RESUMEN
INTRODUCTION: Acute kidney injury (AKI) is a serious complication after coronary artery bypass grafting (CABG). There are conflicting reports whether a miniaturized cardiopulmonary bypass (MCPB) system is associated with a lower AKI incidence compared with conventional cardiopulmonary bypass (CCPB). It is unknown if AKI risk factors differ between the two groups. We assessed if MCPB decreases AKI after CABG and compared the risk factors between both groups. METHODS: Sixty-eight Asian patients presenting for elective CABG at a tertiary heart centre were enrolled. They were randomly assigned to MCPB (n=34) or CCPB group (n=34) and followed up in a single-blinded, prospective, randomized, controlled trial. The primary outcome was Acute Kidney Injury Network stage 1 AKI. RESULTS: The AKI incidence was 21.5% and was not significantly different between patients undergoing MCPB versus CCPB (21.9% versus 21.2%, p=0.948). The first CPB haematocrit was independently associated with AKI in the MCPB group (Relative Risk [RR]=0.484, 95% Confidence Interval [CI]=0.268-0.876, p=0.016); post-operative blood loss and inflammation were independently associated with AKI in the CCPB group (RR=1.005, 95%CI=1.003-1.007, p<0.001; RR=1.018, 95%CI=1.010-1.028, p<0.001). CONCLUSION: The MCPB system is not associated with a lower incidence of AKI in Asian patients undergoing CABG. Risk factors for AKI differed between patients using the MCPB and CCPB systems.
Asunto(s)
Lesión Renal Aguda , Puente Cardiopulmonar , Puente de Arteria Coronaria/efectos adversos , Miniaturización , Complicaciones Posoperatorias/terapia , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Anciano , Puente Cardiopulmonar/instrumentación , Puente Cardiopulmonar/métodos , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
INTRODUCTION: We compared the systemic inflammatory response of the MCPB system to the CCPB system with cell salvage and phosphorylcholine-coated tubing amongst Asian patients undergoing coronary artery bypass grafting. METHODS: Seventy-eight patients were randomly assigned to the MCPB or the CCPB groups equally and followed up in a prospective, single-blinded, randomised, controlled trial. Levels of TNF-α, IL-6, CRP and LDH were measured peri-operatively. RESULTS: The systemic inflammatory response was similar in both groups (TNF-α: p=0.222; IL-6: p=0.991; CRP: p=0.258). Only haemolysis was significantly higher in the CCPB group (LDH: p=0.011). The MCPB system was twice more expensive, but had a near 4-fold cost saving in tranfusions. Overall, the MCPB system cost 20% more than the modified CCPB system. CONCLUSION: These results corroborate with studies that demonstrated the avoidance of cardiotomy suction rather than the MCPB system, itself, leads to an attenuated inflammatory response. The absence of obvious clinical benefit and the higher costs involved with the MCPB system would preclude its routine use.
Asunto(s)
Proteína C-Reactiva/metabolismo , Puente Cardiopulmonar/efectos adversos , Interleucina-6/sangre , L-Lactato Deshidrogenasa/sangre , Complicaciones Posoperatorias/sangre , Síndrome de Respuesta Inflamatoria Sistémica/sangre , Factor de Necrosis Tumoral alfa/sangre , Adulto , Anciano , Anciano de 80 o más Años , Pueblo Asiatico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Respuesta Inflamatoria Sistémica/etiologíaRESUMEN
Non-bronchial systemic arteries, apart from normal and anomalous bronchial arteries, may be a source of massive haemoptysis in a chronically inflamed lung via transpleural anastomoses. Transcatheter embolisation is an established therapeutic method of choice in the management of massive haemoptysis. We report embolisation of a hypertrophied pleural branch of the pericardiophrenic artery for the management of massive haemoptysis in a 61-year-old woman. Initial computed tomography chest imaging showed peribronchial thickening and subpleural scarring in the lingula lobe, with ground-glass changes secondary to haemoptysis. Angiography demonstrated a hypertrophied branch of the left pericardiophrenic artery supplying an abnormal bunch of vessels in the lingula and anastomosing with the homolateral inferior phrenic artery. This was successfully embolised with gel foam. The left internal thoracic artery was later embolised in order to control the repeat haemoptysis. A brief anatomical review of the source of massive haemoptysis, anatomy of the internal thoracic and pericardiophrenic arteries and the clinical implications are discussed.
Asunto(s)
Arterias/patología , Embolización Terapéutica/métodos , Hemoptisis/terapia , Angiografía/métodos , Femenino , Humanos , Pulmón/patología , Mediastino/patología , Persona de Mediana Edad , Radiografía Torácica/métodos , Arterias Torácicas/patología , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Massive pulmonary embolism with shock remains a highly fatal disease. We present twelve cases of massive embolism over the last seven years that required emergent surgery. Five patients suffered haemodynamic collapse and all died despite heroic attempts at salvage. A better outcome can only be achieved in this sub-category of patients with a rapid confirmatory diagnosis and appropriate thrombolysis and early referral to a cardiothoracic surgeon.
Asunto(s)
Embolia Pulmonar/complicaciones , Choque/etiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/mortalidad , Embolia Pulmonar/cirugía , Estudios Retrospectivos , Choque/mortalidad , Choque/cirugíaRESUMEN
Free wall rupture of the left ventricle remains a lethal complication of acute myocardial infarction. Nevertheless, where it presents subacutely with tamponade, salvage with a good outcome is still possible with timely pericardiocentesis preceding definitive repair using a sutureless technique.
Asunto(s)
Taponamiento Cardíaco/cirugía , Rotura Cardíaca Posinfarto/cirugía , Disfunción Ventricular Izquierda/cirugía , Puente Cardiopulmonar , Puente de Arteria Coronaria , Ventrículos Cardíacos/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pericardiocentesis , Adhesivos Tisulares/uso terapéuticoRESUMEN
Acute bowel ischemia is a rare but often catastrophic event after coronary bypass surgery. We report three cases in our department and highlight the difficulty in making the diagnosis thus delaying timely intervention. We discuss why an aggressive approach in both investigating and managing this condition is warranted. We believe that early mesenteric angiogram and directed exploratory laparotomy are the preferred methods in managing this difficult condition.
Asunto(s)
Puente de Arteria Coronaria , Intestinos/irrigación sanguínea , Isquemia/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Anciano , Angiografía , Femenino , Humanos , Isquemia/tratamiento farmacológico , Isquemia/etiología , Laparotomía , Masculino , Papaverina/uso terapéutico , Complicaciones Posoperatorias/tratamiento farmacológico , Factores de Riesgo , Vasodilatadores/uso terapéuticoRESUMEN
Aortic tears commonly occur in multiply injured patients. Recognizing this injury is important. A chest X-ray is helpful and a CT-angiogram or aortogram confirmatory. After attending to life-threatening injuries, the aortic tear should be repaired immediately. Using the left heart bypass technique has the lowest risk of operative neurologic injury. We review our experience over the last 2 years, discuss our preferred technique and report on the outcome.
Asunto(s)
Aorta/lesiones , Aorta/cirugía , Puente Cardíaco Izquierdo , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Pronóstico , Radiografía Torácica , Isquemia de la Médula EspinalRESUMEN
We present 4 neonates with enteroviral meningitis. The cerebrospinal fluid findings were variable and posed a diagnostic problem. Immediate outcome was excellent and 3 of the 4 infants were normal at follow-up at 6 months of age. However long-term follow-up will be necessary to to determine any long-term sequelae.