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Heart Surgery Forum

Tarik Alp Sargut, Panagiotis Pergantis, Christoph Knosalla, Jan Knierim, Manfred Hummel, Volkmar Falk, Felix Schoenrath
Background Several risk models target the issue of posttransplant survival, but none of them have been validated in a large European cohort. This aspect is important, in a time of the planned change of the Eurotransplant allocation system to a scoring system. Material and Methods Data of 761 heart transplant recipients from the Eurotransplant region with a total follow up of 5027 patient-years were analyzed. We assessed 30-day to 10-year freedom from graft failure. Existing post-transplant mortality risk models, IMPACT, Meld-XI and Columbia Risk Stratification Score were (RSS) were evaluated...
December 19, 2018: Heart Surgery Forum
Daniel Phadke, Jared P Beller, Curt Tribble
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. We hypothesized that hemodynamic support with epinephrine exacerbates postoperative hyperglycemia to a greater degree than does treatment with norepinephrine. 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...
December 19, 2018: Heart Surgery Forum
Guiyuan He, Qi Li, Wenxin Li, Li Wang, Jun Yang, Fanju Zeng
OBJECTIVE: The aim of this study was to determine whether N-acetylcysteine (NAC) has an effect on acute kidney injury (AKI) in chronic kidney disease patients undergoing cardiac surgery. METHODS: We reviewed literature through PubMed, Medline through PubMed and OVID, The Cochrane Library, Wan Fang Database, China Biology Medicine Database, Chinese Periodical Database, China Knowledge Resource Integrated Database, and Chinese Clinical Trial Registry (1980 to July 10, 2018)...
December 19, 2018: Heart Surgery Forum
Sarah Eapen, Michael Firstenberg
Intravenous drug abuse rates in the United States have increased exponentially in recent years. Ohio is one of 5 states with the highest age-adjusted drug overdose death rates, with drug overdose causing 39.1 of every 100,000 deaths. In patients who survive, the associated morbidity poses a significant public health burden. Infective endocarditis, defined as an infection of the endocardium of the heart, is a potentially lethal consequence of bacteremia related to intravenous drug abuse. Methicillin-sensitive Staphylococcus aureus (MSSA) is the most commonly implicated organism and may affect the tricuspid valve...
December 19, 2018: Heart Surgery Forum
Curtis G Tribble, Stephen Derryberry
The initial version of this treatise was written as I (Curt Tribble) was learning to do coronary anastomoses over 30 years ago, and I worried that I was not being taught very well how to go about doing them. It seemed to me that my teachers were channeling Dr. Alain Carpentier, who often answered questions about his mitral valve repair techniques by saying, "Oh, you just know." These frustrations were compounded by the fact that the best cardiovascular techniques books, including even those texts dedicated to coronary artery bypass techniques, did not describe these anastomotic techniques in detail, which remains the case to the present day [Kaiser 2007; Copeland 1986]...
December 17, 2018: Heart Surgery Forum
Sophie Z Lin, Todd C Crawford, Alejandro Suarez-Pierre, J Trent Magruder, Michael V Carter, Duke E Cameron, Glenn J Whitman, Jennifer Lawton, William A Baumgartner, Kaushik Mandal
BACKGROUND: Atrial fibrillation (AF) is common after cardiac surgery and contributes to increased morbidity and mortality. Our objective was to derive and validate a predictive model for AF after CABG in patients, incorporating novel echocardiographic and laboratory values. METHODS: We retrospectively reviewed patients at our institution without preexisting dysrhythmia who underwent on-pump, isolated CABG from 2011-2015. The primary outcome was new onset AF lasting >1 hour on continuous telemetry or requiring medical treatment...
