| 1. |
- Svedjeholm, Rolf, 1952-, et al.
(författare)
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Post-infarct left ventricular free wall rupture and ventricular septal defect managed by pericardial aspiration during transport to referral hospital
- 2003
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - 1569-9293 .- 1569-9285. ; 2:2, s. 193-195
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Tidskriftsartikel (refereegranskat)abstract
- Although left ventricular free wall rupture is a comparatively common cause of death in acute myocardial infarction survival is infrequently reported. However, even in cases where surgical expertise is not immediately available the condition can be temporarily controlled by judicious pericardial aspiration and blood transfusion until definitive repair can be undertaken. Here we report the successful management of a patient sustaining combined left ventricular free wall rupture and ventricular septal rupture in a community hospital 130 km from the referral center.
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| 2. |
- Åberg, Torkel, et al.
(författare)
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Improved total quality by monitoring of a cardiothoracic unit. Medical, administrative and economic data followed for 9 years.
- 2004
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press. - 1569-9293 .- 1569-9285. ; 3:1, s. 33-40
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Tidskriftsartikel (refereegranskat)abstract
- To describe monitoring of a cardio-thoracic department from a total quality aspect point of view and to follow the development over 9 years. During the time period 1994-2002 a total of 10,828 cardio-thoracic operations were performed. Capacity, demographic, risk, quality, outcome and economic data were prospectively collected in various registries and analysed. Mean (and median) age increased from 64.2 to 65.3 (66-67). Patients above 70 years increased from 33.6 to 38.7% and above 80 from 2.9 to 5.5%. Operative mortality was unchanged over the time periods at slightly over 2%, with 1-year mortality 6-7%. Mortality for primary, elective coronary artery bypass grafting was 0.26% during the last 3 years. The rate of postoperative complications remained unchanged or decreased with few exceptions: Patients with postoperative confusion increased from 5.0 to 8.1% and patients with a need for face mask ventilation increased from 2.4 to 4.0%. Mean postoperative ventilation time was unchanged at around 22 h, whereas the median decreased from 9.5 to 5.3 h. The workload created by elderly patients was especially noticeable in the intensive care unit (ICU) as both number of postoperative deviations and ICU hours increased as a function of age. Cost per operation decreased by 11%. Total medical rationalisation was higher as salaries increased over time. Mean length of stay decreased by 3 days. Hospital staff hours per operation decreased whereas hospital staff hours per patient hour increased. Physician cost per operation was unchanged. Patient, staff and referring physician satisfaction was high. Several areas for improvement have been found. Monitoring and general feedback of total quality factors has shown itself a powerful tool to detect and follow large and subtle changes in the practice of cardio-thoracic surgery. Most followed factors show improvement in spite of an increase in mean and median age. Several areas may be defined where further development might decrease the trauma to the patient. Aiming at a total quality and patient safety system, monitoring is an essential prerequisite.
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| 3. |
- Ahlsson, Anders, 1962-, et al.
