Asian cardiovascular & thoracic annals
-
Asian Cardiovasc Thorac Ann · Oct 2014
Case ReportsDirect aortic transcatheter valve implantation in a porcelain aorta.
Transcatheter aortic valve implantation has been designed to treat elderly patients with severe aortic stenosis at high risk for surgery, and is generally performed retrogradely with vascular access. However, in certain patients, this access is either not possible or deemed to carry a high risk of vascular injury. We report our experience of a direct aortic approach in a 78-year old man with severe aortic stenosis, excluded from standard aortic valve replacement due to a porcelain aorta, and affected by severe aortic, iliac-femoral, and subclavian arteriopathy, rendering the transfemoral or subclavian approach unemployable.
-
Asian Cardiovasc Thorac Ann · Oct 2014
Continuity of care by cardiothoracic nurse practitioners: impact on outcome.
There have been recent reports on increased mortality in British National Health Service hospitals during weekends. This study aimed to assess the impact on patient care following the introduction of nurse practitioner cover for the cardiothoracic ward, including weekends. ⋯ The introduction of the nurse practitioner grade to provide continuity in patient care including at weekends has been confirmed to improve patient outcomes including survival after cardiac surgery.
-
Asian Cardiovasc Thorac Ann · Oct 2014
Is continuation of antiplatelets until coronary artery bypass safe in Asians?
Controversies have arisen about the risks of discontinuing antiplatelets prior to coronary artery bypass grafting. ⋯ Continuation of antiplatelets until 2 days before coronary artery bypass in Asian patients in our institution is unlikely to increase the risks of bleeding and perioperative transfusion. Taking antiplatelets within 24 h of surgery seems to be associated with a higher rate of 1-year major adverse cardiovascular events and bleeding, and an increased risk of blood product transfusion. Thirty-day and 1-year major adverse cardiovascular event rates were higher in patients without antiplatelet treatment.