December 13, 2018: Heart Surgery Forum
Vitali Azouz, Sarah Hill, Michael Firstenberg
The use of extracorporeal membrane oxygenation (ECMO) in the treatment of acute respiratory distress syndrome (ARDS) has been described as early as 1972 [Hill 1972]. Though a subsequent randomized trial showed no survival benefit over conventional mechanical ventilation [Zapol 1979], protective ventilation strategies and evolving extracorporeal technology improvements have led to a resurgence in the use of ECMO for patients with ARDS. The most recent randomized clinical trial, Conventional Ventilation or ECMO for Severe Adult Respiratory Failure (CESAR), showed a significant mortality reduction in ARDS patients who were treated with ECMO [Peek 2009]...
November 30, 2018: Heart Surgery Forum
Abdurrahim Colak, Ugur Kaya, Münacettin Ceviz, Necip Becit, Fehimca Sevil, Hikmet Kocak
We read the letter of F. Rudman et al [Rudman 2017] about our article entitled "Utility of Omentoplasty in Mediastinitis Treatment following Sternotomy" [Colak 2016]. We thank them for their evaluations.
November 26, 2018: Heart Surgery Forum
George Gellert, Peter Bramlage
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...
November 14, 2018: Heart Surgery Forum
Hae Won Jung, Chul-Min Ahn, Young-Guk Ko
Chronic venous disease is strongly associated with morbidity and leads to considerable medical costs. Therefore, its clinical significance is very important. Currently, iliac vein stenting is the first treatment option for chronic venous disease due to iliac vein obstruction. For iliac vein stenting, ipsilateral femoral or popliteal vein access is common. However, great saphenous vein access may be a good alternative if there is obstruction in the ipsilateral femoropopliteal vein. Until now, there has been no reported case of successful iliac vein stenting using great saphenous vein access...
November 14, 2018: Heart Surgery Forum
Mohammed Ahmed Dawoud, Mohammed Nabil Abd Al Jawad, Tamer Hikal, Khaled Samir
BACKGROUND: Tetralogy of Fallot is the most common cyanotic congenital heart defect. Borderline pulmonary anatomy has been associated with a higher risk of mortality and morbidity. Strategies to manage this condition-namely, single- or multistage repair-have long been debated. OBJECTIVE: The overall outcomes of patients with tetralogy of Fallot with borderline pulmonary arteries (McGoon ratio 1.3 to 1.7) with regard to the need for a single-stage or multistage repair and the outcome of each surgical management were evaluated...
November 13, 2018: Heart Surgery Forum
Peng Teng, Yiming Ni, Qianhui Sun, Haige Zhao
Left atrial appendage aneurysm (LAAA) is a rare anomaly, which predisposes to hazardous cardiovascular events. We present a rare case of a 26-year-old female with a giant left atrial appendage aneurysm. The left atrial appendage was incidentally detected during her pregnancy. Six months later after her parturition, the patient was referred to our department and successfully received surgical treatment prophylactically to prevent potential complications. To the best of our knowledge, only about 100 cases of LAAA have been reported...
November 13, 2018: Heart Surgery Forum
Ivana Jurin, Frane Paić, Stela Bulimbašić, Igor Rudež, Lovorka Đerek, Hrvoje Jurin, Aleksandar Knežević, Boris Starcevic, Marko Ajduk
ses of ischemic stroke. The risk of ischemic stroke increases with the degree of carotid stenosis and plaque vulnerability. The aim of this study was to investigate the association of circulating and plaque resistin levels with plaque vulnerability and ischemic stroke events in patients with moderate- to high-grade carotid artery stenosis. METHODS: 40 patients with ischemic stroke events and 38 neurologically asymptomatic patients scheduled for carotid endarterectomy were recruited for this study...
November 13, 2018: Heart Surgery Forum
Bang-Rong Song, Yanlong Ren, Hong-Jia Zhang
BACKGROUND: We sought to analyze the pathological characteristics of hypertrophic obstructive cardiomyopathy (HOCM) with concomitant mitral valve abnormalities and to discuss the surgical treatment strategies. METHODS: The clinical data of 26 HOCM patients treated from January 2014 to March 2016 were retrospectively analyzed. There were 19 males and 7 females with a mean age of 47 ± 16 years (range, 10-70 years). Echocardiography showed HOCM, systolic anterior motion of the mitral apparatus, and concomitant mitral regurgitation...
