The Annals of thoracic surgery
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Meta Analysis Comparative Study
Similar survival after mitral valve replacement or repair for ischemic mitral regurgitation: a meta-analysis.
Ischemic mitral regurgitation (IMR) occurs in 20% of patients after myocardial infarction. There is no agreement as to the best surgical option. With no prospective randomized controlled trials available, our objective was to perform a meta-analysis comparing replacement and repair. ⋯ Mitral valve repair is associated with lower operative mortality but higher recurrence of regurgitation in patients with ischemic mitral regurgitation. No differences were found regarding survival, NYHA class, and functional indicators.
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Postoperative acute kidney injury (AKI) is a common serious consequence of cardiac surgery. One recent study found higher AKI rates when anemia and hypotension occurred during cardiopulmonary bypass (CPB) relative to anemia alone. To revalidate this post hoc observation we analyzed detailed data from a large cardiac surgery cohort. ⋯ In a large cohort of cardiac surgery patients, we did not confirm any association of cardiac surgery-related AKI risk with the co-occurrence of hypotension and anemia during CPB relative to anemia alone. More detailed analyses also failed to support an anemia-hypotension interaction. Additional studies are required to better understand the relationship among anemia, hypotension during CPB, and postoperative AKI, but existing evidence is insufficient to support changes in clinical practice.
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Comparative Study
Comparison between different risk scoring algorithms on isolated conventional or transcatheter aortic valve replacement.
There are a number of scoring systems for risk evaluation in cardiac surgery, the most important of which are the European System for Cardiac Operative Risk Evaluation (EuroSCORE), The Society of Thoracic Surgeons (STS) score, the ACEF score (acronym for age, preoperative creatinine, and ejection fraction), and more recently, the new EuroSCORE-II. The aim of our study was to analyze and compare the predictive value of these scores in patients undergoing aortic valve replacement (AVR) or transcatheter aortic valve replacement (TAVR). ⋯ Overall, 30-day mortality was best predicted by the STS score. Discrimination threshold predicting mortality was equal between all other risk calculators. Surprisingly, the new EuroSCORE-II was not superior to other models in risk prediction for AVR and TAVR patients.
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A 16-year-old male patient underwent bilateral pulmonary embolectomy complicated by reperfusion injury and acute respiratory distress syndrome requiring venovenous extracorporeal membrane oxygenation support using a bicaval double-lumen catheter. A unique hemodynamic profile developed consistent with tamponade but without an associated decrease in venovenous extracorporeal membrane oxygenation pump flow, improved venovenous extracorporeal membrane oxygenation circuit preload, and decreased recirculation. The use of newer bicaval double-lumen catheters can result in old problems presenting in new ways and require clinicians to be ever vigilant.