Cardiovascular surgery (London, England)
-
The purpose of this study was to examine the necessity of intensive care unit (ICU) utilization following carotid endarterectomy (CEA) and to identify patients who can be managed postoperatively on a vascular unit using a clinical protocol. ⋯ A clinical protocol can select patients for admission to the ICU or the vascular unit following CEA without increase in morbidity or mortality. Selective use of the ICU conserved resources, decreased ICU LOS, and provided substantial cost savings.
-
Early surgical treatment is important for successful outcome in selected cases of active, either native (NVE) or prosthetic valve endocarditis (PVE). The aim of this study was to evaluate the early results of the surgical treatment of active NVE and PVE. ⋯ Along with early diagnosis and appropriate antibiotic treatment, aggressive surgical attitude is of importance for the successful outcome in this group of seriously ill patients. Our data indicate that early surgical treatment in cases of active endocarditis may be associated with low mortality and morbidity.
-
The coincidence of coronary and carotid artery disease (uni- or bilateral, with or without involvement of the supra-aortic branch) is still a problem with regards to surgical strategy. Since the opening of the Heart Centre Duisburg in 1989 the authors have favoured a simultaneous approach to lesions in both arterial systems in order to avoid myocardial infarction or stroke. The aim of this retrospective study was to review the early and late results of the combined procedures for the endpoints of death, myocardial infarction and stroke. ⋯ Mean survival time was 6.18 years. Simultaneous carotid endarterectomy and myocardial revascularization can be justified as a routine surgical management of severe lesions in both arterial systems. The risk of myocardial infarction, apoplectic stroke or mortality was not significantly different than isolated procedures.
-
The most important limitation of the use of the intra-aortic balloon pump is the risk of vascular complications. The aim of this study was to identify risk factors and aspects of diagnosis and management that may decrease the risk of vascular morbidity associated with intra-aortic balloon pumps. Risk factors, surgical techniques, complications and other variables were retrospectively evaluated in 524 patients who had an intra-aortic balloon pump inserted between January 1988 and December 1998. ⋯ Independent predictors for vascular complications included peripheral vascular disease and diabetes. Intra-aortic balloon pump removal and thrombectomy is usually sufficient to provide revascularization. Identification of subclinical disease may aid in the management of subsequent acute limb ischaemia.
-
Comparative Study
Endoluminal pulse oximetry of the sigmoid colon and the monitoring of the colonic circulation.
Colonic ischaemia is a frequently observed serious complication following abdominal aortic reconstruction. For adequate treatment of this disorder, early diagnosis and resection of the diseased colon is essential. The purpose of this study was to evaluate a new method, based on pulse oximetry, to detect colonic ischaemia at an early preclinical stage. ⋯ Thus, in three patients, pulse oximetry was falsely positive for colonic ischaemia. The calculated sensitivity and specificity of pulse oximetry were 100 and 95%, respectively. In comparison to other methods used for early detection of colonic ischaemia, pulse oximetry appears to be a promising method for the evaluation and monitoring of colonic ischaemia because it is non-invasive and easy to apply with a high sensitivity and specificity.