The heart surgery forum
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The heart surgery forum · Feb 2011
ReviewManagement of intraoperative fluid balance and blood conservation techniques in adult cardiac surgery.
Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. ⋯ A multimodal approach to blood conservation, with high-risk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization. This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.
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The heart surgery forum · Feb 2011
Randomized Controlled TrialMonitoring brain oxygen saturation during coronary bypass surgery improves outcomes in diabetic patients: a post hoc analysis.
Having previously demonstrated in a prospective study of 200 coronary artery bypass (CAB) patients that by using the brain as an index organ, interventions to improve cerebral oxygenation would have systemic outcome benefits, we undertook a post hoc analysis of the diabetic subset (n = 57) of the overall study group to determine whether the outcomes of these patients were similarly improved. ⋯ A post hoc analysis of the diabetic cohort of a prospective, randomized, and blinded study of CAB patients revealed that those in whom cerebral oxygen saturation was actively monitored and maintained demonstrated significantly lower incidences of complications, resulting in shorter ICU and postoperative hospital stays compared with an unmonitored control group.
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The heart surgery forum · Feb 2011
Controlled Clinical TrialContinuous elastomeric pump-based ropivacaine wound instillation after open abdominal aortic surgery: how reliable is the technique?
We aimed at quantifying the impact of continuous wound infusion with ropivacaine 0.33% on morphine administration and subjective pain relief in patients after open abdominal aortic repair in a double-blind, placebo-controlled study. ⋯ Continuous wound infusion of ropivacaine 0.33% 2 mL/h using an elastomeric system was not reliable and did not improve postoperative pain control in patients after open abdominal aortic surgery.
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The heart surgery forum · Feb 2011
Case ReportsLevitronix CentriMag pump as perioperative left ventricular support in a patient with critical aortic stenosis, mitral regurgitation, and cardiogenic shock.
Severe aortic stenosis (AS) has a poor prognosis when associated with left ventricular dysfunction and congestive heart failure. Despite a relatively high operative mortality, most patients with severe AS and a depressed left ventricular ejection fraction (LVEF) should be considered candidates for aortic valve replacement. The CentriMag left ventricular assist system (Levitronix) can be used for perioperative or postcardiotomy circulatory support for the failing heart. In this case report, we report the successful use of the Levitronix CentriMag device as perioperative support in a high-risk patient with severe AS, significant mitral insufficiency, and a poor LVEF with advanced organ failure.
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The heart surgery forum · Dec 2010
Case ReportsRobotic totally endoscopic triple coronary artery bypass grafting on the arrested heart: report of the first successful clinical case.
Robotic technology enables "port only" totally endoscopic coronary artery bypass grafting (TECAB). During early procedure development only single bypass grafts were feasible. ⋯ The procedure was performed through 5 ports on the arrested heart using the daVinci S robotic surgical system. This is the first reported triple bypass grafting procedure using an arrested heart approach.