedance and alveolar collapsed area increased significantly. The insufflation to TLC and 10 min of tidal ventilation reduced the lung impedance and the percentage of alveolar collapsed area. Lung preservation techniques disarrange alveolar architecture, which lead to ischemia-reperfusion injury; recruitment maneuvers decrease the pulmonary inhomogeneities and protect the lungs against the ischemia-reperfusion injury.
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Interact Cardiovasc Thorac Surg · Jul 2010
ReviewMight type A acute dissection repair with the addition of a frozen elephant trunk improve long-term survival compared to standard repair?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in patients with an acute type A dissection (TAAD) is a frozen elephant trunk in addition to standard aortic dissection repair advantageous in terms of improved long-term mortality and closure of the distal false lumen? Altogether more than 138 papers were found using the reported search, of which six represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ However, this procedure can be performed safely without increase the operative mortality and morbidity but with an overall higher cardiopulmonary bypass and circulatory arrest time. Spinal cord ischemia and malperfusion syndrome represents the main complications associated with this procedure. Despite few studies, this procedure seems to allow early thrombosis of the false lumen and a reduction of late thoraco-abdominal aneurysm formation and reoperations rate.