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Cardiopulmonary bypass surgery

John S Kim, Jon Kaufman, Sonali S Patel, Marilyn Manco-Johnson, Jorge Di Paola, Eduardo M da Cruz
BACKGROUND: Ketorolac is used for pediatric analgesia after surgery despite its known platelet inhibition via the arachidonic acid (AA) pathway. The degree of platelet inhibitory effect after cardiac surgery is not well characterized. Thromboelastography with platelet mapping (TEG-PM) is emerging as a frequently used test to evaluate platelet inhibition via the AA pathway. METHODS: Post hoc analysis of a data set collected in a prospective observational cohort study evaluating platelet inhibition in children after congenital heart surgery with cardiopulmonary bypass (CPB)...
November 2018: World Journal for Pediatric & Congenital Heart Surgery
Matthew F Barhight, Danielle Soranno, Sarah Faubel, Katja M Gist
Children who undergo cardiac surgery with cardiopulmonary bypass are a unique population at high risk for postoperative acute kidney injury (AKI) and fluid overload. Fluid management is important in the postoperative care of these children as fluid overload is associated with increased morbidity and mortality. Peritoneal dialysis catheters are an important tool in the armamentarium of a cardiac intensivist and are used for passive drainage for fluid removal or dialysis for electrolyte and uremia control in AKI...
November 2018: World Journal for Pediatric & Congenital Heart Surgery
Shusuke Takeshita, Satoru Ogawa, Yoshinobu Nakayama, Nobuhiro Mukai, Yasufumi Nakajima, Toshiki Mizobe, Teiji Sawa, Kenichi A Tanaka
BACKGROUND: Recombinant activated factor VII (rFVIIa) concentrate reduces allogeneic blood transfusions, but it may increase thromboembolic complications in complex cardiac surgery. The mixture of activated factor VII (FVIIa) and factor X (FX) (FVIIa/FX) (FVIIa:FX = 1:10) is a novel bypassing agent for hemophilia patients. We hypothesized that the combination of FX and FVIIa could improve thrombin generation (TG) in acquired multifactorial coagulation defects such as seen in cardiac surgery and conducted in vitro evaluation of FVIIa/FX in parallel with other coagulation factor concentrates using in vitro and in vivo diluted plasma samples...
October 12, 2018: Anesthesia and Analgesia
Vicente Muedra, Lucrecia Moreno, Vicente Rodilla, Cristina Arce, Fermi Montó, Águeda Blázquez, Paloma Pérez, Pilar D'Ocón
Introduction: Decreased antithrombin (AT) activity in patients scheduled for cardiovascular surgery under cardiopulmonary bypass (CPB) is related to increased postoperative complications and hospitalization time. Indirect evidence suggests that glucocorticoids mitigate this decreased AT activity. To better understand the beneficial effects of AT we have analyzed: (i) the clinical relevance of acute dexamethasone (DX) administration before cardiac surgery on AT activity, (ii) the modulation by DX of AT expression in human endothelial cells (hECs), (iii) the activity of AT on migration and angiogenesis of hECs, or on angiogenesis of rat aorta...
2018: Frontiers in Pharmacology
Carlos Domínguez-Massa, Félix Serrano-Martínez, Óscar R Blanco-Herrera, Alberto Berbel-Bonillo, Fernando Hornero-Sos, José A Montero-Argudo
Thorough study is required to decide the appropriate management of hepatic tumors in children. We present a case report of a hepatic embryonal undifferentiated sarcoma with unfavorable prognosis in a nine-year-old girl. After undergoing a detailed cancer characteristics and extension study, a two-stage surgery approach was decided. The hepatic tumor resection was the first procedure to be performed. One week later, under cardiopulmonary bypass, deep hypothermia, and circulatory arrest, thrombectomy of the inferior vena cava and right atrium was accomplished, plus thromboendarterectomy of the right pulmonary artery...
October 14, 2018: World Journal for Pediatric & Congenital Heart Surgery
Andreas Eisenried, Raphael Klarwein, Harald Ihmsen, Andreas Wehrfritz, René Tandler, Christian Heim, Jörg Fechner
OBJECTIVE: Evaluate the accuracy and trending ability of the fourth-generation FloTrac/EV1000 (Edwards Lifesciences, Irvine, CA) system in patients with severe aortic valve stenosis by comparing FloTrac/EV1000-derived cardiac output (CCO-FT) with continuous thermodilution pulmonary artery catheter (CCO-PAC) measurements before and after surgical valve replacement. DESIGN: Prospective clinical study. SETTING: Anesthesia for cardiac surgery, operating room, single-center university hospital...
