Routine presternotomy extracorporeal circulation for redo surgery.

We report our 10-year experience of performing presternotomy ECC for cardiac reoperation and the clinical results. Fifty-seven consecutive cardiac reoperations involving resternotomy were performed between January 2006 and December 2015. ECC was established prior to median sternotomy in all patients. Two patients sustained injury to the right ventricle during sternotomy. Eleven patients sustained injury to the mediastinal structures during dissection (right atrium in 3; superior vena cava in 2; inferior vena cava in 3; left internal thoracic artery in 1; and saphenous vein graft in 2 patients). Longer ECC time and greater transfusion volume were necessary. Two patients (3.5%) died within 30 days of operation. Perioperative morbidity included reexploration for bleeding in 4 (7.0%), stroke in 1 (1.8%), acute renal failure that required hemodialysis in 5 (8.8%), sepsis in 5 patients (8.8%), prolonged ventilation in 9 (15.8%) and tracheostomy in 5 (8.8%). Routine establishment of presternotomy ECC reduces the risk of injury to the mediastinal structures during reentry and facilitates easier repair in the event of structural injury during reentry or dissection. However, longer ECC time and significantly greater transfusion volume requires attention. PMID: 31849373 [PubMed - in process]
Source: Nagoya Journal of Medical Science - Category: International Medicine & Public Health Tags: Nagoya J Med Sci Source Type: research

Related Links:

ConclusionsFor paracetamol versus ibuprofen, when using LSPS methods in the CPRD, it is only possible to distinguish true effects if those effects are large (hazard ratio  >  2). Due to their smaller hazard ratios, the outcomes under study cannot be differentiated from null effects (represented by negative controls) even if there were a true effect. Based on these data, we conclude that we are unable to determine whether paracetamol is associated with an increased ris k of myocardial infarction, stroke, GI bleeding, and acute renal failure compared to ibuprofen, due to residual confounding.
Source: Drug Safety - Category: Drugs & Pharmacology Source Type: research
CONCLUSIONS: This study provides novel information regarding the probability of uneventful recovery while confirming low in-hospital mortality and stroke rates after elective aortic root replacement for aortic aneurysm. Importantly, uneventful recovery ensures excellent long-term survival. PMID: 32246934 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
ConclusionsThis study demonstrates that lower prealbumin levels were not predictive of increased post ‐LVAD morbidity or mortality. Although an established marker of nutritional and inflammatory status, the role of prealbumin in patient selection or prognostication appears limited in LVAD patients.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
AbstractPurposeTo investigate risk factors for severe bleeding during warfarin treatment, including the influence of sex, age, comorbidity and co-medication on bleeding risk.MethodsPatients initiating warfarin treatment between 2007 and 2011 were identified in the nationwide Swedish Prescribed Drug Register, and diagnoses of severe bleeding were retrieved from the National Patient Register. Hazard ratios (HR) with 95% confidence intervals (CI) for severe bleeding were estimated using multiple Cox regression adjusting for indications and including covariates age, sex, comorbidities and co-medications. Interactions between s...
Source: European Journal of Clinical Pharmacology - Category: Drugs & Pharmacology Source Type: research
Extracorporeal membrane oxygenation (ECMO) has become a common treatment strategy with increasing clinical experience and technological advances in recent years.1,2 According to the Extracorporeal Life Support Organization (ELSO) data, 45,299 adult patients with cardiac, pulmonary and extracorporeal cardiopulmonary resuscitation (ECPR) were treated with ECMO in 2019, and survival and discharge rates after ECMO gradually increased.3 ECMO can last for days or weeks. However, such complications as bleeding, stroke, delirium, acute renal failure, pulmonary embolism, displacement of cannulas, vascular perforation and lower extr...
Source: Heart and Lung - Category: Intensive Care Authors: Source Type: research
AbstractBackgroundThe optimal mitral prosthesis in young patients is unclear. This systematic review and meta ‐analysis were performed to compare outcomes between bileaflet mechanical mitral valve replacement (mMVR) and bioprosthesis mitral valve replacement (bioMVR) for MVR patients aged less than 70 years.MethodsWe searched MEDLINE and EMBASE databases from inception to July 2018 for studies comparing surgical outcomes of mMVR vs bioMVR.ResultsThere were 14 observational studies with 20  219 patients (n = 14 658 mMVR and n = 5561 bioMVR). Patients receiving an mMVR were younger...
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
Conclusions In patients supported for PGD, peripheral and central cannulation strategies are safe and feasible for prolonged venoarterial ECMO support. There was no increase in bleeding after central implantation. With regard to the potential complications of a pECMO, we think that aortic cannulation with tunneling of the cannula and closure of the chest could be a good option in patients with PGD after htx. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: The Thoracic and Cardiovascular Surgeon - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Original Cardiovascular Source Type: research
CONCLUSIONS:  In patients supported for PGD, peripheral and central cannulation strategies are safe and feasible for prolonged venoarterial ECMO support. There was no increase in bleeding after central implantation. With regard to the potential complications of a pECMO, we think that aortic cannulation with tunneling of the cannula and closure of the chest could be a good option in patients with PGD after htx. PMID: 32035427 [PubMed - as supplied by publisher]
Source: The Thoracic and Cardiovascular Surgeon - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Thorac Cardiovasc Surg Source Type: research
Conclusions: At a follow-up time period of 2 years, pump replacement was significantly higher with the axial continuous-flow pump in comparison to the magnetic levitated centrifugal continuous flow circulatory pump. However, no significant difference was observed with the other adverse outcomes.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research
Publication date: Available online 20 December 2019Source: The Annals of Thoracic SurgeryAuthor(s): Chetan Pasrija, Mehrdad Ghoreishi, Glenn Whitman, Niv Ad, Diane E. Alejo, Sari D. Holmes, Stefano Schena, Rawn Salenger, Michael A. Mazzeffi, Clifford E. Fonner, Bradley Taylor, Investigators for the Maryland Cardiac Surgery Quality InitiativeAbstractBackgroundSeveral studies have established morbidity associated with bleeding after cardiac surgery. While reoperation has been implicated as the marker for this morbidity, there remains limited understanding regarding relative morbidities of reoperation and substantial transfus...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
More News: Biomedical Science | Bleeding | Cardiovascular & Thoracic Surgery | Dialysis | Gastroschisis Repair | Hemodialysis | International Medicine & Public Health | Renal Failure | Science | Stroke | Tracheostomy