Texas Heart Institute journal
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Review Meta Analysis
Statin therapy may influence the incidence of postoperative atrial fibrillation: what is the evidence?
Atrial fibrillation is the most common postoperative arrhythmia in patients who undergo cardiac surgery. We sought to determine whether the administration of statins reduces the incidence of postoperative atrial fibrillation in cardiac surgery patients. We performed a meta-analysis on all studies published between 2004 and 2008 that reported comparisons between statin treatment or nontreatment in these patients. ⋯ In studies wherein only coronary artery bypass grafting was performed, statin treatment decreased postoperative atrial fibrillation (OR, 0.64; 95% CI, 0.43-0.95). We conclude that statin administration results in a reduction in the incidence of atrial fibrillation in patients who undergo cardiac surgery. Further research into the underlying mechanism can elucidate possible relationships between the dosage and type of statin used.
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Pulmonary arteriovenous fistulae are known to develop in patients who have functional single-ventricle heart disease and interruption of the inferior vena cava with direct hepatic drainage to the heart, in which a bidirectional Glenn shunt is the only source of pulmonary blood flow. The progressive systemic arterial hypoxemia that is associated with pulmonary arteriovenous fistulae can have important clinical consequences. Baffling the hepatic venous return to the pulmonary circulation can alleviate pulmonary arteriovenous fistulae. ⋯ Revision of the conduit improved mixing of hepatic venous effluent with blood flow from the bidirectional Glenn shunt. Three years after this revision, the patient's oxygen saturation remained stable at 90%, and his physical activity was markedly improved. We present our rationale for selected redirection of the conduit and discuss other surgical options that can improve hypoxemia that is associated with pulmonary arteriovenous fistulae.
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Pleural effusions that are caused by congestive heart failure and refractory to medical management are rare, and the options for treating them are few and sometimes ineffective. We report here our experience, over a 2-year period, with a novel device, the Denver Biomedical PleurX pleural catheter, in treating a series of 5 patients who had chronic, refractory, heart-failure-associated pleural effusions. The PleurX catheter is a small-bore chest tube designed to remain in place for prolonged periods, through which drainage of pleural fluid can be performed easily on a daily or less frequent outpatient basis. ⋯ For 1 patient, the catheter resulted in a partially loculated pleural space, and it was removed. In 2 patients, after prolonged use, it was associated with empyema, for which it was removed. We conclude that the PleurX catheter can effectively control refractory congestive-heart-failure-associated pleural effusions temporarily, but that its prolonged use can cause significant complications, most importantly empyema.
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Biography Historical Article
At the cutting edge of the impossible: a tribute to Vladimir P. Demikhov.
Vladimir P. Demikhov (1916-1998) performed the world's first experimental intrathoracic transplantations and coronary artery bypass operation. ⋯ Ironically, his transplantation of a dog's head drew more publicity than did his pioneering thoracic surgical accomplishments, and he became an easy target for criticism. An account of Demikhov's life and work is presented herein.