Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2009
Multicenter StudyAge- and gender-specific values of estimated glomerular filtration rate among 6232 patients undergoing cardiac surgery.
Impaired preoperative renal function as estimated by glomerular filtration rate (GFR) is an independent risk factor for mortality after cardiac surgery. Little is known about the actual prevalence of renal dysfunction among patients undergoing cardiac surgery in Germany. We performed a retrospective analysis of 6232 patients from 20 to 80 years. ⋯ The actual mortality rates varied between 6.3% (307/4869) for patients with an eGFR>60 ml/min/1.73 m(2), 11.3% (137/1051) for patients with an eGFR of 30-60 ml/min/1.73 m(2) and 16.6% (27/163) for patients with an eGFR<30 ml/min/1.73 m(2). Estimated GFR declines are age- and gender-dependent. Preoperative renal dysfunction is an important predictor of in-hospital mortality after cardiac surgery.
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Interact Cardiovasc Thorac Surg · Oct 2009
ReviewIs reduction aortoplasty (with or without external wrap) an acceptable alternative to replacement of the dilated ascending aorta?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether reduction aortoplasty is an acceptable alternative to ascending aorta replacement. From 925 potential papers, 13 papers represented the best evidence to answer the clinical question. ⋯ In particular, an aortoplasty in elderly patients with post-stenotic dilatation, or in patients with significant co-morbidities is attractive. It should be acknowledged that only one study directly compares the technique with conventional replacement and that replacement remains the 'gold standard' technique. It should also be acknowledged that the external wrap is not without risk and wrap dislocation, erosion or fistula formation are recognised complications.
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Interact Cardiovasc Thorac Surg · Oct 2009
Comparative StudyIs the aortic valve pathology type different for early and late mortality in concomitant aortic valve replacement and coronary artery bypass surgery?
We assessed the effects of aortic valve pathology type on the long-term outcomes of patients who underwent concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) surgery. We retrospectively reviewed 150 patients who underwent AVR-CABG at our institution between January 1997 and December 2006. We divided patients into aortic stenosis (AS), aortic regurgitation (AR), and mixed-type groups consisting of 98 (65.3%), 20 (13.3%) and 32 (21.3%) patients, respectively. ⋯ Significant early mortality risk factors included cross-clamp and cardiopulmonary bypass (CBP) time, number of blood transfusion units, chronic obstructive pulmonary disease (COPD), intra-aortic balloon pump (IABP), inotropic drugs, and pacemaker use. Significant late mortality risk factors included intensive care unit (ICU) stay, IABP, stroke, and dialysis. The aortic valve pathology type in patients undergoing concomitant AVR-CABG does not adversely affect survival.
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Interact Cardiovasc Thorac Surg · Oct 2009
A retrospective analysis of terlipressin in bolus for the management of refractory vasoplegic hypotension after cardiac surgery.
Cardiac surgery performed with cardiopulmonary bypass (CPB) may be complicated by hypotension due to low systemic vascular resistance (SVR). Often in those cases, hypotension is resistant to pressor catecholamines. We report six cases of norepinephrine-resistant postcardiotomy hypotension, treated by terlipressin (TP), a potent vasopressor agent. ⋯ Subsequently, the effect on systemic blood pressure enhanced urine output. No major collateral effects were observed. The administration of TP in bolus may result as a useful alternative for treating refractory low SVR hypotension post CPB.