The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2014
The incidence of vasoplegia in adult patients with right-sided congenital heart defects undergoing cardiac surgery and the correlation with serum vasopressin concentrations.
In adults with right-sided congenital heart disease, vasoplegia during and after cardiopulmonary bypass appears to be a frequent complication. The incidence of vasoplegia in the general adult and pediatric cardiac surgical population has been investigated, but the incidence in adult patients with right-sided congenital heart disease is unknown. Perioperative vasopressin levels during cardiac surgery have been studied in other cardiac surgical patients, but are not known in adults with right-sided congenital heart disease. The purpose of this study was to investigate the incidence of vasoplegia in adult patients undergoing right-sided cardiac surgical procedures requiring cardiopulmonary bypass and to determine the vasopressin response to cardiac surgery in this population. ⋯ This study showed that the incidence of vasoplegia (20%) in patients with right-sided congenital heart disease undergoing cardiac surgery was double that of a population of patients undergoing aortic valve surgery (10%). Serum vasopressin concentration was not associated with vasoplegia in this population of congenital cardiac surgical patients.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Comparative StudyNatural history of hypercoagulability in patients undergoing coronary revascularization and effect of preoperative myocardial infarction.
The balance between hyper- and hypocoagulable states is critical after coronary artery surgery both with (coronary artery bypass grafting [CABG]) and without (off-pump coronary artery bypass [OPCAB]) cardiopulmonary bypass to prevent thrombotic or bleeding complications. We aimed to quantify novel parameters of coagulation, fibrinolysis, and overall hemostasis ≤6 months after CABG and OPCAB and to determine the influences on these parameters. ⋯ Patients will be vulnerable to thrombotic events for ≤6 weeks after coronary surgery yet will have resolution of hypercoagulability by 6 months. Preoperative factors, such as MI, could require individualized management of thrombosis prophylaxis in the postoperative period.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Observational StudyBlood lactate level during extracorporeal life support as a surrogate marker for survival.
The establishment of reliable markers to monitor adequate tissue perfusion during extracorporeal life support is clinically important to improve outcomes. ⋯ Blood lactate measurement can be used as a reliable tool for monitoring adequate tissue perfusion during extracorporeal life support and was strongly predictive of mortality. Therefore, in patients without adequate decrement in lactate levels during extracorporeal life support, potential factors responsible for inadequate perfusion should be identified and corrected.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Observational StudyManagement of concomitant mild to moderate functional mitral regurgitation during aortic valve surgery for severe aortic insufficiency.
The optimal management of mild to moderate functional mitral regurgitation (FMR) during aortic valve replacement (AVR) for severe aortic insufficiency (AI) is poorly defined. We aimed to investigate the fate of FMR after AVR with or without concomitant mitral annuloplasty (MAP) and to identify the risk factors and clinical implications of persistent FMR. ⋯ Mild to moderate FMR as a result of severe AI improved with AVR in most patients with or without concomitant MAP. Poor postoperative LVEDD reduction was the only risk factor for persistent FMR. Because persistent FMR tended to be associated with heart failure events, close echocardiographic monitoring and proactive medical management are recommended in patients showing poor LVEDD reduction after AVR.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Comparative StudyRespiratory dynamic magnetic resonance imaging for determining aortic invasion of thoracic neoplasms.
An accurate radiological method for evaluating the presence or extent of aortic invasion by thoracic cancer is essential in the preoperative setting. The aim of this study was to assess whether respiratory dynamic (RD) magnetic resonance imaging (MRI) more accurately detects aortic invasion of mediastinal tumors and lung cancer compared with conventional MRI or computed tomography (CT). ⋯ RD MRI may improve the diagnostic accuracy of MRI by predicting aortic invasion use in preoperative staging.