Journal of cardiac surgery
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Refractory postoperative bleeding complicates a significant number of cardiac surgical procedures and results in both morbidity and mortality. Conventional strategies to effect hemostasis include surgical reexploration and administration of blood products. In some cases, bleeding remains intractable despite these methods, and alternatives are needed. Herein, we report our experience with the use of factor eight inhibitor bypassing activity (FEIBA), a coagulation factor concentrate, for refractory postoperative bleeding. ⋯ FEIBA administration is associated with decreased blood product utilization and chest tube output in patients with refractory postoperative bleeding.
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We evaluated our experience with axillary artery perfusion technique in acute type A aortic dissection repair. ⋯ Right axillary artery cannulation for repair of acute type A aortic dissection is a simple and safe procedure. In the case of pulselessness of right upper limb, femoral artery is still the choice of cannulation site.
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Aortic arch surgery is impossible without the temporary interruption of brain perfusion and therefore is associated with high incidence of neurologic injury. The deep hypothermic circulatory arrest (HCA), in combination with antegrade or retrograde cerebral perfusion (RCP), is a well-established method of brain protection in aortic arch surgery. In this retrospective study, we compare the two methods of brain perfusion. ⋯ The antegrade perfusion seems to be related with significantly lower incidence of temporary neurological complications, earlier extubation, shorter ICU-stay, and hospitalization, and hence lower total cost.
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Comparative Study
Kinetic of procalcitonin in the early postoperative course following heart transplantation.
It was the aim of the study to determine the kinetics of procalcitonin (PCT) levels following heart transplantation (HTx) and to investigate the prognostic suitability of postoperative changes in PCT levels for patients' outcome. ⋯ PCT levels have been consistently low (<10 ng/mL) in patients with an uneventful course, but more frequently increased in patients with postoperative complications and even associated with an increased mortality early postoperatively when values exceed 80 ng/mL. As a clinical consequence, PCT levels in the first few days following cardiac transplantation can help to identify patients at risk, when concentrations exceed the "normal" posttransplant range.
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Impairment of right ventricular functions, especially due to chronic pulmonary regurgitation (PR), is a well-known entity in patients with tetralogy of Fallot (ToF) after repair. The aim of this study was to examine the relation between B-type natriuretic peptide (BNP) levels and right ventricular dysfunction by cardiopulmonary exercise test (ET) in patients after repair of ToF. Twenty-five patients with a mean age of 14.1 +/- 4.4 years at follow-up who underwent repair of ToF at a mean age of 4.9 +/- 5.1 years and 29 age- and sex-matched healthy children at a mean age of 13.1 +/- 2.8 years were enrolled in this study. ⋯ There were significant correlations between the degree of PR and ED (r =-0.3, p = 0.009), HRmax (r =-0.4, p = 0.001), and VO(2)max (r =-0.4, p = 0.001). The correlations were significant both before and after exercise, being more pronounced after exercise between BNP level and the degree of PR (r = 0.6, p = 0.0001). As a result, the severity of PR has a negative influence on right ventricular functions and there is significant relation between right ventricular functions and exercise capacity after repair of tetralogy of Fallot.