Asian cardiovascular & thoracic annals
-
Asian Cardiovasc Thorac Ann · Jun 2012
Risk factors and outcomes of acute renal failure after open cardiac surgery.
The incidence, risk factors, and outcome of acute renal failure following open cardiac surgery were assessed prospectively in 5,164 consecutive patients undergoing open heart surgery between March 2006 and February 2011. Acute postoperative renal failure (creatinine>1.5 mg·dL(-1) within 3 days after surgery) developed in 64 (1.2%) patients with normal preoperative renal function (study group). A control group of 238 cardiac surgery patients who had postoperative creatinine levels≤1.5 mg·dL(-1) were selected randomly during the study period. ⋯ Five of the 10 patients (50%) who needed dialysis died. The most significant prognostic factor for mortality was cardiac dysfunction. This study confirmed that impairment of renal function after cardiac surgery is uncommon without preoperative renal impairment, but carries an increased mortality rate.
-
Asian Cardiovasc Thorac Ann · Jun 2012
Simple and safe graft insertion in the elephant trunk technique.
The elephant trunk technique is a well-established procedure, but aortic wall injury or aneurysmal rupture may occur if the graft is forcibly pushed to insert it into the distal aorta. We have developed simple and safe insertion technique using a syringe.
-
Asian Cardiovasc Thorac Ann · Apr 2012
Randomized Controlled Trial Multicenter Study Comparative StudyPreoperative intra-aortic balloon pump in high-risk coronary bypass grafting.
Prophylactic intra-aortic balloon pumping prior to coronary artery bypass grafting is employed variably despite some evidence to support its use. The aim of this study was to describe the characteristics, preoperative balloon pump utilization, and outcomes of high-risk patients undergoing coronary artery bypass. The study cohort included all patients in the Australian National Cardiac Surgery Database over an 8 year period. ⋯ High-risk patients represent a significant proportion of those undergoing coronary artery bypass grafting. Despite their increased risk of postoperative mortality, only a small minority currently receive a preoperative balloon pump. After adjusting for illness severity, there was no significant association between preoperative balloon pumping and 30-day mortality, although we could not rule out a 20% reduction in mortality.
-
Asian Cardiovasc Thorac Ann · Apr 2012
Comparative StudyManagement of complicated parapneumonic effusion and empyema using different treatment modalities.
To evaluate the efficacy of the 3 treatment modalities (intrapleural instillation of streptokinase, video-assisted thoracoscopic surgery, thoracotomy and decortication) in the management of complicated parapneumonic effusion and empyema, a prospective study was conducted between January 2008 and June 2010. The 69 patients (52 men and 17 women, aged 18-50 years) were divided into 3 groups: 20 patients underwent intrapleural administration of streptokinase, 25 underwent video-assisted thoracoscopic surgery, and 24 had thoracotomy and decortication. Perioperative variables, mortality, and procedure success were compared among groups. ⋯ There was no perioperative mortality in any group. Video-assisted thoracoscopic surgery is a safe and effective treatment modality for complicated parapneumonic effusion and pleural empyema. Earlier intervention with video-assisted thoracoscopic surgery may produce better clinical results.
-
Asian Cardiovasc Thorac Ann · Apr 2012
Comparative StudyFactor VII for excessive bleeding following congenital heart disease surgery.
Recombinant activated factor VII may be effective in patients with severe bleeding following congenital heart disease surgery requiring cardiopulmonary bypass. From August 2009 through June 2011, 13 patients (median age, 5 months) were given recombinant activated factor VII for severe bleeding after open heart surgery, preventing sternal closure 2 h after completion of cardiopulmonary bypass, or chest tube drainage >10 mL · kg(-1) · h(-1) for 2 h. The median dose was 75 μg · kg(-1). ⋯ Nine patients were discharged (median hospital stay, 29 days) and were doing well after 3 months. There were no thrombotic complications. Recombinant activated factor VII may be an effective rescue therapy for severe postoperative hemorrhage.