Asian cardiovascular & thoracic annals
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Asian Cardiovasc Thorac Ann · Mar 2015
Review Meta AnalysisPosterior pericardiotomy in cardiac surgery: systematic review and meta-analysis.
This systematic review with meta-analysis sought to determine the impact of posterior pericardiotomy on incidences of atrial fibrillation and supraventricular arrhythmias, pericardial effusion, pleural effusion, tamponade, and the length of hospital stay after cardiac surgery. We searched for randomized controlled trials, using Medline, Embase, Elsevier and Sciences online databases as well as Google Scholar literature. The effect sizes measured were odds ratio for categorical variables and standard mean difference with 95% confidence interval for calculating differences between mean values of hospital stay in intervention and control groups. ⋯ Posterior pericardiotomy had an odds ratio of 0.33 [95% confidence interval: 0.18-0.61] p < 0.001 for atrial fibrillation; odds ratio 0.32 [0.15-0.67] p = 0.003 for supraventricular arrhythmias; odds ratio 0.09 [0.04-0.19] p = 0.000 for early pericardial effusion and odds ratio 0.04 [0.02-0.08] p < 0.001 for late pericardial effusion; odds ratio 1.64 [1.23-2.20] p = 0.001 for pleural effusion, odds ratio 0.07 [0.02-0.27] p < 0.001 for tamponade, and standard mean difference = 0.01 [-0.12 to 0.14] p = 0.8 for hospital stay. Posterior pericardiotomy is a simple intraoperative technique that can improve postoperative clinical outcomes. However, the incidence of pleural effusion associated with posterior pericardiotomy might be higher.
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Asian Cardiovasc Thorac Ann · Mar 2015
Comparative StudyEffects of propofol versus isoflurane on liver function after open thoracotomy.
Anesthetic agents and type of surgery may contribute to postoperative hepatic injury. Inhalational anesthetics have been associated with hepatic dysfunction after surgery, however, propofol is expected to have a lower potential for postoperative liver injury. This prospective double-blind randomized clinical study was planned to determine whether postoperative liver function differs after anesthesia with isoflurane and total intravenous anesthesia with propofol in patients undergoing a posterolateral thoracotomy. ⋯ Propofol and isoflurane anesthesia have a comparable minor effect on liver function after an elective posterolateral thoracotomy.
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Asian Cardiovasc Thorac Ann · Mar 2015
Spectroscopic limb monitoring in peripheral extracorporeal membrane oxygenation.
Limb-related complications are major contributors to extracorporeal membrane oxygenation-associated complications. Early detection of limb ischemia and or compartment syndrome is paramount to minimizing the adverse effects. With the absence of pulsatile flow, bedside Doppler examination of distal arterial waveforms is an impractical and an unreliable method of monitoring limb perfusion. We describe a new application of near-infrared spectroscopy monitoring of tissue oxygenation for the early detection of limb complications in extracorporeal membrane oxygenation.
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Asian Cardiovasc Thorac Ann · Mar 2015
Rigorous patient-prosthesis matching of Perimount Magna aortic bioprosthesis.
Severe patient-prosthesis mismatch, defined as effective orifice area index ≤0.65 cm(2) m(-2), has demonstrated poor long-term survival after aortic valve replacement. Reported rates of severe mismatch involving the Perimount Magna aortic bioprosthesis range from 4% to 20% in patients with a small annulus. ⋯ Rigorous patient-prosthesis matching maximized the performance of the Perimount Magna, and no severe mismatch resulted in this Japanese population of aortic valve replacement patients.
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Asian Cardiovasc Thorac Ann · Mar 2015
Intraaortic balloon pump boon for off-pump coronary artery bypass grafting.
Off-pump coronary artery bypass techniques have evolved in the past decade, but there are some concerns about hemodynamic decompensation requiring conversion to cardiopulmonary bypass. These conversions are associated with higher morbidity and mortality. We use an intraaortic balloon pump to treat ischemia-induced hemodynamic instability and arrhythmias during off-pump coronary artery bypass. The objective of this study was to assess the impact of intraaortic balloon pump use in off-pump coronary artery bypass to prevent emergency conversion to cardiopulmonary bypass. ⋯ For treating hemodynamic instability during off-pump coronary artery bypass, we recommend intraaortic balloon pump insertion as the preferred bail-out method rather than conversion to cardiopulmonary bypass.