(författare)
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Adenosine in cold blood cardioplegia : a placebo-controlled study
- 2012
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - Oxford, United Kingdom : Oxford University Press. - 1569-9293 .- 1569-9285. ; 14:1, s. 48-55
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Adenosine as an additive in blood cardioplegia is cardioprotective in animal studies, but its clinical role in myocardial protection remains controversial. The aim of this study was to investigate whether the addition of adenosine in continuous cold blood cardioplegia would enhance myocardial protection.Methods: In a prospective double-blind study comparing adenosine 400 μmol l(-1) to placebo in continuous cold blood cardioplegia, 80 patients undergoing isolated aortic valve replacement were randomized into four groups: antegrade cardioplegia with adenosine (n = 19), antegrade cardioplegia with placebo (n = 21), retrograde cardioplegia with adenosine (n = 21) and retrograde cardioplegia with placebo (n = 19). Myocardial arteriovenous differences in oxygen and lactate were measured before, during and after aortic occlusion. Myocardial concentrations of adenine nucleotides and lactate were determined from left ventricular biopsies obtained before aortic occlusion, after bolus cardioplegia, at 60 min of aortic occlusion and at 20 min after aortic occlusion. Plasma creatine kinase (CK-MB) and troponin T were measured at 1, 3, 6, 9, 12 and 24 h after aortic occlusion. Haemodynamic profiles were obtained before surgery and 1, 8 and 24 h after cardiopulmonary bypass. Repeated-measures analysis of variance was used for significance testing.Results: Adenosine had no effects on myocardial metabolism of oxygen, lactate and adenine nucleotides, postoperative enzyme release or haemodynamic performance. When compared with the antegrade groups, the retrograde groups showed higher myocardial oxygen uptake (17.3 ± 11.4 versus 2.5 ± 3.6 ml l(-1) at 60 min of aortic occlusion, P < 0.001) and lactate accumulation (43.1 ± 20.7 versus 36.3 ± 23.0 µmol g(-1) at 60 min of aortic occlusion, P = 0.052) in the myocardium during aortic occlusion, and lower postoperative left ventricular stroke work index (27.2 ± 8.4 versus 30.1 ± 7.9 g m m(-2), P = 0.034).Conclusions: Adenosine 400 μmol l(-1) in cold blood cardioplegia showed no cardioprotective effects on the parameters studied. Myocardial ischaemia was more pronounced in patients receiving retrograde cardioplegia.
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| 4. |
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| 5. |
- Ahlsson, Anders, 1962-, et al.
(författare)
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Positioning of the ablation catheter in total endoscopic ablation
- 2014
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press. - 1569-9293 .- 1569-9285. ; 18:1, s. 125-127
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Tidskriftsartikel (refereegranskat)abstract
- Minimally invasive ablation of atrial fibrillation is an option in patients not suitable for or refractory to catheter ablation. Total endoscopic ablation can be performed via a monolateral approach, whereby a left atrial box lesion is created. If the ablation is introduced from the right side, the positioning of the ablation catheter on the partly hidden left pulmonary veins is of vital importance. Using thoracoscopy in combination with multiplane transoesophageal echocardiography, the anatomical position of the ablation catheter can be established. Our experience in over 60 procedures has confirmed this to be a safe technique of total endoscopic ablation.
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| 6. |
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| 7. |
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| 8. |
- Albåge, Anders, et al.
(författare)
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The Berglin apical stitch : a simple technique to straighten things out in atrial fibrillation surgery
- 2014
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 19:4, s. 685-686
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Tidskriftsartikel (refereegranskat)abstract
- In the Cox-Maze IV procedure, or in endocardial left atrial ablation, correct positioning of the surgical ablation probe within the left atrium might be difficult due to bulging or folds in the posterior left atrial wall. The Berglin apical stitch is a simple trick of the trade to create a smooth surface in the posterior left atrium that facilitates performing a safe transmural lesion and, consequently, may increase antiarrhythmic efficiency.
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| 9. |
- Andersson, Bodil, et al.
(författare)
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Gastrointestinal complications after cardiac surgery - improved risk stratification using a new scoring model.
- 2010
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 10:3, s. 366-370
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Tidskriftsartikel (refereegranskat)abstract
- Gastrointestinal (GI) complications are serious consequences of cardiac surgery. The aim of this study was to develop, evaluate and validate a new risk score model for GI complications after cardiac surgery. The risk score model, named gastrointestinal complication score (GICS), was developed using prospectively collected data from 5593 patients who underwent 5636 cardiac surgical procedures between 1996 and 2001. The model was validated on 1031 cardiac surgery patients between 2005 and 2006. The scoring system's ability to predict GI complications was estimated by receiver operating characteristic (ROC)-curves and Hosmer-Lemeshow test. Fifty GI complications were identified in 47 patients (0.8%) in the developmental data set and eight (0.8%) in the validation data set. The ROC area in the developmental data set was 0.81 with a good calibration estimated by Hosmer-Lemeshow test (p=0.89). In the validation data set, the area under the curve was 0.83. The estimated probability for the patient to develop a GI complication after cardiac surgery at a GICS >/=15 is >20% and at a GICS
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| 10. |
- Avdikos, Vasileios, et al.