November 7, 2018: Heart Surgery Forum
Song-Wen Chen, Li-Dong Cai, Tetsuya Asakawa, Gen-Qing Zhou, Yong Wei, Bao-Zhen Qi, Zhi-Yu Ling, Hai-Qing Wu, Juan Xu, Shao-Wen Liu
BACKGROUND: The conventional index for ablation accuracy is to compare the distance between mapping points with and without treatment by using image integration. We attempted to quantitatively evaluate the role of angle as an index in the ablation accuracy in patients with atrial fibrillation (AF). METHODS: A total of 48 patients with AF were included in the present study. Virtual fluoroscopy planes were predicted by pulmonary vein (PV) angiography, and the standard image planes were defined on the basis of the computed tomography images...
November 6, 2018: Heart Surgery Forum
YuHui Wu, Rui Jiang, Ping Xu, Guanron Wang, Jianhu Wang, Sumi Yang
BACKGROUND: The study was to analyze the therapeutic effect and risk factors of in-hospital mortality in patients with acute Stanford type A aortic dissection operated by Sun's procedure. METHODS: From Jan. 2010 to March 2016, 72 patients whose data was fully accessible underwent Sun's procedure in our hospital due to acute Stanford type A aortic dissection. Patients were divided into the survival group and the death group, and the risk factors for in-hospital mortality were collected and analyzed...
November 6, 2018: Heart Surgery Forum
Curtis G Tribble
There are three major transitions in the educational trajectory of those heading into a career in surgery. The first transition is from the first year or two of medical school to the clerkships of the third year.  The second is the transition from medical school into the first postgraduate year of residency training. The third, which is widely held to be the toughest transition of all, is from residency into independent practice.  This review, which could be called 'a rookie's survival guide,' will address the second of those 'lurches,' that of the transition from medical school into a surgical internship...
October 3, 2018: Heart Surgery Forum
Onur Sen, Ersin Kadirogullari, Unal Aydin, Salih Guler, Sertaç Haydin
BACKGROUND: Our goal is to evaluate postoperative outcomes of continuous versus interrupted suturing techniques in ventricular septal defect (VSD) closure surgery. METHODS: The study included 286 patients with isolated VSD who underwent VSD closure surgery between June 2010 and April 2017. VSD closure was performed by using the interrupted suturing technique in group 1 (n = 74, 25.9%) and the continuous suturing technique in group 2 (n = 212, 74.1%). The groups were compared in terms of mortality and rates of clinical morbidities such as infection and complete atrioventricular (AV) block...
October 2, 2018: Heart Surgery Forum
Mohsen Mirmohammadsadeghi, Amir Mirmohammadsadeghi, Mahsa Mahmoudian
BACKGROUND: Atrial fibrillation is one of the most frequent complications and a major risk of morbidity and mortality after cardiac surgery. Antioxidants such as vitamin C are used for prevention of this arrhythmia. Different results of studies have been reported, but most of them have shown efficiency of vitamin C in prophylaxis of postoperative AF. We tried to examine this efficacy with larger sample size. METHODS: Three hundred and fourteen on pump coronary artery bypass graft surgery alone...
October 1, 2018: Heart Surgery Forum
Michael Salna, Yasuhiro Shudo, Jeffrey J Teuteberg, Dipanjan Banerjee, Richard V Ha, Y Joseph Woo, William Hiesinger
INTRODUCTION: The planned use of a temporary right ventricular assist device (RVAD) at the time of left ventricular assist device (LVAD) implantation may prevent the need for a permanent biventricular assist device (BiVAD). Herein we describe our RVAD weaning protocol that was effectively employed in 4 patients to prevent the need for permanent BiVAD. METHODS: Four patients in refractory cardiogenic shock underwent planned RVAD insertion during LVAD implantation due to severely depressed right ventricular function with dilation preoperatively...
October 1, 2018: Heart Surgery Forum
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