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Low cardiac output syndrome

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https://www.readbyqxmd.com/read/29662808/critical-illness-related-corticosteroid-insufficiency-in-patients-with-low-cardiac-output-syndrome-after-cardiac-surgery
#1
You Jung Ok, Ju Yong Lim, Sung-Ho Jung
Background: Low cardiac output syndrome (LCOS) after cardiac surgery usually requires inotropes. In this setting, critical illness-related corticosteroid insufficiency (CIRCI) may develop. We aimed to investigate the clinical features of CIRCI in the presence of LCOS and to assess the efficacy of steroid treatment. Methods: We reviewed 28 patients who underwent a rapid adrenocorticotropic hormone (ACTH) test due to the suspicion of CIRCI between February 2010 and September 2014...
April 2018: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29662806/early-clinical-outcomes-of-tricuspid-valve-repair-with-a-tri-ad-annuloplasty-ring-in-comparison-with-the-outcomes-using-an-mc-3-ring
#2
Woohyun Jung, Jae Woong Choi, Ho Young Hwang, Kyung Hwan Kim
Background: We evaluated the early clinical outcomes of tricuspid valve annuloplasty (TAP) with the Tri-Ad annuloplasty ring for functional tricuspid regurgitation (TR). Methods: From January 2015 to March 2017, 36 patients underwent TAP with a Tri-Ad ring for functional TR. To evaluate the early clinical outcomes of TAP with the Tri-Ad ring, we conducted a propensity score-matched analysis comparing the Tri-Ad and MC3 tricuspid annuloplasty rings (n=34 in each group)...
April 2018: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29652271/prophylactic-preoperative-levosimendan-for-off-pump-coronary-artery-bypass-grafting-in-patients-with-left-ventricular-dysfunction-single-centered-randomized-prospective-study
#3
Pushkar Mahendra Desai, Manjula S Sarkar, Sanjeeta R Umbarkar
Background: Off-pump coronary artery bypass surgery (OPCAB) is often complicated by hemodynamic instability, especially in patients with prior left ventricular (LV) dysfunction and appropriate choice of inotrope plays a vital role in perioperative management of these patients. Aim and Objective: To study hemodynamic effects and immediate outcome of prophylactic infusion of levosimendan in patients with the LV dysfunction undergoing OPCAB surgery and whether this strategy helps in successful conduct of OPCAB surgery...
April 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29628028/-disorders-associated-with-mild-cognitive-impairment-risk-factors-and-predictors
#4
Manuel Antón Jiménez, José Luis González Guerrero
Traditionally, cognitive impairment has been associated not only with ageing itself but also with concomitant comorbidities that interact in the disease continuum from the prodromic phases. Notable among these are delirium, nutritional alterations, balance and gait, infections and even a progressive incidence of neoplasms. However, with regard to diagnosis and staging, clinicians should perhaps remain especially alert to the possibility of pharmacological iatrogeny, which is not limited to psychopharmacological treatment...
June 2017: Revista Española de Geriatría y Gerontología
https://www.readbyqxmd.com/read/29618063/endoscopic-port-access-surgery-for-isolated-atrioventricular-valve-endocarditis
#5
Johan van der Merwe, Filip Casselman, Bernard Stockman, Apostolos Roubelakis, Yvette Vermeulen, Ivan Degrieck, Frank Van Praet
OBJECTIVES: Our goal was to report the clinical and echocardiographic outcomes of endoscopic port access surgery for isolated active and convalescent atrioventricular valve endocarditis (AVVE). METHODS: Our current surgical team performed endoscopic port access surgery in 66 consecutive patients with isolated AVVE (mean age, 65.5 ± 12.7 years, 37.9% women, mean EuroSCORE II 31.2 ± 24.9%, 45.5% prosthetic AVVE, Staphylococcus aureus 22.2%), between 1 May 2004 and 31 July 2015...
April 2, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29573810/meta-analysis-of-trials-on-prophylactic-use-of-levosimendan-in-patients-undergoing-cardiac-surgery
#6
Ayman Elbadawi, Islam Y Elgendy, Marwan Saad, Michael Megaly, Amgad Mentias, Ahmed S Abuzaid, Hend I Shahin, Vinay Goswamy, Hesham Abowali, Barry London
BACKGROUND: The role of prophylactic levosimendan in patients undergoing cardiac surgery is controversial. METHODS: We performed a computerized search of Medline, Embase, and Cochrane databases through September 2017 for randomized trials evaluating the prophylactic use of levosimendan in patients undergoing cardiac surgery (ie, patients without low cardiac output syndrome). The main study outcome was mortality at 30 days. RESULTS: The final analysis included 16 randomized trials with total of 2,273 patients...
