The heart surgery forum
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The heart surgery forum · Jan 2005
Case ReportsClopidogrel-related refractory bleeding after coronary artery bypass graft surgery: a rationale for the use of coagulation factor concentrates?
Clopidogrel, an irreversible ADP-receptor antagonist, inhibits platelet aggregation mediated by reduced activation of glycoprotein receptor IIb/IIIa. Clopidogrel in combination with aspirin has been shown to be superior to aspirin alone for treating unstable angina, but clopidogrel recipients have shown increases in blood loss, transfusion requirements, and rate of reoperation after cardiac surgery. We describe a patient who had taken clopidogrel 75 mg daily until the day prior to coronary artery bypass graft surgery. ⋯ Then, to promote clot formation and firmness, 2 g of fibrinogen and 1250 IU of factor XIII were administered, and the bleeding finally stopped. No further transfusions were required, and the patient was discharged from the hospital on day 10 after the operation. This case suggests that in clopidogrel-related bleeding refractory to conventional hemostatic therapy, hemostasis may be achieved by a stepwise administration of coagulation factor concentrates.
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The heart surgery forum · Jan 2005
Slightly elevated serum creatinine predicts renal failure requiring hemofiltration after cardiac surgery.
Acute renal failure (ARF) after cardiac surgery is a serious adverse event that is associated with high perioperative mortality and prolonged hospitalization. The aim of our study was to evaluate pre- and intraoperative risk factors for the development of ARF requiring hemofiltration after cardiac surgery. ⋯ Our data indicate that emergent surgery as well as advanced age and long duration of cardiopulmonary bypass independently predict ARF after cardiac surgery. Most importantly, even slightly impaired preoperative creatinine levels predict the development of ARF requiring hemofiltration after cardiac surgery.
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The heart surgery forum · Jan 2005
Outcomes for off-pump coronary artery bypass grafting in high-risk groups: a historical perspective.
The outcomes of off-pump coronary artery bypass (OPCAB) and conventional coronary artery bypass grafting with cardiopulmonary bypass (cCABG) have been compared in detail. Similarly, several reports have examined outcomes of high-risk subsets of patients in OPCAB as a selection strategy for reducing morbidity and mortality compared to cCABG. We undertook a retrospective study comparing outcomes from the early years in our experience of beating-heart surgery in high-risk patients selected for OPCAB compared to low-risk patients having OPCAB. This study was premised on strict selection criteria in an era prior to stabilizing devices and cardiac positioners. ⋯ In this retrospective and historical review, OPCAB was found to be equally safe in carefully selected high- and low-risk patients. These results provided for the enthusiasm and innovation to expand the usage of OPCAB in patients with coronary artery disease.
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The heart surgery forum · Jan 2005
On-pump/beating-heart myocardial protection for isolated or combined coronary artery bypass grafting in patients with severe left ventricle dysfunction: assessment of myocardial function and clinical outcome.
Myocardial protection in coronary artery bypass grafting (CABG) with severe left ventricular (LV) dysfunction is still a surgical dilemma. Preoperative myocardial infarction (MI) and postoperative low output syndrome are serious complications in cases of inadequate protection of the heart, which has limited myocardial reserve. The aim of this study was to evaluate myocardial function and clinical outcome after on-pump/beating-heart CABG in patients with severe LV dysfunction. ⋯ On-pump/beating-heart CABG technique is effective in protecting myocardial functions in patients with severe LV dysfunction. The main advantage of the on-pump/beating-heart technique is the ability it provides one to perform complete revascularization, and intracavitary procedures with low morbidity and mortality even in impaired LV function.
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The heart surgery forum · Jan 2005
Case ReportsTreatment of double vessel coronary artery disease by totally endoscopic bypass surgery and drug-eluting stent placement in one simultaneous hybrid session.
Hybrid coronary artery revascularization is a combination of minimally invasive coronary artery surgery and catheter-based coronary intervention. Hybrid procedures enable adequate revascularization of patients with multivessel coronary artery disease without complete opening of the chest and with the advantage of the most durable option, a left internal mammary artery (LIMA) graft is placed to the left anterior descending (LAD) artery. ⋯ Simultaneous hybrid procedures would be desirable. We report on a case in which robotic totally endoscopic LIMA to LAD grafting using the da Vinci telemanipulation system was combined with placement of a rapamycin coated stent to the right coronary artery in one single procedure.