Journal of cardiac surgery
-
Randomized Controlled Trial Comparative Study Clinical Trial
The reinforced sternal closure system is reliable to use in elderly patients.
Sternal dehiscence is a rare, but serious complication after cardiac surgery procedures when performed through mid-line sternotomy. Osteoporosis, especially at advanced age, may be a significant factor in the unfavorable results of sternum fixation. The present prospective, randomized study was carried out to evaluate whether the reinforced sternal-closure system is an effective and safe fixation and approximation of the sternum in cardiac procedures, and to compare with the conventional sternal-closure method in elderly patients. ⋯ The reinforced sternal-closure system provided no additional risk with similar postoperative pain index and postoperative hospital stay compared with conventional method. It is reliable to use in elderly patients undergoing open heart surgery, in the cases presenting a risk factor such as osteoporosis for increased incidence of sternal dehiscence.
-
The aim of this study is to investigate the effects of ischemic preconditioning (IP) on myocardium and the level of nitric oxide (NO) in patients undergoing aorta-coronary bypass surgery. ⋯ These data may suggest that cardioprotection by ischemic preconditioning offers higher NO production, a lower myocardial ischemia, and better functional recovery of the hearts in coronary artery surgery patients.
-
Erythropoietic protoporphyria (EPP) is an autosomal dominant disorder of heme synthesis, causing excess of protoporphyrin in blood, skin, liver, and other organs. A 58-year-old male patient with EPP underwent aortic valve replacement and a concomitant aortocoronary bypass. The patient has been followed without complications due to EPP postoperatively. Cardiac surgery can safely be performed on patients with EPP by considering close attention not to stimulate porphyrin synthesis.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Inhaled prostacyclin, nitric oxide, and nitroprusside in pulmonary hypertension after mitral valve replacement.
Pulmonary hypertension increases morbidity and mortality in patients undergoing heart surgery. Mitral valve stenosis is frequently associated with an increase in pulmonary vascular resistance (PVR). Cardiopulmonary bypass exacerbates pulmonary hypertension in patients undergoing cardiac surgery. The aim of this study was to compare the hemodynamic effects of inhaled prostacyclin and nitric oxide and the administration of i.v. nitroprusside during cardiac surgery with a clinical, pharmacodynamic dose-response, prospective, randomized, and double-blind study (Group A: inhaled prostacyclin; Group B: inhaled nitric oxide; Group C: nitroprusside). ⋯ Inhaled prostacyclin and nitric oxide are effective in the treatment of postoperative pulmonary hypertension in patients with mitral valve stenosis undergoing mitral valve surgery. Both drugs improve cardiac output and reduce mean pulmonary arterial pressure, pulmonary vascular resistance, and trans-pulmonary gradient. They may be useful in patients with acute right ventricular failure following cardiac surgery. In comparison to nitric oxide, inhaled prostacyclin is free from toxic side effects and is easier to administer.
-
Comparative Study
Multivessel off-pump revascularization in patients with significant left main coronary artery stenosis: early and midterm outcome analysis.
The presence of significant left main stenosis (> or =50%) has been considered a relative contraindication to the use of off-pump coronary artery bypass (OPCAB) stemming from well-documented hemodynamic perturbations during the displacement of the heart. We examined our experience with patients with critical left main stenosis (LMS) to assess the safety and feasibility of OPCAB in this subgroup. ⋯ Multivessel off-pump revascularization in patients with severe left main disease is a safe and effective alternative to conventional bypass grafting and conveys a survival benefit.