March 21, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29564979/levosimendan-for-perioperative-cardioprotection-myth-or-reality
#7
Elpidio Santillo, Monica Migale, Carlo Massini, Raffaele Antonelli Incalzi
BACKGROUND: Levosimendan is a calcium sensitizer drug causing increased contractility in the myocardium and vasodilation in the vascular system. It is mainly used for the therapy of acute decompensated heart failure. Several studies on animals and humans provided evidence of the cardioprotective properties of levosimendan including preconditioning and anti-apoptotic. In view of these favorable effects, levosimendan has been tested in patients undergoing cardiac surgery for the prevention or treatment of low cardiac output syndrome...
March 21, 2018: Current Cardiology Reviews
https://www.readbyqxmd.com/read/29538053/prevention-of-low-cardiac-output-syndrome-after-pediatric-cardiac-surgery-a-double-blind-randomized-clinical-pilot-study-comparing-dobutamine-and-milrinone
#8
Anna Cavigelli-Brunner, Maja I Hug, Hitendu Dave, Oskar Baenziger, Christoph Buerki, Dominique Bettex, Vincenzo Cannizzaro, Christian Balmer
OBJECTIVES: Dobutamine and milrinone are commonly used after open-heart surgery to prevent or treat low cardiac output syndrome. We sought to compare efficacy and safety of these drugs in pediatric patients. DESIGN: Prospective, single-center, double-blinded, randomized clinical pilot study. SETTING: Tertiary-care university children's hospital postoperative pediatric cardiac ICU. PATIENTS: After written consent, 50 consecutive patients (age, 0...
March 13, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29537977/fulminant-myocarditis-characteristics-treatment-and-outcomes
#9
Giacomo Veronese, Enrico Ammirati, Manlio Cipriani, Maria Frigerio
Myocarditis is an inflammatory disease of the myocardium with a broad spectrum of clinical presentations, ranging from mild symptoms to severe heart failure. The course of patients with myocarditis is heterogeneous, varying from partial or full clinical recovery in few days to advanced low cardiac output syndrome requiring mechanical circulatory support or heart transplantation. Fulminant myocarditis (FM) is a peculiar clinical condition and is an acute form of myocarditis, whose main characteristic is a rapidly progressive clinical course with the need for hemodynamic support...
March 13, 2018: Anatolian Journal of Cardiology
https://www.readbyqxmd.com/read/29531820/warm-blood-cardioplegia-versus-cold-crystalloid-cardioplegia-for-myocardial-protection-during-coronary-artery-bypass-grafting-surgery
#10
Paolo Nardi, Calogera Pisano, Fabio Bertoldo, Sara R Vacirca, Guglielmo Saitto, Antonino Costantino, Emanuele Bovio, Antonio Pellegrino, Giovanni Ruvolo
We retrospectively analyzed early results of coronary artery bypass grafting (CABG) surgery using two different types of cardioplegia for myocardial protection: antegrade intermittent warm blood or cold crystalloid cardioplegia. From January 2015 to October 2016, 330 consecutive patients underwent isolated on-pump CABG. Cardiac arrest was obtained with use of warm blood cardioplegia (WBC group, n  = 297) or cold crystalloid cardioplegia (CCC group, n  = 33), according to the choice of the surgeon. Euroscore II and preoperative characteristics were similar in both groups, except for the creatinine clearance, slightly lower in WBC group (77...
December 2018: Cell Death Discovery
https://www.readbyqxmd.com/read/29482650/intraoperative-milrinone-versus-dobutamine-in-cardiac-surgery-patients-a-retrospective-cohort-study-on-mortality
#11
Dorthe Viemose Nielsen, Christian Torp-Pedersen, Regitze Kuhr Skals, Thomas A Gerds, Zidryne Karaliunaite, Carl-Johan Jakobsen
BACKGROUND: Several choices of inotropic therapy are available and used in relation to cardiac surgery. Comparisons are necessary to select optimal therapy. In Denmark, dobutamine and milrinone are the two inotropic agents most commonly used to treat post-bypass low cardiac output syndrome. This study compares all-cause mortality with these drugs. METHODS: In a retrospective observational study we investigated 10,700 consecutive patients undergoing cardiac surgery from 1 April 2006 to 31 December 2013 at Aarhus and Aalborg University Hospitals in the Central and Northern Denmark Region...
