European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Nov 2008
Case ReportsUse of Argatroban for anticoagulation during cardiopulmonary bypass in a patient with heparin allergy.
The use of Argatroban for treatment of heparin-induced thrombocytopenia (HIT) and for percutaneous coronary intervention in patients with HIT is well described and FDA approved. The use of Argatroban for cardiopulmonary bypass remains off label and the subject of a few case reports. We report the case of a patient with a heparin allergy requiring cardiopulmonary bypass (CPB) for mitral valve replacement. Argatroban was successfully used as anticoagulation for CPB.
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Eur J Cardiothorac Surg · Nov 2008
Restrictive enlargement of the pulmonary annulus at surgical repair of tetralogy of Fallot: 10-year experience with a uniform surgical strategy.
Retrospective data suggest that a wide pulmonary annulus after Fallot repair aggravates pulmonary regurgitation. Therefore, since 1997, in our institution transannular patch enlargement was only intended for patients with a native pulmonary annulus z-score less than -4. If transannular patching was needed, enlargement was aimed to diameters within the range of a z-score of -2. We sought to determine whether this strategy of restrictive enlargement of the pulmonary annulus was adequate to reduce transannular patch rate and to limit pulmonary annulus width without increased right ventricular pressure load. ⋯ Restrictive enlargement of the pulmonary annulus at Fallot repair lowers transannular patch rate, limits the postoperative width of the pulmonary annulus but does not result in increased right ventricular pressure load or reoperation rate for residual right ventricular outflow tract obstruction. A limitation of postoperative pulmonary regurgitation can be expected when the extent of pulmonary annulus enlargement at repair is limited.
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Eur J Cardiothorac Surg · Oct 2008
Patency rate of the internal thoracic artery to the left anterior descending artery bypass is reduced by competitive flow from the concomitant saphenous vein graft in the left coronary artery.
In coronary artery bypass grafting (CABG), insufficient bypass flow can be a cause of occlusion or string sign of the internal thoracic artery (ITA) graft. A patent saphenous vein (SV) graft from the ascending aorta can reduce the blood flow through the ITA graft, and may affect its long-term patency. In the present study, we examined the impact of the patent SV graft to the left coronary artery on the long-term patency of the ITA to left anterior descending (LAD) artery bypass. ⋯ Long-term patency of the ITA-LAD bypass was affected by the presence of the patent SV graft to the left coronary artery, particularly when the native coronary stenosis between the two anastomotic sites was not severe. Competitive flow from SV graft could play an important role in occlusion of the in-situ arterial graft.
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Eur J Cardiothorac Surg · Oct 2008
Risk factors for aortic insufficiency and aortic valve replacement after the arterial switch operation.
Long-term results after the arterial switch operation have shown that patients may develop aortic insufficiency, and that some even require aortic valve replacement. ⋯ The incidence of trivial or mild AI after the ASO is considerable and a progression over time is evident. However, severe AI and the need for AVR are rare. Patients with VSD or Taussig-Bing anomaly, and those with left ventricular outflow tract obstruction exhibit a higher risk of developing significant aortic insufficiency. Particularly patients who have developed an AI at 1 year after the ASO need to be under close observation.
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Eur J Cardiothorac Surg · Oct 2008
The mortality from acute respiratory distress syndrome after pulmonary resection is reducing: a 10-year single institutional experience.
Acute respiratory distress syndrome (ARDS) is a major cause of death following lung resection. At this institution we reported an incidence of 3.2% and a mortality of 72.2% in a review of patients who underwent pulmonary resection from 1991 to 1997 [Kutlu C, Williams E, Evans E, Pastorino U, Goldstraw P. Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg 2000;69:376-80]. The current study compares our recent experience with this historical data to assess if improved recognition of ARDS and treatment strategies has had an impact on the incidence and mortality. ⋯ The incidence and mortality of ARDS have decreased in our institution. We postulate that this is due to more aggressive strategies to avoid pneumonectomy, greater attention to protective ventilation strategies during surgery and to the improved ICU management of ARDS.