September 13, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Hao Liu, Ju Mei, Yi He, Zhaolei Jiang, Min Tang
Epicardial surgical repair has been proven to be effective for patients with coronary- pulmonary artery fistula (CPAF). However, most of the surgery has been performed through a median sternotomy under cardiopulmonary bypass. In this report, we describe a novel technique of performing minimally invasive surgery for CPAF patients without extracorporeal circulation via a parasternal minithoracotomy. This technique has proved to be safe and effective and may be worthy of use for patients with CPAF.
September 29, 2018: Heart, Lung & Circulation
Tiago R Velho, Hugo Duarte Ferreira, Catarina Carvalheiro, André Sena, Nádia Juqueira, Nuno Guerra, Javier Gallego, Ângelo Nobre
BACKGROUND: Aortic valve disease is the most common valvular heart disease. Surgical aortic valve replacement remains the gold-standard of treatment. Recently, minimally invasive approaches have been developed to reduce surgical trauma and to compete with percutaneous treatment of valvular heart disease. Minimally invasive approaches are associated with reduced perioperative morbidity and mortality. METHODS: Single-center retrospective study comparing clinical data of patients submitted to surgical treatment of aortic stenosis by limited sternotomy versus conventional sternotomy between January 2014 and August 2016...
January 2018: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Min Ho Ju, Jin Hyung Huh, Chee-Hoon Lee, Ho Jin Kim, Hyung Gon Je, Joon Bum Kim, Sung-Ho Jung, Jae Won Lee
BACKGROUND: Data on robotic-assisted surgical atrial fibrillation (AF) ablation in patients undergoing mitral valve (MV) surgeries are lacking. This study aimed to evaluate early and late outcomes following robotic-assisted ablation of AF combined with MV surgery. METHODS: Between 2007 and 2017, this study enrolled 94 patients (53.9±12.7 years; 67 males) undergoing AF ablation using an argon-based flexible cryoablation system during robotic-assisted MV surgery...
October 11, 2018: Annals of Thoracic Surgery
Jamshid H Karimov, Tomislav Mihaljevic, Shengqiang Gao, Gengo Sunagawa, Patrick Grady, Martin Sinkewich, Kiyotaka Fukamachi
OBJECTIVE: With heart disease increasing worldwide, demand for new minimally invasive techniques and transcatheter technologies to treat structural heart disease is rising. Cardioscopy has long been considered desirable, as it allows direct tissue visualization and intervention to deliver therapy via a closed chest, with real-time fiber-optic imaging of intracardiac structures. Herein, the feasibility of the advanced cardioscopic platform, allowing both transapical and fully percutaneous access is reported...
October 9, 2018: Seminars in Thoracic and Cardiovascular Surgery
Anirudh Vinnakota, Robert D Stewart, Hani Najm, Eugene H Blackstone, Joanna Ghobrial, Gosta B Pettersson
BACKGROUND: Anomalous aortic origin of the coronary arteries (AAOCA) is associated with sudden cardiac death and frequently treated with unroofing of an intramural segment. Most reports on AAOCA are in patients under age 30. We have reviewed our "older" patients who have undergone surgical repair and report a novel unroofing technique. METHODS: A retrospective review was conducted of 40 adult patients who underwent surgery for AAOCA from 6/2005 to 6/2016...
October 9, 2018: Annals of Thoracic Surgery
Erkki Pesonen, Petru Liuba, Elhadi H Aburawi
AIM: The aim of this review was to develop a deeper knowledge of the physiology of coronary blood flow and coronary flow reserve in young patients with congenital heart disease and inflammatory diseases. METHODS: We searched for papers published in English on coronary blood flow and coronary flow reserve using the PubMed and google search databases. This identified 42 papers extending back to 1976 and a book from 2008 (ref 10). RESULTS: Our review showed that the implications of coronary blood flow and coronary flow reserve in paediatric patients with congenital heart disease and inflammatory diseases are still not fully understood...
October 12, 2018: Acta Paediatrica
Shu Y Lu, Kenneth T Shelton, Michael G Fitzsimons
Essential thrombocytosis (ET) is a rare chronic myeloproliferative disorder characterized by elevated platelet counts. The management of patients with ET undergoing coronary artery bypass graft remains unclear. Often, patients who are deemed "high risk" for thrombotic events receive cytoreductive therapy before surgery, while patients deemed "low risk" do not receive cytoreductive therapy. Here, we present a case of a patient with ET with only a mild elevation in platelets deemed "low risk" for thrombotic complications who was found to have a small intracardiac thrombus around the pulmonary artery catheter before initiation of cardiopulmonary bypass...
