The heart surgery forum
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The heart surgery forum · Apr 2009
Comparative StudyContinuous arterial pressure waveform analysis accurately detects cardiac output in cardiac surgery: a prospective comparison with thermodilution, echocardiography, and magnetic resonance techniques.
The aim of this study was to compare the accuracy of cardiac output (CO) measurements of noninvasive continuous arterial pressure waveform analysis, thermodilution technique and echocardiography with magnetic resonance (MRI) imaging. ⋯ Arterial pressure-based and thermodilution CO measurement systems yielded results comparable to those obtained with cardiac MRI assessment after cardiac surgery. Arterial pressure wave-form analysis systems for CO measurement may be feasible, noninvasive methods for use in cardiac surgery.
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The heart surgery forum · Apr 2009
Clinical TrialBenefits of the preemptive intra-aortic balloon pump: an audit of practice in a regional cardiothoracic center.
Recent evidence suggests that preemptive use of an intra-aortic balloon pump (IABP) is associated with better outcomes in high-risk patients undergoing cardiac surgery. This retrospective study compares preemptive (planned) use of the IABP to emergency (unplanned) use in a regional cardiothoracic center. ⋯ Preemptive use of the IABP in this patient cohort was associated with a 50% advantage in mortality compared with emergency IABP use. The logistic EuroSCORE may be used preoperatively to guide IABP use. Complications are rare and can be treated successfully. The risk-to-benefit ratio of preemptive IABP use is low in this cohort of patients.
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The heart surgery forum · Apr 2009
Case ReportsLupus aortitis leading to aneurysmal dilatation in the aortic root and ascending aorta.
Systemic lupus erythematosus (SLE) is an autoimmune disease in which organs, tissues, and cells undergo damage mediated by tissue-binding autoantibodies and immune complexes. We describe the case of a 23-year-old African American woman with a history of recurrent pneumonias. Computed tomography, magnetic resonance imaging (MRI), and echocardiographic evaluations, as well as clinical and laboratory findings, indicated a diagnosis of SLE with inflammatory aortitis secondary to SLE vasculitis. ⋯ The patient has done well postoperatively. Aortitis and aortic aneurysms are an uncommon manifestation of SLE, and a literature search revealed an apparent association between aortic aneurysms and steroid medications for SLE. This case is the first report of aortitis resulting in a nondissecting aortic root aneurysm in an SLE patient without a history of steroid use, indicating that all SLE patients, including those without a history of steroid use, require screening for aortic disease to improve surgical outcomes and to prevent fatal complications.
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The heart surgery forum · Jan 2009
Randomized Controlled TrialCardioprotective effects of sevoflurane, isoflurane, and propofol in coronary surgery patients: a randomized controlled study.
This study was undertaken to compare the in vivo effects of isoflurane, sevoflurane, and propofol anesthesia on ischemia- and reperfusion-mediated free-radical injury and oxidative stress during coronary artery bypass graft surgery. We also compared the effects of these anesthetic agents on levels of end products of lipid peroxidation and nitric oxide (NO) in human right atrial tissue and blood. ⋯ Inhalation anesthetics such as isoflurane and sevoflurane preserved cardiac function in coronary surgery patients after CPB with less evidence for myocardial damage than propofol. Furthermore, propofol induced lower blood levels of lipid peroxidation than isoflurane and sevoflurane. Propofol also increased glutathione peroxidase activity but induced less NO production compared to sevoflurane. These findings also support the cardioprotective properties that are demonstrated by hemodynamic parameters.
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The heart surgery forum · Dec 2008
Comparative StudyComparison of valve annuloplasty and replacement for ischemic mitral valve incompetence.
Mitral incompetence is a chronic sequela of myocardial infarction. It is caused by apical displacement and tethering of the mitral valve leaflets after myocardial infarction, resulting in incomplete coaptation. The consensus is for mitral valve surgery in the presence of significant ischemic mitral regurgitation (IMR). Previously, the only option was mitral valve replacement (MVR) with a mechanical or tissue valve. The suboptimal results obtained prompted the development of several methods of mitral valve repair. Today, the most commonly used repair is undersized annuloplasty. ⋯ Correcting chronic IMR with either repair or replacement produces a good mid-term survival rate (approximately 75%) for survivors in NYHA classes I and II. In our study, mortality rates for the MVP and MVR groups were similar, even though the repair group had a lower mean ejection fraction and a higher NYHA class before and after the operation. We therefore conclude that repair is superior to replacement in treating ischemic mitral insufficiency. A prospective randomized study is needed to better compare these 2 approaches.