Journal of cardiac surgery
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Case Reports
Endovascular stent: grafting in penetrating atherosclerotic ulcer of the thoracic aorta.
The aim of our study is the presentation of some interesting images of a case with symptomatic penetrating atherosclerotic ulcer (PAU) of the thoracic aorta and its endovascular treatment. Penetrating atherosclerotic ulcer is an ulcerating atherosclerotic lesion that penetrates the elastic lamina and is correlated with intramural hematoma (IMH) formation into the media layer of the aortic wall. ⋯ Surgical treatment may become necessary in cases involving the ascending aorta or in cases of intramural haematoma formation. In the era of minimally invasive surgery stent-grafting is indicated mainly in the elderly patients in presence of serious co-morbidities.
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Revascularization of the subclavian artery during complex arch surgeries may be challenging. Options include ligation of the subclavian artery with or without in situ revascularization. ⋯ Furthermore, an aberrant subclavian artery also obviates in situ revascularization through a sternal approach. We herein report our experience with the use of an extra-anatomical bypass to revascularize the subclavian artery in these circumstances.
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Cardiac resynchronization therapy improves systolic function in patients with heart failure and left ventricular (LV) dyssynchrony. However, the effect of biventricular (BiV) pacing on perioperative hemodynamics in cardiac surgery is not well known. We investigated the acute hemodynamic response using LVdP/dt(max) in patients with depressed LV function and conduction disturbances undergoing cardiac surgery. ⋯ BiV pacing results in acute hemodynamic improvement of LV function during cardiac surgery. Optimization of the interventricular pacing interval contributes to the effect of the therapy.
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Neurologic injury is a feared and serious long-term complication of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). Postoperative hyperthermia was found to enhance postischemic neurologic injury. The use of core temperature as the reference point through CPB assumes parallel changes in brain temperature. We tested the hypothesis that regional and deep brain temperature (DBT) differ during cooling, DHCA, and rewarming. ⋯ Deep brain hyperthermia routinely occurs during the last stages of rewarming following DHCA. DBT is accurately reflected by NPT and is directly correlated with inflow temperature. Therefore, during rewarming inflow temperatures should not exceed 36 degrees C and NPT should be closely monitored.
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Randomized Controlled Trial
Phosphorylcholine-coated circuits improve preservation of platelet count and reduce expression of proinflammatory cytokines in CABG: a prospective randomized trial.
The interaction of blood with foreign artificial surfaces during cardiopulmonary bypass (CPB) has been recognized as a major stimulus in evoking a systemic inflammatory and metabolic response. Phosphorylcholine (PC) is a new-generation coating material designed to ameliorate biocompatibility and thereby to reduce the detrimental interactions of CPB. We studied the effects of PC-coated perfusion circuits on platelet function and the humoral and cellular response to CPB. ⋯ Despite similar clinical outcome, the obvious reduction of cytokine expression and improved preservation of platelet count suggest superior biocompatibility of PC-coated circuits.