(författare)
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Outcomes following surgical repair of absent pulmonary valve syndrome : 30 years of experience from a Swedish tertiary referral centre
- 2022
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 35:2
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Tidskriftsartikel (refereegranskat)abstract
- Surgical approach with reduction pulmonary artery plasty and valved conduit in patients with respiratory compromise prior to repair is associated with excellent long-term survival at the cost of a higher reintervention rate. OBJECTIVES: Absent pulmonary valve syndrome is a rare congenital heart defect with pulmonary artery dilatation and secondary airway compression. Although preoperative respiratory support and early surgical repair with pulmonary arterioplasty are often required in patients with airway compromise, the need for extensive plasty in these patients and for plasty in general in those with no or mild respiratory issues remains debatable. METHODS: We performed a retrospective survey of patients with this diagnosis and repair from 1988 to 2018. RESULTS: Twenty patients were identified. The median age and weight at repair were 0.8 (0.1-2.4) years and 7.0 (2.5-13.8) kg and included a valved conduit in 17 (85%) patients and a transannular patch in 3 patients. Five (29%) patients were ventilator-dependent prior to repair at the age of 0.3 (0.1-0.4) years. Pulmonary arterioplasty was performed in 7 patients (35%), including all 5 with ventilator dependency and 2 with respiratory symptoms due to recurrent infections. Two patients (10%) with preoperative ventilator dependency underwent extensive intrahilar arterioplasty. Preoperative ventilator dependency was associated with earlier repair and reinterventions (P < 0.05). There were 3 late deaths among cases with repair after 2000 (n = 14), none with preoperative ventilator dependency. CONCLUSIONS: The long-term outcomes of patients with this rare defect are good, comparable to those of other previous studies. Reduction pulmonary arterioplasty, which in this study was used only in patients with respiratory distress and ventilator dependency, is associated with excellent survival. Reinterventions are common in these patients.
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| 11. |
- Axelsson, Ida, et al.
(författare)
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Does microbiological contamination of homografts prior to decontamination affect the outcome after right ventricular outflow tract reconstruction?
- 2021
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 33:4, s. 605-613
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Homografts are often in short supply. Today, European guidelines recommend that all tissues contaminated by any of 18 different bacteria and fungi be discarded before antibiotic decontamination has been conducted. The tissue bank in Lund uses more liberal protocols: It accepts all microbes prior to decontamination except multiresistant microbes and Pseudomonas species. The aim of this study was to analyse the effect of contamination on the long-term outcome and occurrence of endocarditis in recipients. METHODS: Data were collected on homografts and on recipients of homografts in the right ventricular (RV) outflow tract who were operated on between 1995 and 2018 in Lund. The long-term outcome of recipients was analysed in relation to different types of contamination using Cox proportional hazard regression. The proportion of patients with endocarditis was analysed with the χ2 test. RESULTS: The study included 509 implanted homografts. Follow-up was a maximum of 24 years and 99% complete. A total of 156 (31%) homografts were contaminated prior to antibiotic decontamination. Homografts contaminated with low-risk microbes had the lowest reintervention rate, but there was no significant difference compared to no contamination [hazard ratio (HR) 1.1, 95% confidence interval (CI) 0.73-1.7] or contamination with high-risk microbes (HR 1.6, 95% CI 0.87-2.8) in the multivariable analysis. There was no significant difference in the proportion of cases of endocarditis during the follow-up period between recipients of homografts contaminated prior to decontamination and recipients of homografts with no contamination (P = 0.83). CONCLUSIONS: Contamination of homograft tissue prior to decontamination did not show any significant effect on the long-term outcome or the occurrence of endocarditis after implantation in the RV outflow tract. Most contaminated homografts can be used safely after approved decontamination.
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| 12. |
- Bjursten, Henrik, et al.
(författare)
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Circulating particles during cardiac surgery.
- 2009
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293.
