The heart surgery forum
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The heart surgery forum · Aug 2019
Comparative StudyA Comparative Study of TAVR versus SAVR in Moderate and High-Risk Surgical Patients: Hospital Outcome and Midterm Results.
Although the use of transcatheter aortic valve replacement (TAVR) has recently become an attractive strategy in prohibitive surgical high-risk patients undergoing aortic valve replacement (AVR), the most appropriate treatment option in patients with an intermediate- to high-risk profile- whether conventional surgery (SAVR) or TAVR-has been widely debated. ⋯ In this study, we could not detect an advantage in survival when SAVR or TAVR were utilized in intermediate to high surgical risk patients needing aortic valve replacement for severe aortic stenosis.
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The heart surgery forum · Jul 2019
Case ReportsSurgery for the Venous Disaster - Phlegmasia Cerulea Dolens.
Phlegmasia cerulea dolens is an acute fulminating form of extensive venous thrombosis. Limb loss, post-thrombotic syndrome and life-threatening conditions can occur without appropriate management. ⋯ Endovascular procedures have been a good option for treating deep vein thrombosis, yet they may be insufficient for patients suffering from phlegmasia cerulea dolens. Venous thrombectomy with the guidance of venography quickly relieves symptoms, hardly causes complications, yields optimal mid-term results, and can be a justifiable treatment for phlegmasia cerulea dolens.
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The heart surgery forum · Feb 2019
Randomized Controlled TrialComparison of sufentanil-midazolam and sevoflurane for anesthesia induction in children undergoing cardiac surgery by real-time hemodynamic and cardiac efficiency monitoring: A prospective randomized study.
Background Intravenous sufentanil-midazolam and inhalational sevoflurane are widely used for anesthetic induction in children undergoing cardiac surgery. However, knowledge about their effects on hemodynamics and cardiac efficiency remains limited due largely to the lack of direct monitoring method. We used minimally invasive technique pressure recording analytical method (PRAM) to directly monitor hemodynamics and cardiac efficiency and compared the effects of the two anesthetic regimens in children undergoing ventricular septal defect repair. ⋯ SBP, MBP and CI were related to time after polynomial transformation, and showed an increase after intubation in Group SM but a decrease in Group S (Ptime2*group<0.0001). Conclusion PRAM provides meaningful and direct monitoring of hemodynamics and cardiac efficiency during the dynamic period of anesthetic induction in children undergoing cardiac surgery. As compared to inhalational sevoflurane, intravenous sufentanil-midazolam exerts more favorable effects on systemic hemodynamics and cardiac efficiency during anesthetic induction in this group of patients.
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The heart surgery forum · Dec 2018
ReviewThe Disparate Effects of Epinephrine and Norepinephrine on Hyperglycemia in Cardiovascular Surgery.
Hyperglycemia is a metabolic derangement that frequently develops after cardiovascular surgery. The perioperative administration of inotropic and vasoactive agents, such as epinephrine and norepinephrine, are common in the management of cardiac surgery patients and are known to contribute to the development of postoperative hyperglycemia. ⋯ This literature review outlines the mechanisms by which epinephrine and norepinephrine alter glucose homeostasis, while highlighting the significant differences in their effects on hepatic glucose mobilization and peripheral glucose utilization. This review suggests that the use of epinephrine exacerbates postoperative hyperglycemia to a greater degree than does norepinephrine.
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The heart surgery forum · Nov 2018
ReviewUse of the ClearSight® System for Continuous Noninvasive Hemodynamic Monitoring during Heart Valve Interventions: Review of the Literature and Single-Site Experience.
During interventional and structural cardiology procedures, such as mitral valve (MitraClip, BMV), aortic valve (TAVR, BAV), tricuspid valve (MitraClip), left atrial appendage (Watchman, Lariat), atrial septum (ASD/PFO closure), and coronary artery intervention (high-risk PCI), among others, patients are at a high risk of hemodynamic instability and require continuous monitoring. This is conventionally achieved through arterial catheterization and transpulmonary thermodilution. However, such invasive techniques are time-consuming and have been associated with steep learning curves, vascular complications, and increased risk of infection. ⋯ In addition to AP and CO, the system provides up-to-date information on stroke volume (SV), stroke volume variation (SVV), and systemic vascular resistance, which can be useful in aiding decision-making and provide better postoperative outcomes, such as shorter length of stay (LOS), decreased postoperative infection, decreased postoperative arrhythmia, decreased postoperative renal failure, decreased postoperative congestive heart failure (CHF), and decreased readmission. Additionally, the simplicity of the system setup has translated into a time saving of up to 3 hours per day, allowing one team to perform an additional 2 to 3 valve interventions without moving rooms. Moving forward, a formal study comparing patient outcomes and cost-effectiveness between invasive and noninvasive hemodynamic monitoring techniques in valve replacement would be insightful.