Heart, lung & circulation
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Heart, lung & circulation · Oct 2009
Simplified cerebral protection using unilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest.
Antegrade cerebral perfusion is one of the most reliable methods of organ protection during hypothermic circulatory arrest for aortic arch surgery. We used a simplified antegrade cerebral perfusion technique with low mortality and morbidity. ⋯ The mortality and neurological outcomes of aortic surgery using unilateral antegrade cerebral perfusion with moderate hypothermic circulatory arrest produced satisfactory results. Bilateral cannulation and deep hypothermia appear to be unnecessary in most cases. The coagulopathy from deep hypothermia is thereby avoided.
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Heart, lung & circulation · Aug 2009
Predictors of successful early extubation following congenital cardiac surgery in neonates and infants.
There is a paucity of literature discussing the predictive likelihood of successfully extubating neonates and infants in the operating room immediately following congenital cardiac surgery. Given the unknown consequences of anaesthetics on neurodevelopmental outcomes, minimising the exposure of this population to such agents may have long-term benefits. ⋯ The practice of immediate extubation of infants and neonates is achievable, safe and predicted based on specific patient variables. This practice will minimise the anaesthetic exposure of these especially young patients who may be at risk for long-term consequences related to anaesthetic exposure.
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Heart, lung & circulation · Aug 2009
Randomized Controlled TrialProtocol based on thromboelastograph (TEG) out-performs physician preference using laboratory coagulation tests to guide blood replacement during and after cardiac surgery: a pilot study.
Allogenic blood transfusion may affect clinical outcomes negatively. Up to 20% of blood transfusions in the United States are associated with cardiac surgery and so strategies to conserve usage are of importance. This study compares administration according to physician's choice based on laboratory coagulation tests with application of a strict protocol based on the thromboelastograph (TEG). ⋯ This pilot study suggests that a strict protocol for blood product replacement based on the TEG might be highly effective in reducing usage without impairing short-term outcome.
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Heart, lung & circulation · Aug 2009
Case ReportsLife-saving percutaneous mitral valvuloplasty on a pregnant woman with refractory cardiogenic shock.
Pregnancy increases body blood volume and cardiac output. These changes can exacerbate mitral stenosis symptoms. ⋯ We present the case of a 35-year-old white female who developed cardiogenic shock due to severe mitral stenosis at the 22nd week of gestation and it was successfully treated with emergent PMV. This case illustrates the ability of PMV to be life-saving in such extreme conditions.
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Heart, lung & circulation · Jun 2009
Comparative StudyClinical characteristics and early mortality of patients undergoing coronary artery bypass grafting compared to percutaneous coronary intervention: insights from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) and the Melbourne Interventional Group (MIG) Registries.
Controversy continues over the optimal revascularisation strategy for patients with multi-vessel coronary artery disease. Clinical characteristics, risk profile, and mortality of patients undergoing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are thought to differ but there are limited contemporary comparative data. ⋯ In contemporary clinical practice, CABG is preferred in patients with multi-vessel coronary and associated non-coronary vascular disease, while PCI is the dominant strategy for acute MI. Despite this, in-hospital and 30-day mortality rates were similar. Predictors of early mortality after CABG differ to those of PCI.