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Tidskriftsartikel (refereegranskat)abstract
- Shed blood is known to be a source of lipid micro-emboli in cardiac surgery. The aim of this study was to characterize the occurrence of these particles at different stages of the operation, and to study their occurrence in the circulation at multiple time-points after the retransfusion of shed blood. 44 patients undergoing routine surgery with cardiopulmonary bypass were included. Blood was sampled from the surgical field at different sampling locations during the operation. Shed blood was collected in a transfusion bag and retransfused. After which, blood was sampled from the arterial line of the heart-lung machine. A Coulter counter was used for particle determinion. The mean volume of shed blood collected was 340+/-215 ml. Particles in the size range 10-60 microm were found at varying concentrations, with the highest concentrations being found in blood collected after cannulation and from the pleura. After retransfusion of this blood, a biphasic response was seen in the blood drawn from the efferent line of the heart-lung machine. Particles are found in shed blood at all times during cardiac surgery, and when this blood was retransfused an increase was seen in particle concentration in the heart-lung machine. Keywords: Particles; Lipid particles; Circulation; Shed mediastinal blood.
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| 13. |
- Bjursten, Henrik, et al.
(författare)
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Giant aneurysm in the sinus of Valsalva presenting as an acute coronary symptom.
- 2013
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 17:1, s. 193-195
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Tidskriftsartikel (refereegranskat)abstract
- We describe an 85-year old male who was admitted to the hospital with acute coronary symptoms. Bedside echocardiography revealed a structure in the aortic root, and a computed tomography scan verified the diagnosis of an aneurysm in the sinus of Valsalva below the left coronary ostium. A coronary angiography also depicted the aneurysm clearly and clearly showed how the aneurysm compressed and dislocated the left main coronary artery, explaining his initial symptoms. The patient was operated on with an aortic root replacement procedure, and recovered quickly.
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| 14. |
- Bjursten, Henrik, et al.
(författare)
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Once after a full moon : acute type A aortic dissection and lunar phases
- 2022
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press. - 1569-9293 .- 1569-9285. ; 34:1, s. 105-110
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Acute type A aortic dissection (ATAAD) is a rare but severe condition, routinely treated with emergent cardiac surgery. Many surgeons have the notion that patients with ATAAD tend to come in clusters, but no studies have examined these observations. This investigation was undertaken to study the potential association between the lunar cycle and the incidence of ATAAD.METHODS: We collected information on 2995 patients who underwent ATAAD surgery at centres from the Nordic Consortium for Acute Type A Aortic Dissection collaboration. We cross-referenced the time of surgery with lunar phase using a case-crossover design with 2 different definitions of full moon (>99% illumination and the 7-day full moon period).RESULTS: The period when the moon was illuminated the most (99% definition) did not show any significant increase in incidence for ATAAD surgery. However, when the full moon period was compared with all other moon phases, it yielded a relative risk of 1.08 [95% confidence interval (CI) 1.00-1.17, P = 0.057] and, compared to waxing moon, only the relative risk was 1.11 (95% CI 1.01-1.23, P = 0.027). The peak incidence came 4-6 days after the moon was fully illuminated.CONCLUSIONS: This study found an overrepresentation of surgery for ATAAD during the full moon phase. The explanation for this is not known, but we speculate that sleep deprivation during full moon leads to a temporary increase in blood pressure, which in turn could trigger rupture of the aortic wall. While this finding is interesting, it needs to be corroborated and the clinical implications are debateable.
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| 15. |
- Björklund, Erik, et al.
