The Annals of thoracic surgery
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The use of cardiopulmonary bypass is still necessary for the repair of many congenital cardiac defects. However, exposure to cardiopulmonary bypass can still lead to major morbidity and sometimes mortality, especially in neonates and infants, despite a perfect surgical repair. Various research-based strategies have been used to minimize some of the complications related to cardiopulmonary bypass, including the systemic inflammatory response, hemodilution, and transfusion requirement. This overview provides some of the strategies that we use in our practice in applying cardiopulmonary bypass in the repair of congenital cardiac defects in neonates and infants.
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Case Reports
Heparin-induced thrombocytopenia and cardiopulmonary bypass: perioperative argatroban use.
Heparin-induced thrombocytopenia (HIT), a serious complication of heparin therapy, mandates heparin cessation and alternative anticoagulation. We report a patient with a history of HIT who successfully underwent cardiopulmonary bypass (CPB) using short-term reexposure to heparin and perioperative therapy with argatroban. ⋯ The pharmacokinetics of argatroban, especially its hepatic rather than renal elimination, makes it the drug of choice for some HIT patients in whom other alternative anticoagulants (eg, danaparoid and hirudin) are less well suited. Because of interference with the international normalized ratio (INR), switching from argatroban to oral anticoagulants is not straightforward.
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Stroke remains a devastating complication after cardiac surgical procedures despite advances in perioperative monitoring and management. The purpose of this study was to determine the predictors of stroke in a large, contemporary cardiac surgery population. ⋯ Identification of predictors for stroke is important for understanding the pathogenesis of this devastating complication as well as for developing preventative strategies. Although retrospective analyses can be subject to selection bias we believe beating heart CABG is associated with a lower incidence of stroke and may therefore improve patient outcomes.
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Left atrial dissection, a rare complication occurring mainly after mitral repair, is reported after double valve replacement in a patient with a connective tissue disease. A 63-year-old woman with systemic sclerosis underwent double valve replacement. Laceration of the tissue between the two mechanical prostheses and dissection of the left atrial wall emerged postoperatively and regurgitation through the dissection caused heart failure, which later improved without surgery. The possible causes of the dissection were thought to be shear forces against the tissue between the two prostheses and tissue fragility due to systemic sclerosis and corticosteroid therapy.