Journal of cardiac surgery
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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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Congenitally bicuspid pulmonary valves are uncommon. When they occur, it is usually in association with other congenital cardiac lesions, most often a tetralogy of Fallot. ⋯ The patient did well for 17 years, but needed further reconstruction when the pulmonary valve started getting stenosed and RV pressures went up significantly. The pulmonary valve showed fibroses, thickening, and focal calcification.
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From a disease that just a few decades ago carried an ominous prognosis, aortic dissection has become a highly treatable condition. Similar development has occurred in regard to the treatment of thoracic aortic aneurysms. Treatment options are medical, surgical, or endovascular. ⋯ Treatment for hypertensive emergency begins in the intensive care unit and continues during and after surgery. Improved surgical techniques as well as newer, safer agents that reduce BP to acceptable levels have reduced the risk of mortality and improved prognosis in the postoperative period. Nevertheless, mortality rates remain high, and successful management of aortic dissection and aortic aneurysm still poses a clinical challenge.
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An estimated 50% of patients undergoing routine cardiac surgery require intravenous antihypertensive therapy to manage life-threatening arterial bleeding, myocardial ischemia, or cardiac failure in the perioperative period. Managing hypertension in this setting can be challenging because of the need to reduce blood pressure while maintaining adequate end organ perfusion. Hypotensive episodes can increase the risk of cardiac complications and end organ hypoperfusion, particularly in patients whose underlying cardiovascular disease has altered autoregulation of blood flow. ⋯ The ideal agent for postoperative hypertension should have a rapid onset of action, be highly vascular selective, and be rapidly reversible. In addition, it should be safe, with little risk of overshoot hypotension or adverse drug reaction. Precise management of arterial pressure in the perioperative period has the potential to improve clinical outcome by avoiding hypotensive episodes, ensuring adequate end organ perfusion, decreasing the risk of adverse drug effects, and serving as a bridge to definitive long-term therapy for essential hypertension.
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Comparative Study
Predictors and outcomes of extended intensive care unit length of stay in patients undergoing coronary artery bypass graft surgery.
To assess risk predictors of increased intensive care unit (ICU) length of stay in patients undergoing isolated coronary artery bypass surgery (CABG) and assess outcomes associated with increased ICU length of stay. ⋯ In patients undergoing CABG surgery an increased age, increased pump time, COPD, and urgent surgical procedure significantly increased the risk of an increased ICU length of stay. Patients with an increased ICU length of stay also experienced more negative outcomes.