Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Mar 2010
ReviewThe Fontan circulation: who controls cardiac output?
In a Fontan circuit the mechanisms involved in control of cardiac output at rest and during exercise differ significantly from normal. The classical model presumes an unlimited preload which is not available in the Fontan circuit. This review critically analyses the role of contractility, heart rate, and afterload and highlights the importance of pulmonary vascular resistance (PVR) in determining adequate preload and, therefore, cardiac output in these patients. A conceptual model of the determinants of cardiac output in Fontan patients is presented.
-
Interact Cardiovasc Thorac Surg · Mar 2010
Randomized Controlled Trial Comparative StudyClinical performance and biocompatibility of hyaluronan-based heparin-bonded extracorporeal circuits in different risk cohorts.
This prospective randomized study compares novel hyaluronan-based heparin-bonded circuits vs. uncoated controls across EuroSCORE patient risk strata including biomaterial evaluation. Over a two-year period, 90 patients undergoing coronary artery bypass grafting were prospectively randomized to one of the two perfusion protocols: Group 1 was treated with hyaluronan-based heparin-bonded preconnected circuits (Vision HFO-GBS, Gish, CA, USA) and Group 2 with identical uncoated controls. Each group was composed of three subgroups (n=15) with respect to preoperative evaluation of low (EuroSCORE 0-2), medium (3-5) and high (6+) risk patients. ⋯ C3a (ng x ml(-1)) levels were significantly lower at T3 (0.2+/-0.04 vs. 0.31+/-0.05), T4 (0.25+/-0.04 vs. 0.51+/-0.05), T5 (0.38+/-0.04 vs. 0.56+/-0.05) and interleukin-6 (pg x ml(-1)) at T4 (91+/-18 vs. 124+/-20), T5 (110+/-20 vs. 220+/-25) in coated group vs. control (P
-
Interact Cardiovasc Thorac Surg · Mar 2010
Comparative Study Clinical TrialFive years follow-up after Y-graft arterial revascularization: on pump versus off pump; prospective clinical trial.
We report our comparative experience of on-pump and off-pump full arterial coronary artery bypass grafting (CABG) using both internal mammary arteries (IMAs) anastomosed as a Y-graft. ⋯ The use of a free RIMA as Y-graft from the LIMA performed off pump eradicates aortic manipulations and provides complete revascularization to high-risk patients with mortality similar to the one of a lower risk population operated on pump. The morbidity and cost was lower in the off-pump group. This advocates for the widespread usage of the technique in high-risk patients.
-
Interact Cardiovasc Thorac Surg · Mar 2010
Comparative StudyShort- and medium-term survival following coronary artery bypass surgery in British Indo-Asian and white Caucasian individuals: impact of diabetes mellitus.
Previous studies have suggested that South Asian (SA) ethnicity is a predictor of poorer outcome after coronary artery bypass grafting (CABG). Our aim was to identify potential reasons for the higher postoperative mortality in SA patients and investigate all these reasons. All individuals undergoing isolated CABG in a tertiary cardiac centre from April 2002 to September 2007. ⋯ The higher early postoperative mortality observed in SA patients is related to higher incidence of diabetes among them. SA diabetics have a significantly higher postoperative mortality and worse overall life expectancy. Ethnicity per se is not an independent predictor of short- or medium-term survival after CABG.
-
Interact Cardiovasc Thorac Surg · Mar 2010
Determinants of body weight gain and association with neurodevelopmental outcome in infants operated for congenital heart disease.
The aim of this prospective study was to examine the determinants of growth failure and the association with neurodevelopmental outcome in infants undergoing open-heart surgery. In 107 infants undergoing open-heart surgery for congenital heart disease (CHD), we evaluated weight at birth, at surgery, and at one year of age (expressed as z-scores). Neurodevelopmental status was assessed before surgery and at one year of age. ⋯ In conclusion, impaired body weight gain before surgery is followed by a catch-up growth after surgery. However, there is no relationship to neurodevelopmental outcome. Genetic comorbidity is the most significant factor for poor weight gain.