February 26, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29456049/six-month-outcomes-after-high-risk-coronary-artery-bypass-graft-surgery-and-preoperative-intra-aortic-balloon-counterpulsation-use-an-inception-cohort-study
#12
Edward Litton, Frances Bass, Anthony Delaney, Graham Hillis, Silvana Marasco, Shay McGuinness, Paul S Myles, Christopher M Reid, Julian A Smith
OBJECTIVE: To inform the design of a pivotal randomized controlled trial of prophylactic intra-aortic balloon counterpulsation (IABC) in patients undergoing coronary artery bypass graft (CABG) at high risk of postoperative low cardiac output syndrome (LCOS). DESIGN: Inception cohort study. SETTING: A total of 13 established cardiac centers in Australia, Canada, New Zealand, and the United Kingdom. PARTICIPANTS: Adult patients were eligible for inclusion if they were listed for CABG surgery and had 2 or more LCOS risk factors (low ejection fraction, severe left main coronary artery disease, redo sternotomy, unstable angina)...
January 5, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29451075/short-term-outcomes-of-preoperative-intra-aortic-balloon-pump-use-in-patients-undergoing-adjunctive-coronary-endarterectomy-a-retrospective-observational-study
#13
Liangshan Wang, Xing Hao, Xiaomeng Wang, Chengxiong Gu, Hong Wang, Xiaotong Hou
BACKGROUND: Coronary artery bypass grafting (CABG) combined with coronary endarterectomy (CE) can be associated with high operative mortality and morbidity. An intra-aortic balloon pump (IABP) has been the most widely used mechanical circulatory support device during perfusion treatment. However, the benefits of preoperative IABP in CABG combined with CE remain unknown. We conducted a retrospective observational study to evaluate the efficacy of preoperative IABP therapy in patients undergoing adjunctive right coronary artery (RCA) endarterectomy...
February 1, 2018: Perfusion
https://www.readbyqxmd.com/read/29448828/role-of-terminal-warm-blood-cardioplegia-in-complex-congenital-heart-surgery
#14
Pribadi Wiranda Busro, Harvey Romolo, Sudigdo Sastroasmoro, Jusuf Rachmat, Mohammad Sadikin, Anwar Santoso, Cindy Elfira Boom, Suhendro Suwarto, Ahmad Aulia Jusuf
Introduction Myocardial protection is vital to ensure successful open heart surgery. Cardioplegic solution is one method to achieve good myocardial protection. Inevitably, ischemia-reperfusion injury occurs with aortic crossclamping. Histidine-tryptophan-ketoglutarate solution is a frequently used cardioplegia for complex congenital heart surgery. We postulated that addition of terminal warm blood cardioplegia before removal of the aortic crossclamp might improve myocardial protection. Method A randomized controlled trial was conducted on 109 cyanotic patients aged, 1 to 5 years who underwent complex biventricular repair...
January 1, 2018: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/29376560/inotropic-agents-and-vasodilator-strategies-for-the-treatment-of-cardiogenic-shock-or-low-cardiac-output-syndrome
#15
REVIEW
Julia Schumann, Eva C Henrich, Hellen Strobl, Roland Prondzinsky, Sophie Weiche, Holger Thiele, Karl Werdan, Stefan Frantz, Susanne Unverzagt
BACKGROUND: Cardiogenic shock (CS) and low cardiac output syndrome (LCOS) as complications of acute myocardial infarction (AMI), heart failure (HF) or cardiac surgery are life-threatening conditions. While there is a broad body of evidence for the treatment of people with acute coronary syndrome under stable haemodynamic conditions, the treatment strategies for people who become haemodynamically unstable or develop CS remain less clear. We have therefore summarised here the evidence on the treatment of people with CS or LCOS with different inotropic agents and vasodilative drugs...
January 29, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29324494/myocardial-protection-by-glucose-insulin-potassium-in-moderate-to-high-risk-patients-undergoing-elective-on-pump-cardiac-surgery-a-randomized-controlled-trial
#16
Christoph Ellenberger, Tornike Sologashvili, Lukas Kreienbühl, Mustafa Cikirikcioglu, John Diaper, Marc Licker
BACKGROUND: Low cardiac output syndrome is a main cause of death after cardiac surgery. We sought to assess the impact of glucose-insulin-potassium (GIK) to enhance myocardial protection in moderate- to high-risk patients undergoing on-pump heart surgery. METHODS: A randomized controlled trial was performed in adult patients (Bernstein-Parsonnet score >7) scheduled for elective aortic valve replacement and/or coronary artery bypass surgery. Patients were randomized to GIK (20 IU of insulin, 10 mEq of potassium chloride in 50 mL of glucose 40%) or saline infusion given over 60 minutes on anesthetic induction...