(författare)
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Postoperative platelet function is associated with severe bleeding in ticagrelor-treated patients
- 2019
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 28:5, s. 709-715
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Preoperative testing of platelet function predicts bleeding risk in cardiac surgery patients treated with dual antiplatelet therapy, but the value of postoperative platelet function testing, reflecting both preoperative antiplatelet therapy and perioperative changes in platelet function, has not been evaluated. Methods: Seventy-four patients with acute coronary syndrome treated with acetylsalicylic acid and ticagrelor within 5 days before cardiac surgery were included in a prospective observational study. Platelet aggregation induced by adenosine diphosphate, arachidonic acid and thrombin receptor-activating peptide was assessed with multiple electrode impedance aggregometry immediately before surgery and 2 h after weaning off cardiopulmonary bypass. Receiver operating characteristic curves were used to determine any association between platelet aggregation and severe bleeding according to the universal definition of perioperative bleeding in adult cardiac surgery. Results: Severe bleeding occurred in 25 of 74 patients (34%). Preoperative and postoperative adenosine diphosphate-induced platelet aggregations were associated with bleeding, with comparable areas under the receiver operating characteristic curve [0.77 (95% confidence interval 0.65-0.89) vs 0.75 (0.62-0.87)]. Postoperative arachidonic acid-and thrombin receptor-activating peptide-induced aggregation had markedly smaller areas under the curve. There were significant correlations between preoperative and postoperative platelet aggregation induced by adenosine diphosphate (r2 = 0.77, P < 0.001), arachidonic acid (r2 = 0.24, P < 0.001) and thrombin receptoractivating peptide (r2 = 0.21, P < 0.001) but with large interindividual variations. Conclusions: Poor postoperative platelet function was associated with severe bleeding, with accuracy comparable to that of preoperative platelet function. There was a correlation between preoperative and postoperative platelet function, but the predictability in an individual patient was limited. © 2018 The Author(s). Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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| 16. |
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| 17. |
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| 18. |
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| 19. |
- Brynjarsdottir, H. B., et al.
(författare)
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Long-term outcome of surgical revascularization in patients with reduced left ventricular ejection fraction-a population-based cohort study
- 2022
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 35:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Surgical revascularization is an established indication for patients with advanced coronary artery disease and reduced left ventricular ejection fraction (LVEF). Long-term outcomes for these patients are not well-defined. We studied the long-term outcomes of patients with ischaemic cardiomyopathy who underwent surgical revascularization in a well-defined nationwide cohort. MATERIALS AND METHODS: A retrospective study on 2005 patients that underwent isolated coronary artery bypass grafting in Iceland between 2000 and 2016. Patients were categorized into two groups based on their preoperative LVEF; LVEF ≤35% (n=146, median LVEF 30%) and LVEF >35% (n=1859, median LVEF 60%). Demographics and major adverse cardiac and cerebrovascular events were compared between groups along with cardiac-specific and overall survival. The median follow-up was 7.6years. RESULTS: Demographics were similar in both groups regarding age, gender and most cardiovascular risk factors. However, patients with LVEF ≤35% more often had diabetes, renal insufficiency, chronic obstructive pulmonary disease and a previous history of myocardial infarction. Thirty-day mortality was 4 times higher (8% vs 2%, P<0.001) in the LVEF ≤35%-group compared to controls. Overall survival was significantly lower in the LVEF ≤35%-group compared to controls, at 1 year (87% vs. 98%, P < 0.001) and 5 years (69% vs. 91%, P < 0.001). In multivariable analysis LVEF ≤35% was linked to inferior survival with an adjusted hazard ratio of 2.0 (95%-CI 1.5 - 2.6, p<0.001). CONCLUSIONS: A good long-term outcome after coronary artery bypass grafting can be expected for patients with reduced LVEF, however, their survival is still significantly inferior to patients with normal ventricular function. © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
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| 20. |
- Dahlin, Lars-Göran, 1956-, et al.
(författare)
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A multimodal approach for reducing wound infections after sternotomy
- 2004
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 3:1, s. 206-210
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Tidskriftsartikel (refereegranskat)abstract
- As previous efforts failed to reduce infection rates after cardiac surgery at our institution, we developed a concept based on adjustment of surgical technique. This concept was then evaluated in clinical practice. We modified our surgical technique towards: minimizing contamination, avoidance of devitalizing tissue, and securing a rigid fixation of the caudal part of sternum. After a pilot series sequential series was compared before and after introduction of the modified technique in a case-series design. All surgical site infections were recorded at discharge, after 6 weeks and by the attending cardiologist at 2 and 6 months. In the pilot series 9/136 patients developed sternal wound infections (SWI) compared with 15/89 patients in the control group (P=0.015). In the larger study population we found a significant drop in the total number of SWIs (72/772 vs 124/772, P≪0.0001). Although not statistically significant a 32% reduction in deep SWIs was observed. No reduction in infections at harvest sites for graft material was seen. The preliminary results from the pilot study appear reproducible and we were able to reduce the incidence of SWIs significantly, using this simple modified surgical technique.
