Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Apr 2009
ReviewCould atrial natriuretic peptide be a useful drug therapy for high-risk patients after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether atrial natriuretic peptide (ANP) or brain natriuretic peptide (BNP) could be a useful alternative diuretic for patients post cardiac surgery. Altogether more than 250 papers were found using the reported search, of which eight RCTs represented the best evidence to answer the clinical question. ⋯ Lower urea and creatinine levels were also found postoperatively and also reduced decreases in glomerular filtration rate compared to placebo, both in studies of patients with preoperatively normal renal function and those who had impaired function. In addition, two studies found a reduction in the incidence of AF, and renin/aldosterone levels were lower. The NAPA trial of 272 CABG patients with LV dysfunction was the only study to show a shorter ICU stay and reduced early mortality with nesiritide compared to placebo.
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Interact Cardiovasc Thorac Surg · Apr 2009
Case ReportsHeparin-induced thrombocytopenia with thrombosis syndrome managed with plasmapheresis.
Heparin-induced thrombocytopenia with thrombosis syndrome is an antibody-mediated disorder that has a high mortality in cardiac surgical patients in spite of early diagnosis and management with direct thrombin inhibitors. Plasmapheresis, an extracorporeal technique that has been designed for the removal of large molecular weight substances from the plasma, can remove the offending antibodies from these desperately ill patients. We describe a case of a postoperative cardiac surgery patient with heparin-induced thrombocytopenia with thrombosis syndrome and multi-system failure who was dependent upon a left ventricular assist device. ⋯ This patient survived because of plasmapheresis. Removing the antibodies to the heparin-platelet factor four complex with plasmapheresis is an effective strategy to treat these patients. We believe that the use of plasmapheresis as a bail-out procedure in these often desperately ill post-operative cardiac surgical patients who have heparin-induced thrombocytopenia with thrombosis syndrome could be lifesaving.
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Interact Cardiovasc Thorac Surg · Apr 2009
Case ReportsSpontaneous bronchopleural fistula following lung volume reduction surgery for emphysema.
Five days following bilateral thoracoscopic lung volume reduction surgery for emphysema, a 63-year-old man underwent reoperation for closure of a massive bronchopleural fistula. It was discovered intraoperatively that the fistula was located distant from prior staple lines or resection sites from his surgery. This case is an example of what may be a unique pathophysiologic mechanism of bronchopleural fistula formation--a 'stress rupture' of the lung parenchyma following lung volume reduction surgery.
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Interact Cardiovasc Thorac Surg · Apr 2009
ReviewCan a mini-bypass circuit improve perfusion in cardiac surgery compared to conventional cardiopulmonary bypass?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the 'mini-bypass technique' can give a reduction in complications after cardiac surgery compared to the conventional cardiopulmonary bypass circuit. Altogether 144 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. ⋯ Six studies find significantly reduced inflammatory markers, and 5 measure superior myocardial protection. There are several anecdotal references to a 'learning curve' with this technique but no significant morbidity with complications arising from this were found. Mini-bypass seems to be a promising technique with many documented benefits in studies reporting as many as 1000 patients undergoing this technique.