The heart surgery forum
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The heart surgery forum · Jan 2008
Randomized Controlled TrialThe role of clopidogrel and acetylsalicylic acid in the prevention of early-phase graft occlusion due to reactive thrombocytosis after coronary artery bypass operation.
Reactive thrombocytosis has been reported in 20% of patients after coronary artery bypass grafting (CABG), a frequency that might be related to the high incidence of thrombotic complications. The present study was planned to investigate the effect of combined treatment with clopidogrel and acetylsalicylic acid (ASA) on post-CABG reactive thrombocytosis. ⋯ Combination antiplatelet therapy with ASA and clopidogrel seems to be more effective than ASA alone for maintaining graft patency in patients with reactive thrombocytosis.
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The heart surgery forum · Jan 2008
Routine use of the direct thrombin inhibitor bivalirudin for off-pump coronary artery bypass grafting is safe and effective.
Anticoagulation with unfractionated heparin has been the standard of care for more than a half-century for patients undergoing cardiac surgery. The risk of heparin-induced adverse reactions dictates the need for a safe and effective alternative, particularly in off-pump coronary artery bypass (OPCAB) surgery, an approach associated with a perioperative prothrombotic condition that may negatively influence graft patency. Between March 2003 and January 2005, 243 consecutive patients underwent OPCAB with bivalirudin (0.75 mg/kg bolus with 1.75 mg/kg per hour infusion). ⋯ Bivalirudin is a safe and effective anticoagulant that may be routinely used as an alternative to heparin and protamine in patients undergoing OPCAB. This is evidenced by low hospital mortality and morbidity rates. Further follow-up is warranted to discern the influence of bivalirudin on long-term clinical outcomes.
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The heart surgery forum · Jan 2008
Restrictive mitral valve annuloplasty for chronic ischemic mitral regurgitation: a 5-year clinical experience with the physio ring.
This study investigated the results of restrictive mitral annuloplasty with the semirigid Carpentier-Edwards Physio ring in patients with moderately severe to severe chronic ischemic mitral regurgitation (IMR) and advanced ischemic cardiomyopathy (ICM). ⋯ Restrictive mitral valve annuloplasty using the semirigid Physio ring corrected chronic IMR in ICM patients with very low mortality and improved contractility. Surgery also prevented recurrence of significant IMR in parallel with the phenomenon of postoperative continuous reverse myocardial remodeling.
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The heart surgery forum · Jan 2008
Randomized Controlled TrialUse of high-thoracic epidural analgesia in pulmonary endarterectomy: a randomized feasibility study.
The suitability of combined high-thoracic epidural anesthesia for pulmonary endarterectomy was studied. ⋯ This study has shown that combined epidural and general anesthesia is a suitable anesthetic option in patients who are selected for pulmonary endarterectomy. It provides hemodynamic stability and reduces the duration of tracheal intubation postoperatively and improves postoperative pain relief, although this option has not been shown to decrease either the length of the intensive care unit stay or mortality.