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1.
Tex Heart Inst J ; 47(2): 108-116, 2020 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-32603472

RESUMEN

Warm blood cardioplegia has been an established cardioplegic method since the 1990s, yet it remains controversial in regard to myocardial protection. This review will describe the physiologic and technical concepts behind warm blood cardioplegia, as well as outline the current basic and clinical research that evaluates its usefulness. Controversies regarding this technique will also be reviewed. A long history of experimental data indicates that warm blood cardioplegia is safe and effective and thus suitable myocardial protection during cardiopulmonary bypass surgeries.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Paro Cardíaco Inducido/métodos , Cuidados Intraoperatorios/métodos , Daño por Reperfusión Miocárdica/prevención & control , Humanos
2.
Tex Heart Inst J ; 43(6): 534-536, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28100977

RESUMEN

We report the case of a 61-year-old obese male patient in whom we found a well-functioning 33-year-old Starr-Edwards aortic prosthesis during repeat aortic surgery. Rather than explant the prosthesis, we remodeled the aortic root, almost completely removing the aortic sinuses and leaving only a pillar of aortic tissue around the coronary ostia. The proximal end of a Hemashield tube-graft was then scalloped to accommodate the remaining aortic tissue. The patient's heart function was excellent after his weaning from cardiopulmonary bypass. Simplifying the repeat aortic root repair, by preserving a well-functioning Starr-Edwards valve, might lead to a better outcome in similar cases. We also discuss other instances of this valve's durability.


Asunto(s)
Aneurisma de la Aorta/cirugía , Válvula Aórtica/cirugía , Implantación de Prótesis Vascular , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/fisiopatología , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Factores de Tiempo , Resultado del Tratamiento
3.
J Emerg Trauma Shock ; 7(4): 310-2, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25400394

RESUMEN

Left atrial (LA) rupture is rare following blunt chest injury. We describe a case of blunt LA rupture that was treated surgically. This report is intended to alert practitioners for a need of a close multiple disciplinary collaborations among them for optimal management of patients with this type of trauma; because other non-cardiac injuries involving the head, abdomen, or extremities are considered covariates for in-hospital mortality. As in the present case, the patient eventually died from associated extrathoracic injuries. The diagnosis of LA rupture is by exclusion. However, the initial radiological reading may be misinterpreted, because this injury can easily be mistaking for an aortic rupture. The final reappraisal of the chest imaging studies should be interpreted by a skilled radiologist to avoid misdiagnosis. Subtle radiological features can help distinguish aortic thoracic injury as illustrated in this patient. These factors may be useful to the practicing surgeon in deciding surgical approach.

4.
J Card Surg ; 29(5): 593-9, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24965706

RESUMEN

BACKGROUND: Red blood cell transfusion (Tx) induces a proinflammatory state. Inflammatory mediators are associated with an increased risk of postoperative atrial fibrillation (AF). Therefore, in this study we determined the association between AF and Tx after isolated coronary artery bypass graft surgery (CABG). METHOD: Between January 2008 and December 2010, a total of 879 patients underwent CABG. Of these, 815 (92.7%) had complete data extracted from our institution's Society of Thoracic Surgeons (STS) database. Predictors of AF development among four levels of Tx versus nontransfused patients were examined. Multivariable logistic regression and propensity score matching models were used. RESULTS: The mean age was 65.8 years (±10.3), 77.4% were male, and 54.4% had an STS predicted risk score (mortality/morbidity) of ≥10%. A total of 564 (69.2%) had at least one unit of Tx. Adjusting for age, sex, time on pump, congestive heart failure, stroke, creatinine level (<1.5 mg per deciliter vs. ≥1.5), STS morbidity/mortality score, perioperative myocardial infarction (MI), cross-clamp time, medications, and hemoglobin level, the odds ratio (OR) of AF increased with increasing Tx (OR, 1.36; 95% confidence interval [CI], 1.11 to 1.68; p = 0.003). The odds of AF increased 61% with each increasing level of Tx (OR, 1.61; 95% CI, 1.15 to 2.26; p = 0.006, by propensity analysis). CONCLUSIONS: Perioperative Tx may be associated with excess AF following CABG. This risk increases with increasing number of Tx.


