European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Dec 2015
Meta Analysis Comparative StudyAxillary versus femoral arterial cannulation in type A acute aortic dissection: evidence from a meta-analysis of comparative studies and adjusted risk estimates.
There is a growing perception that femoral arterial cannulation (FAC), by reversing the flow in the thoracoabdominal aorta, may increase the risk of retrograde brain embolization, dissection and organ malperfusion in type A aortic dissection. Axillary artery cannulation (AXC) has been reported to improve operative outcomes by allowing antegrade blood flow. However, FAC still remains largely utilized as a consensus for the routine use of AXC has not yet been reached. ⋯ The present meta-analysis demonstrated that AXC is superior to FAC in reducing in-hospital mortality and the incidence of PND in patients operated on for type A acute aortic dissection.
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Eur J Cardiothorac Surg · Dec 2015
Risk factors for mortality after pericardiectomy for chronic constrictive pericarditis in a large single-centre cohort.
Constrictive pericarditis (CP) is an uncommon disease with multiple causes and unclear clinical outcomes. To date, few publications have clearly defined risk factors of poor outcomes after surgery for CP. We performed a retrospective analysis of almost 100 patients undergoing surgical treatment for CP at a single institution in order to identify risk factors for perioperative and long-term mortality. ⋯ Surgery for CP is associated with a significant risk based on the poor preoperative patient status. Whenever justified, partial over radical pericardiectomy should be preferred and TVR should be indicated liberally. Reduced LVEF and right ventricular dilatation were independent predictors for early mortality, whereas CAD, chronic obstructive pulmonary disease and renal insufficiency were risk factors for late mortality. Thus, an optimal timing for surgery on CP remains crucial to avoid secondary morbidity with an even worse natural prognosis.
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Eur J Cardiothorac Surg · Nov 2015
Clinical TrialCefazolin and linezolid penetration into sternal cancellous bone during coronary artery bypass grafting.
Deep sternal wound infection is a severe complication after cardiac surgery. Insufficient antibiotic target site concentrations may account for variable success of perioperative prophylaxis. Therefore, we measured perioperative penetration of cefazolin and of linezolid into sternal cancellous bone after sternotomy in coronary artery bypass grafting (CABG) patients by in vivo microdialysis. ⋯ Direct measurement of antibiotic concentration in sternal cancellous bone with in vivo microdialysis is technically demanding but safe and feasible. We could demonstrate sufficient antibiotic coverage with our standard cefazolin-dosing regimen in the sternal cancellous bone during cardiac surgery. Mammary artery harvesting had no clinically relevant effect on tissue penetration. Linezolid concentrations were not sufficient for some relevant pathogens.
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Eur J Cardiothorac Surg · Nov 2015
New-onset atrial fibrillation at discharge in patients after coronary artery bypass surgery: short- and long-term morbidity and mortality.
Atrial fibrillation (AF) after coronary artery bypass surgery is often considered a non-harmful and self-terminating condition. We studied the mortality and morbidity in patients with new-onset AF (NOAF) present at the time of hospital discharge. ⋯ A majority of NOAF patients revert to SR during the first months after surgery. On the other hand, 20-25% of NOAF patients develop chronic AF during long-term follow-up. Almost half of the NOAF patients were hospitalized during follow-up due to cardiovascular causes. Similarly, NOAF was associated with increased mortality due to cardiac causes, but not increased risk of stroke. This highlights the need for proper oral anticoagulation therapy in these patients.