The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Dec 2011
Case ReportsLate onset Takotsubo cardiomyopathy after mitral valve replacement.
We report a case of delayed onset Takotsubo cardiomyopathy (TC) in a 69-year-old woman, associated with minor stressors, two weeks after mitral valve replacement. After suffering several minor complications she had fully recovered and her discharge was planned. On the 14th postoperative day she had to be resuscitated due to cardiogenic shock. ⋯ Treatment with catecholamines and intra-aortic balloon pump led to full recovery. She continues to do well two years after surgery. TC should be considered as a potential cause of delayed ventricular dysfunction in postcardiac surgery patients.
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Thorac Cardiovasc Surg · Oct 2011
Comparative StudyAspirin does not increase bleeding and allogeneic blood transfusion in coronary artery surgery.
Traditionally, the administration of aspirin is stopped seven days before coronary artery bypass surgery to reduce the risk of postoperative bleeding. The aim of this study was to evaluate the effect of preoperative aspirin on bleeding in these patients. ⋯ Aspirin does not increase bleeding or increase the need for allogeneic blood transfusion in coronary artery surgery.
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Thorac Cardiovasc Surg · Oct 2011
Intra-aortic balloon pump implantation does not affect long-term survival after isolated CABG in patients with acute myocardial infarction.
Intra-aortic balloon pump (IABP) is an established therapy to support patients with heart failure during coronary artery bypass grafting (CABG). The impact of the timing of IABP on the hospital course and on follow-up is of particular clinical interest. The purpose of this study was to analyze the relationship between the time of IABP implantation and its impact on early, mid- and long-term survival in patients with acute myocardial infarction (AMI) who underwent emergent CABG for NSTEMI and STEMI. ⋯ This study demonstrates that CABG with IABP support in high-risk patients with AMI can be performed with acceptable in-hospital and long-term survival rates. The decision for IABP placement should consider the preoperative clinical condition and the intraoperative course of each patient. IABP placement does not appear to affect the long-term outcome after isolated CABG in patients with AMI.
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Thorac Cardiovasc Surg · Oct 2011
Comparative StudyKCH, the German preoperative score for isolated coronary artery bypass surgery: is it superior to the logistic EuroSCORE?
The accuracy of the logistic EuroSCORE in different patient populations has been questioned. Using the German registry database, the KoronarCHirurgie (KCH) score was introduced as a preoperative risk stratification tool specifically for patients who undergo isolated coronary artery bypass surgery in Germany. However, no direct statistical comparison of this score with the well-established logistic EuroSCORE has been previously performed. The aim of this study was to validate the preoperative German KCH score and to compare it to the logistic EuroSCORE for all coronary artery bypass surgery patients as well as for on-pump and off-pump subgroups. ⋯ The KCH-3.0 is more reliable than the logistic EuroSCORE as a preoperative mortality prediction score for patients undergoing isolated coronary artery bypass surgery, providing predicted mortality rates that are closer to the actual mortality rates with a lower overprediction of mortality.
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Thorac Cardiovasc Surg · Sep 2011
Early aggressive medical treatment associated with selective prophylactic aortic stent-grafting for aortic intramural hematoma.
Although recent studies suggest that medical treatment is appropriate for patients with aortic intramural hematoma (IMH), the outcomes of supportive medical treatment alone have not been satisfactory, and clear guidelines for medical treatment are not yet available. We assessed whether a management protocol of combined early aggressive medical treatment and selective prophylactic aortic stent-grafting would benefit patients with IMH. ⋯ Our protocol may be used as an alternative approach for patients with IMH. After initial clinical and radiological evaluation, the condition of patients without complications can be stabilized with medical treatment; frequent follow-up imaging is required in such cases. Early aggressive medical treatment combined with prophylactic aortic stent-grafting is a safe and effective treatment modality for IMH patients with penetrating aortic ulcers in the descending aorta.