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| 21. |
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| 22. |
- Danielsson, Eric, et al.
(författare)
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Generalized ischaemia in type A aortic dissections predicts early surgical outcomes only.
- 2015
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 21:5, s. 583-589
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Tidskriftsartikel (refereegranskat)abstract
- In patients with acute type A aortic dissection (aTAAD), early post-surgical outcomes are largely influenced by preoperative conditions, specifically localized or generalized ischaemia. Such states are reflected in the recent Penn classification. Our aim was to determine the impact of preoperative ischaemia (by Penn class) on in-hospital and long-term mortality.
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| 23. |
- Dimberg, Axel, et al.
(författare)
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Re-exploration for bleeding associated with increased incidence of the need for reintervention after coronary artery bypass graft surgery
- 2019
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 28:2, s. 214-221
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Re-exploration for bleeding after cardiac surgery increases the risk of other severe postoperative complications and early mortality. Patients re-explored for bleeding after coronary artery bypass grafting are potentially subject to threats to graft patency. Our goal was to assess the effects of re-exploration for bleeding regarding the incidence of coronary angiographies, the need for coronary reintervention and mortality during long-term follow-up.METHODS: Within the SWEDEHEART registry, all isolated coronary artery bypass operations with a single internal mammary artery and saphenous vein graft in patients aged 40-80 between the years 2005 and 2015 were identified. Incidences of coronary angiography and the subsequent need for coronary reintervention were recorded, and multivariable adjusted hazard ratios (HRs) were calculated.RESULTS: The study cohort consisted of 27 957 patients, and the mean follow-up time was 6.5 ± 3.1 years. The incidence of re-exploration for bleeding was 3.8% (n = 1071). The cumulative incidence [95% confidence interval (CI)] of a clinically occurring coronary angiography within 1 year after surgery was 7.8% (6.3-9.7) in re-explored and 4.8% (4.6-5.1) in non-re-explored patients, and the adjusted HR was 1.64 (1.31-2.06), (P < 0.001). The cumulative incidence of the need for coronary reintervention within 1 year (95% CI) was 4.9% (3.7-6.4) in re-explored and 2.6% (2.4-2.8) in non-re-explored patients, and the adjusted HR was 1.91 (1.43-2.56). No difference in incidence or hazard ratio was observed beyond the first year. Mortality rate was increased within but not beyond 90 days after surgery.CONCLUSIONS: Re-exploration for bleeding is associated with an increased risk for the need of repeat coronary reintervention during the first year after coronary artery bypass surgery.
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| 24. |
- D'Oria, Mario, et al.
(författare)
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Narrative review on endovascular techniques for left subclavian artery revascularization during thoracic endovascular aortic repair and risk factors for postoperative stroke
- 2021
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 32:5, s. 764-772
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVESThe aim of this study was to present a narrative review on endovascular techniques (ET) for revascularization of the left subclavian artery (LSA) during zone 2 thoracic endovascular aortic repair (TEVAR) and on risk factors for postoperative stroke following TEVAR procedures.METHODSNon-systematic search of the literature from the PubMed, Ovid and Scopus databases to identify relevant English-language articles fully published in the period 1 January 2010–1 August 2020.RESULTSCurrent general agreement is that LSA revascularization should be always attempted in the elective setting. Under urgent circumstances, it can be delayed but might be considered during the same session on a case-by-case basis. Three ET are currently available: (i) chimney/snorkels (also known as parallel grafts), (ii) fenestrations or branches and (iii) proximal scallops. The main issue with ET is the potential for increased peri-operative stroke risk owing to increased manipulation within the aortic arch. Also, they are relatively novel and further assessment of their long-term durability is needed. Intra-operative embolism and loss of left vertebral artery perfusion are hypothesized as the main causes of stroke in patients undergoing TEVAR.CONCLUSIONSThe overall risk of stroke seems higher without LSA revascularization during zone 2 TEVAR. As LSA revascularization might have a direct effect in preventing posterior stroke, it should be routinely performed in elective cases, while a case-by-case evaluation can be made under urgent circumstances. While ET can provide effective options for LSA revascularization during zone 2 TEVAR, they are novel and need further durability assessment. Stroke after TEVAR is a multifactorial pathological process and preventing TEVAR-related cerebral injury remains a significant unmet clinical need.
