The heart surgery forum
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The heart surgery forum · May 2018
Histidine-Tryptophan-Ketoglutarate Solution versus Blood Cardioplegia in Cardiac Surgery: A Propensity-Score Matched Analysis.
Choosing a cardioplegic solution is a significant issue in modern cardiac surgery. Although different options are available, the optimal strategy for myocardial protection has not been established. The aim of this study was to compare intraoperative and postoperative effects of histidine-tryptophan-ketoglutarate (HTK) solution with those of standard blood cardioplegia with St Thomas No 2 solution. The study was conducted using a large cohort of adult patients undergoing complex cardiac surgery. ⋯ During complex cardiac surgery, both cardioplegia techniques were equivalent in terms of early clinical outcomes.
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The heart surgery forum · Feb 2018
Carcinoid Heart Disease: Early Outcomes after Surgical Valve Replacement in Nine Patients.
To describe the early outcomes of carcinoid patients undergoing surgical heart valve replacement. ⋯ Although carcinoid syndrome is a rare and progressive disease, valve replacement in symptomatic patients is a reasonable option with survival benefit, low early postoperative mortality, without valve-related complications, and with functional improvement. Cardiac assessment is required in all patients with carcinoid disease from the earliest time of medical treatment to improve patients' result.
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The heart surgery forum · Jan 2018
Validation of EuroSCORE II in Chinese Patients Undergoing Coronary Artery Bypass Surgery.
Comparisons between the EuroSCORE and EuroSCORE II in the patient populations for coronary artery bypass grafting are limited. The aim of the study was to compare the use of the EuroSCORE and EuroSCORE II as risk model for predicting in-hospital mortality in Chinese patients undergoing coronary artery bypass grafting (CABG). ⋯ EuroSCORE II model reduces the overestimation of the calculated risk by logistic EuroSCORE in this population. EuroSCORE II risk model may be suitable in patients undergoing coronary artery bypass surgery in China.
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The heart surgery forum · Jan 2018
Observational StudyCerebral Function and Perfusion during Cardiopulmonary Bypass: A Plea for a Multimodal Monitoring Approach.
Postoperative neurological injury still represents a major cause of morbidity after cardiac surgery. Our objective was to compare the limits as well as advantages of routine monitoring tools for the detection of cerebral function and perfusion deficits during cardiopulmonary bypass in a daily clinical setting. ⋯ Our findings reveal inherent technical limitations of each individual monitoring component, such as high interindividual variability (TCD), low spatial resolution (NIRS), or interaction with anesthetics (BIS). We therefore argue for a multimodal neuromonitoring that combines several qualities. Such approach would help reducing these limitations while individual components complement each other, thus providing more patient safety during cardiac surgery. Furthermore, such an approach would be easily applicable in a routine clinical setting.
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The heart surgery forum · Jan 2018
Identifying the Risk Factor and Prevention of Limb Ischemia in Extracorporeal Membrane Oxygenation with Femoral Artery Cannulation.
Application of extracorporeal membrane oxygenation (ECMO) for life support has been widely used in various fields of resuscitation. When the common femoral artery (CFA) is used during cannulation for ECMO support in adults, it is often complicated by limb ischemia. Placement of distal perfusion catheter (DPC) can reduce the incidence of limb ischemia and increases the likelihood of limb preservation, but selection criteria is uncertain. ⋯ Smaller common femoral artery diameter (≤6.3 cm); known peripheral arterial occlusive disease; higher VIS (≥15.8); absence of distal pulsation pre-cannulation or immediately after post-cannulation or 4 hrs later have higher risk of limb ischemia when CFA cannulation is used for VA-ECMO. Due to this, the mortality and morbidity rate increases when limb ischemia occurs. A DPC should be prophylactically inserted in high-risk patients who meet selection criteria.