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Minimally Invasive Atrial Ablation Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Weimar et al. reported a larger study of 89 patients with paroxysmal (35%), persistent (24%) or long-standing persistent (42%) AF undergoing the Dallas epicardial lesion set. The mean hospital length of stay was 8 days. One patient required conversion to extracorporeal circulation. Freedom from AF and antiarrhythmic drug therapy was 71%, 82% and 90% at 6, 12 and 24 months, respectively, with no difference in those with paroxysmal or persistent AF. However, 5% of patients required subsequent catheter ablation for recurrent AF or atrial flutter [35].
Direct Myocardial Revascularization Sequential Grafting Techniques
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
The operative risk correlates with the time of extracorporeal circulation. It is related to the damage produced at the myocardial level, mainly the subendocardial zone, by the combination of fibrillation and anoxia.
Venous and lymphatic disease: A historical review
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Christine M. Dubberke, Ruth L. Bush
On April 18, 1961, Denton Cooley (Figure 1.8) from Houston, Texas, accomplished the first pulmonary embolectomy under extracorporeal circulation in a 37-year-old woman recovering from abdominal hysterectomy.2 However, even with extracorporeal circulation, there continued to be a tremendous risk of mortality secondary to fatal intraoperative embolisms and high rates of rethrombosis.8,21 It remained a measure of last resort reserved only for massive, acute PEs or chronic, recurrent PEs resulting in large thrombi wedged in the pulmonary arteries and causing severe pulmonary hypertension.2 A few years later, in 1969, Dr. Lazar Greenfield suggested a less invasive method of pulmonary embolectomy using a catheter introduced into the femoral vein under fluoroscopic guidance. This technique, known as transvenous catheter embolectomy or thrombo-fragmentation, was associated with a 25% mortality rate and similar indications as open pulmonary embolectomy.2
Streptococcus agalactiae infective endocarditis: analysis of eight surgical cases from a single centre
Published in Infectious Diseases, 2021
Vincent Tchana-Sato, Gregory Hans, Frederic Frippiat, Ines Zekhnini, Raluca Dulgheru, Samuel Bruls, Rodolphe Durieux, Jean Paul Lavigne, Jean Olivier Defraigne
All patients underwent surgery in addition to medical treatment because of heart failure and septic shock (two patients), cerebral emboli and uncontrolled infection (two patients), or uncontrolled infection despite an appropriate antibiotic therapy (four patients). The mean time between diagnosis and surgery was 10.5 days (range, 2–27 days) for the whole cohort and 9 days (range, 2–27) for patients with left-sided IE. One patient was transferred to our centre after being treated conservatively with antibiotics for three weeks in another centre. The mean Euroscore II was 15.7 (range, 1.0–70.9) and the mean Risk-E score for patients with left-sided IE was 17.05 (range, 3.36–36.8). An aortic root reconstruction with a cryopreserved homograft was performed in three patients who presented local annular abscess extending to the aorto-mitral curtain. The other procedures included, two AV replacement with a mechanical prosthesis, one mitral valve (MV) replacement with a mechanical prosthesis, one double AV and MV replacement with mechanical prosthesis, and one pacemaker leads extraction followed by ablation of right atrial and tricuspid valve vegetations. The mean extracorporeal circulation time was 148.13 min (range, 47–309 min), while the mean cross-clamp time was 120.71 min (range, 70–223 min). The mean intensive care unit (ICU) length of stay (LOS) was 6.14 days (range, 2–13 days), while the mean hospital LOS was 40.4 days (range, 14–65 days).
Thromboembolic Risk of C1 Esterase Inhibitors: A Systematic Review on Current Evidence
Published in Expert Review of Clinical Pharmacology, 2020
Kevin Burnham, Justin P. Reinert
In the assessment of thrombotic events associated with C1-INHs, studies included in this review demonstrated that the risk of thromboembolism is low. The systematic search criteria particularly selected for articles that included a discussion about thromboembolic risk with C1-INHs, and therefore excluded many studies where no TEEs occurred. Underlying risk factors make it difficult to determine if C1-INH use has a causal link to the events. Certain risk factors are more compelling than others and may aid in deciding if a patient should avoid using these agents. The risk factors that were discussed in the reviewed studies included all of the risk factors found in the C1-INHs package inserts. Other risk factors were also mentioned, such as extracorporeal circulation and venous compression. Patients with multiple baseline risk factors were shown to tolerate these agents without complications. Some studies did not provide enough details regarding dosing or information to assess the impact of patient risk factors in those experiencing a TEE.
Preoperative oral methadone for postoperative pain in patients undergoing cardiac surgery: A randomized double-blind placebo-controlled pilot
Published in Canadian Journal of Pain, 2019
Timothy M. Bolton, Sarah O. Chomicki, William P. McKay, D. Ryan Pikaluk, Jeffrey G. Betcher, John C. Tsang
An obvious limitation of our study is its small size; despite this, the data showed a reduction of morphine consumption postoperatively. A second limitation is that high-risk patients and opioid-tolerant patients were excluded from enrollment. It is unclear what effect preoperative oral methadone would have in this group; however, one could speculate that it might show a similar benefit. Due to our small sample size, we only captured two patients with chronic pain and, due to randomization, they both received placebo; however, they did not use significantly more morphine than other patients in the placebo group and therefore did not skew the results. Extracorporeal circulation was used for every patient undergoing coronary artery bypass grafting. Although we know that initiation of cardiopulmonary bypass decreases the plasma concentration of other lipophilic opioids, such as fentanyl (by 53%) and sufentanil (by 34%), separation from cardiopulmonary bypass returns these sequestered narcotics into the systemic circulation of the patient30–32; however, formal pharmacokinetic studies of methadone for comparison are unpublished.