Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2006
Perioperative outcome in adults undergoing elective deep hypothermic circulatory arrest with retrograde cerebral perfusion in proximal aortic arch repair: evaluation of protocol-based care.
The purpose of this study was to describe perioperative outcome in adults undergoing elective proximal aortic arch repair with protocol-based deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP). ⋯ The above parameters establish a baseline incidence for major perioperative complications in adults undergoing elective DHCA with RCP for elective proximal aortic arch repair. In approaching the open aortic arch for short periods of circulatory arrest, deep hypothermia with adjunctive RCP is safe and effective.
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J. Cardiothorac. Vasc. Anesth. · Feb 2006
Postoperative white blood cell count predicts atrial fibrillation after cardiac surgery.
Postoperative atrial fibrillation (AF) occurs in as many as 50% of cardiac surgery patients and represents the most common postoperative rhythm complication. The cause of AF after cardiac surgery is incompletely understood, and its prevention remains suboptimal. Currently the role of inflammation and oxidative stress on electrical remodeling is under investigation, and recent studies have demonstrated that C-reactive protein levels are elevated in AF. The purpose of the present study was to investigate the correlation between the postoperative white blood cell (WBC) count as a marker of inflammation and the development of postoperative AF after cardiac surgery. ⋯ Cardiac surgery is associated with an elevated postoperative WBC count that represents a common marker of inflammation. A more pronounced increase in postoperative WBC count independently predicts development of postoperative AF. These data provide additional evidence to support the association between the inflammatory response and postoperative AF.
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Major vascular surgery such as aortic aneurysm repair may be associated with prolonged in-patient hospitalization. Certain patients undergo a tracheostomy to aid in weaning from mechanical ventilation or for secretion management. The authors hypothesized that tracheostomy after aortic reconstruction for aneurysmal disease was associated with poor outcomes. ⋯ Tracheostomy in patients after aortic reconstruction for aneurysmal disease is associated with a high incidence of in-hospital mortality. Patients who survive to ICU discharge are likely to be transferred to a CVDU for further respiratory management. The preoperative diagnosis of COPD is associated with improved survival, whereas postoperative sepsis is associated with an increased mortality. These observations should be considered when counseling patients and their families regarding tracheostomy after aortic surgery.
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J. Cardiothorac. Vasc. Anesth. · Feb 2006
Clinical predictors for prolonged intensive care unit stay in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest.
The purpose of this study was to describe clinical predictors for prolonged length of stay in the intensive care unit (PLOS-ICU) after adult thoracic aortic surgery requiring standardized deep hypothermic circulatory arrest (DHCA); and to determine the incidence of PLOS-ICU after DHCA, univariate predictors for PLOS-ICU, and multivariate predictors for PLOS-ICU. ⋯ PLOS-ICU after DHCA is common. The identified multivariate predictors merit further hypothesis-driven research to enhance perioperative protection of the brain, kidney, and cardiovascular system.