Asunto(s)
Fibrilación Atrial/etiología , Puente de Arteria Coronaria , Transfusión de Eritrocitos/efectos adversos , Complicaciones Posoperatorias/etiología , Factores de Edad , Anciano , Fibrilación Atrial/epidemiología , Constricción , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Riesgo , Factores Sexuales
5.
J Card Surg ; 28(3): 238-47, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23578196

RESUMEN

BACKGROUND: Fibrin sealants are used for hemostasis and tissue adherence. AIM OF STUDY: This systematic review summarizes published clinical data for fibrin sealant use in cardiovascular surgery. METHODS: A literature search for the following terms was conducted using PubMed and EMBASE: (TISSEEL or Tissucol or Beriplast P or Evicel or Quixil or Crosseal or Reliseal or Fibringluraas or Bolheal or Tachosil or Vivostat or Vitagel or Artiss or "fibrin glue" or "fibrin sealant" or "fibrin tissue adhesive") and (cardiac or cardiovascular or vascular or heart or coronary or surgery). Case reports and series were excluded; although reports of controlled trials were preferred, uncontrolled trial data were also considered. RESULTS: Clinical trials and chart review analyses of fibrin sealants were identified and summarized. Although clinical trial data were available for other agents, the majority of published studies examined TISSEEL. Overall, TISSEEL and other fibrin sealants showed improvements over standard of care or control groups for a variety of predefined endpoints. Safety findings are also summarized. CONCLUSIONS: Data from these studies showed that fibrin sealants were well tolerated and provided effective hemostasis in a range of cardiac and aortic surgeries.


Asunto(s)
Enfermedades Cardiovasculares/cirugía , Adhesivo de Tejido de Fibrina/administración & dosificación , Método Doble Ciego , Humanos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto
7.
J Card Surg ; 27(3): 371-3, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22500618

RESUMEN

We report an extremely rare complication of a delayed aorto-pulmonary artery wall disruption with false aneurysm formation after repair of acute type-A aortic dissection with BioGlue®. The potential role of BioGlue® in this complication is the subject of this report.


Asunto(s)
Aneurisma Falso/etiología , Aorta/patología , Rotura de la Aorta/cirugía , Implantación de Prótesis Vascular/instrumentación , Proteínas/efectos adversos , Arteria Pulmonar/patología , Adhesivos Tisulares/efectos adversos , Anciano , Aneurisma Falso/cirugía , Aorta/cirugía , Resultado Fatal , Femenino , Humanos , Arteria Pulmonar/cirugía
11.
Ann Thorac Surg ; 83(5): 1906-7, 2007 May.
Artículo en Inglés | MEDLINE | ID: mdl-17462437

RESUMEN

Repair of an aortic root aneurysm using a composite graft is sometimes complicated by proximal suture line bleeding, which may be very difficult to control. We adopted a previously described technique of "double overlap" sutures on the annulus and the prosthetic cuff, which has virtually eliminated this complication.


Asunto(s)
Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/métodos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Técnicas de Sutura , Humanos
14.
J Am Soc Echocardiogr ; 15(3): 267-70, 2002 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11875392

RESUMEN

A membranous structure causing functional stenosis at the mouth of the left atrial appendage (LAA) has been reported. In this study we describe the presence of nonobstructive membranes traversing the cavity of the LAA found incidentally on transesophageal echocardiography (TEE).


Asunto(s)
Apéndice Atrial/anatomía & histología , Apéndice Atrial/diagnóstico por imagen , Anciano , Ecocardiografía Transesofágica , Femenino , Humanos , Masculino , Membranas/anatomía & histología , Membranas/diagnóstico por imagen , Persona de Mediana Edad
15.
Echocardiography ; 15(4): 405-408, 1998 May.
Artículo en Inglés | MEDLINE | ID: mdl-11175057

RESUMEN

This case illustrates the complementary use of transthoracic echocardiography and transesophageal echocardiography in the diagnosis of partial anomalous pulmonary venous connection. The transthoracic echocardiogram suggested the presence of anomalous pulmonary venous return by demonstrating right heart volume overload and evidence of an intact atrial septum. Transesophageal echocardiography was required to confirm these findings and provide a firm anatomic diagnosis before surgery. This case also emphasizes that a high degree of clinical suspicion for this condition should occur in situations in which apparent right heart volume overload is otherwise unexplained.

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