J Cardiovasc Surg
-
All types of cardiac surgery involve considerable injury to the myocardium. However, little is known about the prognostic value of cardiac troponin (cTnI), which is a cardiac-specific biologic marker. The purpose of this prospective study was to evaluate the prognostic value of cTnI concentrations measured 20 hours after the end of surgery in patients undergoing coronary bypass grafting (CABG). ⋯ Our study indicates that cTnI concentration 20 hours after the end of surgery is an independent predictor of in-hospital death after CABG. Furthermore, high concentrations of cTnI were associated with a cardiac cause of death and major clinical outcomes.
-
Celiac artery aneurysms are rare but potentially fatal because of the risk of rupture. Atherosclerosis and fibrous dysplasia are the two most common etiologies. ⋯ We report three cases of post-stenotic celiac artery aneurysm with median arcuate ligament compression admitted to our hospital over the past two years. Although the incidence is rare with only 8 cases reported in the literature, a median arcuate ligament may have a role in the development of celiac artery aneurysms and its presence can influence the surgical strategy.
-
Most endovascular stent-grafts in endovascular aortic aneurysm repair (EVAR) are designed to deploy from the renal artery level down to the iliac level. The Powerlink device (Endologix Inc, Irvine, Calif) can be deployed from the iliac level up to the renal artery level. The aim of this study was to summarize our clinical experience of EVAR using the Powerlink device. ⋯ Results from multiple clinical trials and our clinical practice proved that the Powerlink device is simple to implant, effective to endovascular repair, durable to mid- and long-term follow up. The implanting technique of combination of an anatomically-fixed unibody Powerlink device and proximal extension sealing leads to a superior outcome, even in challenging anatomy cases deemed unsuitable for endovascular repair. With this intuitive approach, migration and the associated sequelae were virtually eliminated.
-
The aim of this paper was to evaluate the results in patients from the religious community of Jehovah's Witnesses (JW) undergoing open heart surgery. ⋯ The decrease of hematocrit serum levels is significantly characterizing the postoperative period of open heart surgery in JW. In patients undergoing CABG without CPB and in patients undergoing isolated valve replacement, decrease of hematocrit serum levels was lowest. Therefore, these techniques should be considered for first choice when appropriate. Furthermore, highly normal preoperative hematocrit serum levels and a meticulous surgical technique remain the mainstay of therapy in these patients.
-
Outcomes after surgery for acute type A aortic dissection in the octogenarian are controversial. To analyze this issue further, the authors reviewed their experience in the hope of finding ways to improve results in these high-risk patients. ⋯ Surgery for acute type A aortic dissection in the octogenarian shows high hospital mortality but satisfactory long-term survival among discharged patients. A less aggressive approach should increase the outcomes of surgically managed patients.