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| 25. |
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| 26. |
- Fakhro, Mohammed, et al.
(författare)
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25-year follow-up after lung transplantation at Lund University Hospital in Sweden : superior results obtained for patients with cystic fibrosis
- 2016
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 23:1, s. 65-73
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In Sweden, two centres perform lung transplantation for a population of about 9 million and the entire population is covered for lung transplantation by government health insurance. Lund University Hospital is one of these centres. This retrospective report reviews the 25-year experience of the Skåne University Hospital Lung Transplant Program with particular emphasis on short-term outcome and long-term survival but also between different subgroups of patients and types of transplant [single-lung transplantation (SLTx) versus double-lung transplantation (DLTx)] procedure performed.METHODS: Between January 1990 and June 2014, 278 patients underwent lung transplantation at the Skåne University Hospital Sweden. DLTx was performed in 172 patients, SLTx was performed in 97 patients and heart-lung transplantation was performed in 9 patients. In addition, 15 patients required retransplantation (7 DLTx and 8 SLTx).RESULTS: Overall 1-, 5-, 10-, 15- and 20-year survival rates were 88, 65, 49, 37 and 19% for the whole cohort. DLTx recipients showed 1-, 5-, 10- and 20-year survival rates of 90, 71, 60 and 30%, compared with SLTx recipients with 1-, 5-, 10- and 20-year survival rates of 83, 57, 34 and 6% (P < 0.05), respectively. Comparing the use of intraoperative extracorporeal membrane oxygenation, extracorporeal circulation (ECC) and no circulatory support in the aspect of survival, a significant difference in favour of intraoperative ECC was seen.CONCLUSIONS: Superior long-term survival rates were seen in recipients diagnosed with cystic fibrosis, α1-antitrypsin deficiency and pulmonary hypertension. DLTx showed better results compared with SLTx especially at 10 years post-transplant. In the present study, we present cumulative incidence rates of bronchiolitis obliterans syndrome of 15% at 5 years, 26% at 10 years and 32% at 20 years post-transplant; these figures are in line with the lowest rates presented internationally.
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| 27. |
- Fengsrud, Espen, 1970-, et al.
(författare)
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Total endoscopic ablation of patients with long-standing persistent atrial fibrillation : a randomized controlled study
- 2016
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - Oxford, United Kingdom : Oxford University Press. - 1569-9293 .- 1569-9285. ; 23:2, s. 292-298
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Total endoscopic ablation of atrial fibrillation is an alternative to catheter ablation, but its clinical role needs further evaluation. The aim of this study was to compare total endoscopic ablation with rate control in patients with long-standing persistent atrial fibrillation and to examine the effect of endoscopic ablation on heart rhythm, symptoms, physical working capacity and myocardial function during 1 year of follow-up.Methods: In a prospective controlled study, 36 patients aged >50 years with symptomatic long-standing persistent atrial fibrillation were randomized to either total endoscopic ablation (n = 17, after two drop-outs before ablation n = 15) or rate control therapy (n = 19). In the ablation group, a box lesion encircling the pulmonary veins was performed, using temperature-controlled radiofrequency energy. Loop recorders were implanted in all patients. Echocardiography and quality-of-life assessment were performed at 6 and 12 months, and physical working capacity assessment at 6 months.Results: There was no mortality or thromboembolic event. In the control group, all patients were in permanent atrial fibrillation during 12 months of follow-up. In the ablation group, the proportion of patients in sinus rhythm without antiarrhythmic drugs was 12/15 (80%) at 12 months. The median freedom of atrial fibrillation at 3-12 months was 95% in the ablation group and the proportion of patients with an atrial fibrillation burden of <5% at 3-12 months was 8/15 (53%). The left ventricular ejection fraction increased during follow-up in the ablation group compared with the control group (from 53.7 ± 8.6 to 58.8 ± 6.5%, P = 0.003), combined with a reduction in the left atrial area (from 29.2 ± 5.5 to 27.2 ± 6.3 cm(2), P = 0.002). The physical working capacity increased in the ablation group compared with the control group (from 94 ± 21.4 to 102.9 ± 14.4%, P = 0.011). The subjective physical and mental capacity scale also improved during follow-up in the ablation group, but not in the control group (P =0.003 and 0.018, respectively).Conclusions: Total endoscopic ablation in patients with long-standing persistent atrial fibrillation significantly reduced atrial fibrillation burden 12 months after intervention compared with controls. The left ventricular function, physical working capacity and subjective physical and mental health were improved. These results need to be confirmed in larger randomized trials.