April 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29250516/use-of-therapeutic-plasma-exchange-during-extracorporeal-life-support-in-critically-ill-cardiac-children-with-thrombocytopenia-associated-multi-organ-failure
#17
Mei Chong, Alejandro J Lopez-Magallon, Lucas Saenz, Mahesh S Sharma, Andrew D Althouse, Victor O Morell, Ricardo Munoz
Background: Thrombocytopenia-associated multi-organ failure (TAMOF) in children is a well-described factor for increased hospital mortality. Low cardiac output syndrome (LCOS) and the effects of cardiopulmonary bypass may manifest with several adverse physiologic and immunologic effects, with varying degrees of thrombocytopenia and multi-organ dysfunction, sometimes very similar to TAMOF. LCOS is a common occurrence in children with critical heart disease, presenting in as much as 23...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29246551/comparative-effectiveness-of-coronary-screening-in-heart-valve-surgery-computed-tomography-versus-conventional-coronary-angiography
#18
Wonjae Lee, Joon Bum Kim, Dong Hyun Yang, Cherry Kim, Jihoon Kim, Min Ho Ju, Ho Jin Kim, Joon-Won Kang, Sung-Ho Jung, Young-Hak Kim, Suk Jung Choo, Cheol Whan Lee, Cheol Hyun Chung, Jae Won Lee, Tae-Hwan Lim
BACKGROUND: Although conventional coronary angiography (CAG) is considered the gold standard for coronary artery disease (CAD) screening in the setting of heart valve surgery, coronary artery computed tomography angiography (CCTA) has emerged as an alternative modality. This study was conducted to evaluate the clinical outcomes of CCTA compared with conventional CAG for CAD screening in patients undergoing heart valve surgery. METHODS: A total of 3150 consecutive patients aged >40 years or with coronary risk factors undergoing elective valve operations between 2001 and 2015 were evaluated...
April 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29211225/off-pump-versus-on-pump-coronary-artery-bypass-grafting-in-frail-patients-study-protocol-for-the-fragile-multicenter-randomized-controlled-trial
#19
RANDOMIZED CONTROLLED TRIAL
Omar Asdrúbal Vilca Mejía, Michel Pompeu Barros Oliveira Sá, Maurilio Onofre Deininger, Luís Roberto Palma Dallan, Rodrigo Coelho Segalote, Marco Antonio Praça de Oliveira, Fernando Antibas Atik, Magaly Arrais Dos Santos, Pedro Gabriel Melo de Barros E Silva, Rodrigo Mussi Milani, Alexandre Ciappina Hueb, Rosangela Monteiro, Ricardo Carvalho Lima, Luiz Augusto Ferreira Lisboa, Luís Alberto Oliveira Dallan, John Puskas, Fabio Biscegli Jatene
INTRODUCTION: Advances in modern medicine have led to people living longer and healthier lives. Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. When it comes to CABG surgery, randomized controlled clinical trials have primarily focused on low-risk (ROOBY, CORONARY), elevated-risk (GOPCABE) or high-risk patients (BBS), but not on frail patients. Therefore, we believe that off-pump CABG could be an important technique in patients with limited functional capacity to respond to surgical stress...
September 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29176374/intraoperative-vasoplegia-methylene-blue-to-the-rescue
#20
Sharon L McCartney, Lorent Duce, Kamrouz Ghadimi
PURPOSE OF REVIEW: To evaluate the efficacy, dosing, and safety of methylene blue (MTB) in perioperative vasoplegic syndrome (VS). RECENT FINDINGS: Vasoplegic syndrome is a state of persistent hypotension with elevated cardiac output, low filling pressures, and low systemic vascular resistance (SVR). It occurs in up to 25% of patients undergoing cardiac surgery with cardiopulmonary bypass, can last up to 72 h, and is associated with a high mortality rate. MTB has been found to increase SVR and decrease vasopressor requirements in vasoplegic syndrome by inhibiting nitric oxide synthase, thus limiting the generation of nitric oxide, while inhibiting activation of soluble guanylyl cyclase and preventing vasodilation...
February 2018: Current Opinion in Anaesthesiology
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