Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2015
Comparative StudyImpact of a new definition of acute kidney injury based on creatinine kinetics in cardiac surgery patients: a comparison with the RIFLE classification.
Acute kidney injury (AKI) after cardiac surgery is associated with adverse patient outcome. A new definition and staging system for AKI based on creatinine kinetics (CKs) has been proposed recently. Their proponents hypothesize that early absolute increases in serum creatinine (sCr) after kidney injury are superior to percentage increases, especially in patients with chronic kidney disease (CKD). The aims of our study were to measure agreement between CK definition and the current consensus definition [risk, injury, failure, loss and end-stage renal disease (RIFLE) system], and to compare time to diagnosis and prognostic value between both systems. ⋯ In cardiac surgery, the CK definition and classification system showed substantial agreement with the current standard, was more sensitive than RIFLE and detected AKI earlier without loss of prognostic information.
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Interact Cardiovasc Thorac Surg · Mar 2015
ReviewBalloon aortic valvuloplasty as a bridge to aortic valve surgery for severe aortic stenosis.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with severe aortic stenosis, can balloon valvuloplasty be used as a bridge to aortic valve replacement? Altogether 463 papers were found using the reported search, of which 11 papers 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. ⋯ Outcomes in patients bridged to AVR/TAVI are better than in patients treated with balloon aortic valvuloplasty only. Owing to the high mortality of patients in this cohort without destination therapy, delays to progression to TAVI or AVR should be avoided in selected patients. A discussion with the patient about expectations, mortality and morbidity risks with all management options will aid decision-making.
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Interact Cardiovasc Thorac Surg · Mar 2015
Inverted-Takotsubo cardiomyopathy: severe refractory heart failure in poly-trauma patients saved by emergency extracorporeal life support.
The sequelae of severe poly-trauma may include myocardial dysfunction followed by acute heart failure and death. Inverted-Takotsubo cardiomyopathy (ITC) is a variant of stress cardiomyopathy, characterized by a contractile abnormality with extensive left ventricular circumferential dyskinesia or akinesia with a hyperkinetic apex. We report our experience with refractory cardiogenic shock and/or cardiac arrest, treated with extracorporeal life support. ⋯ Rapid heparin-free ECLS may improve outcome in the most severe cases of poly-traumatized patients demonstrating refractory inverted-Takotsubo cardiomyopathy.
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Interact Cardiovasc Thorac Surg · Mar 2015
Starting minimally invasive valve surgery using endoclamp technology: safety and results of a starting surgeon.
To critically review the learning curve, safety issues and outcome of a single surgeon while starting up minimally invasive mitral valve surgery (MIMVS). ⋯ Implementation of new equipment and techniques is challenging. However, minimally invasive mitral valve surgery with the endoclamp system is safe even during the learning curve. During our evolution from simple reconstructions/replacements to complex valve surgery with concomitant procedures, we could safely optimize our technique without mortality. A longer aortic cross-clamp time during the learning curve did not result in longer ICU and hospital stay.
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Interact Cardiovasc Thorac Surg · Feb 2015
Randomized Controlled Trial Comparative StudyRole of sevoflurane in organ protection during cardiac surgery in children: a randomized controlled trial.
The protective effects of volatile anaesthetics against ischaemia-reperfusion injury have been shown in vitro, but clinical studies have yielded variable results. We hypothesized that, in children, sevoflurane provides superior cardioprotection after cardiac surgery on cardiopulmonary bypass (CPB) compared with totally intravenous anaesthesia (TIVA). ⋯ Sevoflurane did not provide superior myocardial protection in our general paediatric cardiac surgical population. In children under 6 months, however, sevoflurane might be beneficial in comparison with midazolam. The conditioning effects of sevoflurane in specific paediatric subgroups need to be further investigated.