October 11, 2018: A&A practice
Ali Kemal Gür, Mehmet Coşkun Aykaç
OBJECTIVE: Although seen rarely compared to all tumors, cardiac tumors are tumors which may have a mortal course with possible complications. The most common cardiac tumor in adults is myxoma with its benign character. The results of cardiac tumors resected with open cardiac surgery in our center are reported in this study. MATERIALS AND METHODS: Twenty-three cardiac tumor patients electively operated on in our clinic between January 2010 and August 2017 were retrospectively included in the study...
September 13, 2018: Heart Surgery Forum
Mehmet Adnan Celkan, Ismail Kork, Abdullah Ulucay
BACKGROUND: In this study, we present the outcomes of 53 patients with concomitant coronary artery disease and ischemic mitral regurgitation (IMR)who underwent coronary bypass grafting (CABG) plus mitral repair (flexible posterior band annuloplasty). MATERIALS AND METHODS: A total of 53 patients with concomitant ischemic mitral regurgitation  and coronary artery disease underwent CABG plus posterior mitral band annuloplasty between June 2008 and June 2015. Flexible Duran AnCore® annuloplasty band (Medtronic) was used in all patients...
August 14, 2018: Heart Surgery Forum
Yuji Kawano, Minoru Tabata
Minimally invasive cardiac surgery(MICS)rapidly has become popular in recent years. To perform meticulous surgical procedures in the limited space, specially designed surgical instruments are very useful. For excellent exposure of the surgical target, thoracoscopic system with high imaging quality such as 4K or 3D HD endoscopy is often used. An articulated rib spreader and/or soft tissue retractor is also useful since those instruments do not interfere with other surgical instruments. A suture catcher is used to pull traction sutures through the chest wall...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Hao Ma, Zhenghua Xiao, Jun Shi, Lulu Liu, Chaoyi Qin, Yingqiang Guo
BACKGROUND: Aortic arch cannulation for an antegrade central perfusion during the surgery for Stanford type A aortic dissection can be performed within median sternotomy. We summarize the safety and convenient profile of the central cannulation strategy using the guidance of transesophageal echocardiography (TEE) in comparison to traditional femoral cannulation strategy. METHODS: Sixty-two patients with acute Stanford type A aortic dissection underwent aortic arch surgery in our hospital...
October 11, 2018: Journal of Cardiothoracic Surgery
Lei Chen, Liangrong Wang, Qian Zhuo, Qiong Zhang, Feifei Chen, Liling Li, Lina Lin
BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication after cardiac surgery that influences the clinical outcomes and quality of life of patients. This study aimed to evaluate the effects of Shenmai injection (SMI) on POCD of patients who underwent cardiac valve replacement under cardiopulmonary bypass (CPB). METHODS: This prospective, randomized, controlled trial was conducted from September 2014 to January 2017. Eighty-eight patients receiving cardiac valve replacement under CPB were randomized into the control (C) or the SMI (S) group...
October 11, 2018: BMC Anesthesiology
Ruslan Natanov, Faikah Gueler, Christine S Falk, Christian Kühn, Ulrich Maus, Erin C Boyle, Thierry Siemeni, Ann-Katrin Knoefel, Serghei Cebotari, Axel Haverich, Nodir Madrahimov
Cardiopulmonary bypass (CPB) with moderate hypothermic cardiac arrest (MHCA) is essential for prolonged complex procedures in cardiac surgery and is associated with postoperative complications. Although cytokine release provoked through MHCA under CPB plays a pivotal role in postoperative organ damage, the pathomechanisms are unclear. Here, we investigated the cytokine release pattern and histological organ damage after MHCA using a recently described mouse CPB model. Eight BALB/c mice underwent 60 minutes of circulatory arrest under CPB, were successively rewarmed and reperfused...
2018: PloS One
Josh Zimmerman, Linda Shore-Lesserson
PURPOSE OF REVIEW: As our population ages and cardiovascular disease increases in prevalence, a growing number of patients will be candidates for coronary artery bypass grafting (CABG). Outcomes from this common surgery can be improved by a coordinated team approach involving physicians, nurses, and healthcare professionals from multiple specialties. This review will discuss the role cardiovascular anesthesiologists play in the perioperative care of these complex patients. RECENT FINDINGS: Cardiovascular anesthesiologists may play a variety of important roles throughout the entire perioperative period of patients undergoing CABG...
November 2018: Current Opinion in Cardiology
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