Journal of cardiac surgery
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Comparative Study
Postoperative chylothorax: differences between patients who received median sternotomy or lateral thoracotomy for congenital heart disease.
Chylothorax after surgery for congenital heart disease is rare. We wanted to compare the different presentations of chylothorax in patients who received median sternotomy or lateral thoracotomy. ⋯ The majority of pediatric patients who develop chylothorax after cardiac surgery can be successfully managed by medical treatment only. To avoid complications in pediatric patients after cardiac surgery, chylothorax should be suspected for patients with unexplainable, prolonged, and abundant pleural effusion.
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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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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.
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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.