Journal of cardiac surgery
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Case Reports
Central cannulation through a standard left thoracotomy for surgery on the descending thoracic aorta.
Surgery on the descending thoracic aorta is often performed with hypothermic cardiopulmonary bypass established via the femoral vessels. This, however, produces retrograde flow, which may potentially dislodge atheromatous debris from a diseased descending aorta or results in malperfusion due to cannulation of the false lumen in patients with descending aortic dissection. In view of this, we have described a technique of central cannulation of the ascending aorta and main pulmonary artery, established via a standard left thoracotomy, providing antegrade flow and limiting the cerebral ischemic time.
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Review Meta Analysis
Does the use of erythropoietin reduce the risk of exposure to allogeneic blood transfusion in cardiac surgery? A systematic review and meta-analysis.
The use of blood conservation techniques is important in cardiac surgery as postoperative bleeding is common and allogeneic blood transfusion carries the risk of transfusion reactions and infection transmission. Erythropoietin with and without preoperative autologous blood donation is one of the modalities to avoid allogeneic blood transfusion. The objective of this review was to assess the effectiveness of erythropoietin in reducing the risk of exposure to allogeneic blood transfusion during or after cardiac surgery. ⋯ The administration of erythropoietin before cardiac surgery is associated with a significant reduction in the risk of exposure to allogeneic blood transfusion. Further studies are warranted to define the patients' subgroups that may benefit the most from EPO administration.
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The presence of antibodies directed against heparin necessitates the use of an alternative anticoagulant in patients undergoing cardiac surgery. Bivalirudin is a short-acting direct thrombin inhibitor that has been used successfully in routine cardiac surgical cases. Experience in complicated cases requiring extended cardiopulmonary bypass is limited, however. We report the successful use of bivalirudin in a patient who underwent complex cardiac surgery. ⋯ Bivalirudin can be safely used for anticoagulation during CPB even in complex cardiac surgery.
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Case Reports
Iatrogenic coronary artery stenosis and late ventricular septal defect after penetrating cardiac trauma repair.
We report herein a 20-year-old male who has apical myocardial infarction due to suturing of the distal left anterior descending artery and late ventricular septal defect after penetrating cardiac trauma repair.
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Comparative Study
Coronary artery bypass grafting in patients with severe left ventricular dysfunction--early and mid-term outcomes.
The prevalence of patients with severe left ventricular dysfunction (LVD) referred for coronary artery bypass grafting (CABG) is increasing. The aim of the present study was to assess the outcomes of patients with severe LVD undergoing CABG. ⋯ CABG in patients with severe LVD can be performed with a low mortality, albeit with higher morbidity and longer length of hospital stay, than patients with LVEF >30%. Low ejection fraction per se was not a predictor of hospital mortality. CABG should be considered a safe and effective therapy for low ejection fraction patients with ischemic heart disease. Mitral valve repair/replacement in the presence of moderate degree of MR should be considered at the time of the initial operation.