Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2009
ReviewIs patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is patient-prosthesis mismatch an independent risk factor for 30-day and mid-term overall mortality in adult patients undergoing aortic valve replacement (AVR)? Altogether, almost 400 papers were found using the reported search, of which 22 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. ⋯ An exception could be represented by patients with poor ejection fraction, a condition that can make moderate mismatch a predictor of overall mortality after AVR. On the other hand, severe mismatch is a predictor of overall 30-day or mid-term mortality for patients undergoing AVR independently from the presence of poor ejection fraction. In conclusion, our review suggests that the condition of severe PPM should be always avoided, while the presence of moderate mismatch could be tolerated in patients with normal ejection fraction without any impact on overall survival.
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Interact Cardiovasc Thorac Surg · Sep 2009
ReviewEndovascular versus open surgical repair for blunt thoracic aortic injury.
A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether patients with acute traumatic thoracic aortic injury have a better outcome with endovascular or open surgical repair. ⋯ We concluded that the peri-procedural mortality rate for patients with traumatic thoracic blunt aortic injury is lower for patients treated with an endovascular stent graft when compared to the open technique. This important benefit is at the cost of a high procedure complication rate, requirement for long-term surveillance of the stent and uncertain medium and longer-term outcome.
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Interact Cardiovasc Thorac Surg · Sep 2009
Microalbuminuria and short-term prognosis in patients undergoing cardiac surgery.
To examine if preoperative microalbuminuria (MA) is associated with in increased risk of adverse outcomes in patients undergoing elective cardiothoracic surgery, and if adding information on MA could improve the accuracy of the additive EuroSCORE. ⋯ Preoperative MA in patients undergoing elective cardiothoracic surgery was not associated with most early adverse outcomes. However, risk of septicaemia was higher and patients with MA also had a marginally longer length of ICU and hospital stay. Information on preoperative MA did not improve the accuracy of the additive EuroSCORE.
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Interact Cardiovasc Thorac Surg · Sep 2009
Safe use of recombinant activated factor VIIa for recalcitrant postoperative haemorrhage in cardiac surgery.
The aim of this case series is to review the effect of recombinant activated factor VIIa (rFVIIa) on refractory haemorrhage, despite aggressive treatment with conventional blood products and medications at our institution. All patients undergoing cardiac surgery who received rFVIIa as rescue therapy for persistent uncontrollable haemorrhage were studied. We examined coagulation immediately before and after rFVIIa was given; international normalized ratio (INR), activated partial thromboplastin (APTT) fibrinogen and platelet levels, in addition to the use of red cell and non-red cell blood products, morbidity and mortality. ⋯ There was significant reduction in red blood cell and product transfusion before and after rFVIIa administration (P<0.001). There was significant correction in coagulation parameters after rFVIIa. Recombinant FVIIa appears to be safe, and is effective in reducing red blood cell and product transfusion requirements and may impact on early and late outcomes in this small complex subgroup of patients.