Journal of cardiac surgery
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Comparative Study
In which patients should sheathless IABP be used? An analysis of vascular complications in 1211 cases.
The purpose of our study is to compare the results of the sheathed and sheathless techniques for intraaortic balloon pump (IABP) insertion and to determine the rate of vascular complications in both conditions. ⋯ PAD, DM, and sheathed insertion technique are the major risk factors of ischemia during IABP use. Among all these risk factors, the only modifiable risk factor is the use of introducer sheath. With the presence of PAD and DM, the choice of sheathed method would increase the probability of ischemia almost 35 times. Sheathless method of insertion should be preferred in patients with DM and PAD.
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Internal thoracic artery (ITA) grafting to the left anterior descending artery (LAD) may have catastrophic consequences and can be fatal due to "ITA malperfusion syndrome." We have investigated the efficacy of a second graft in this syndrome. ⋯ Double supply to LAD using an additional saphenous vein graft is the treatment of choice for ITA malperfusion syndrome. The time interval between the first and the second grafts appears to be crucial for postoperative patient outcome.
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Comparative Study
Minimally invasive reoperative isolated valve surgery: early and mid-term results.
Minimally invasive, nonsternotomy approaches for valve procedures may reduce the risks associated with cardiac surgery after prior sternotomy and may improve outcomes. We analyzed our institutional experience to test this hypothesis. ⋯ Reoperative valve surgery can be safely performed using a nonsternotomy, minimally invasive approach, with at least equal mortality, less hospital morbidity, decreased hospital length of stay, and slightly favorable mid-term survival as compared to sternotomy.
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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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The role of Swan-Ganz catheterization for cardiac surgery and perioperative management has recently been scrutinized. ⋯ The incidence of serious Swan-Ganz catheter complications in our patient population is comparable to the incidence reported in the literature. Based on these results the use of Swan-Ganz catheters in cardiac surgery is still justified since the rate of associated serious complications is extremely low. Despite the rare occurrence of serious complications and the infrequent fatal outcomes, the benefit of its use in selected cases of cardiac surgery overweight its associated complications.