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| 28. |
- Friberg, Örjan, et al.
(författare)
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Collagen-gentamicin implant for prevention of sternal wound infection : long-term follow-up of effectiveness
- 2009
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - Amsterdam : Elsevier. - 1569-9293 .- 1569-9285. ; 9:3, s. 454-458
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Tidskriftsartikel (refereegranskat)abstract
- In a previous randomized controlled trial (LOGIP trial) the addition of local collagen-gentamicin reduced the incidence of postoperative sternal wound infections (SWI) compared with intravenous prophylaxis only. Consequently, the technique with local gentamicin was introduced in clinical routine at the two participating centers. The aim of the present study was to re-evaluate the technique regarding the prophylactic effect against SWI and to detect potential shifts in causative microbiological agents over time. All patients in this prospective two-center study received prophylaxis with application of two collagen-gentamicin sponges between the sternal halves in addition to routine intravenous antibiotics. All patients were followed for 60 days postoperatively. From January 2007 to May 2008, 1359 patients were included. The 60-day incidences of any SWI was 3.7% and of deep SWI 1.5% (1.0% mediastinitis). Both superficial and deep SWI were significantly reduced compared with the previous control group (OR=0.34 for deep SWI, P<0.001). There was no increase in the absolute incidence of aminoglycoside resistant agents. The majority of SWI were caused by coagulase-negative staphylococci (CoNS). The incidence of deep SWI caused by Staphylococcus aureus was 0.07%. The results indicate a maintained effect of the prophylaxis over time without absolute increase in aminoglycoside resistance. (ClinicalTrials.gov NCT00484055).
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| 29. |
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| 30. |
- Haraldsen, Pernille, et al.
(författare)
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A porcine model for acute ischaemic right ventricular dysfunction.
- 2014
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 18:1, s. 43-48
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Tidskriftsartikel (refereegranskat)abstract
- To establish an experimental model for acute ischaemic isolated right ventricular dysfunction and the subsequent haemodynamic changes.
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| 31. |
- Hashemi, Nashmil, et al.
(författare)
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Improved right ventricular index of myocardial performance in the assessment of right ventricular function after coronary artery bypass grafting
- 2018
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press. - 1569-9293 .- 1569-9285. ; 26:5, s. 798-804
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Decreased right ventricular (RV) longitudinal function following coronary artery bypass grafting (CABG), as assessed by tricuspid annular systolic excursion (TAPSE) and RV peak systolic velocity (RVS') is a known condition. We aimed to explore the feasibility of the right ventricular index of myocardial performance (RIMP) in the assessment of RV function after CABG at rest and during peak dobutamine stress echocardiography (DSE). METHODS: Forty-two patients indicated for CABG were included in this study. Coronary angiography, DSE and exercise bicycle test were performed within 6 weeks before and 3 months after CABG. The RIMP, RVS' and TAPSE at the lateral tricuspid annulus were also assessed. The results were presented as mean +/- standard deviation. RESULTS: The RIMP improved after CABG both at rest (0.45 +/- 0.11 before vs 0.38 +/- 0.08 after CABG, P= 0.013) and during DSE (0.75 +/- 0.23 vs 0.49 +/- 0.14, P < 0.001). TAPSE declined significantly when comparing the values from before CABG to after CABG both at rest (23.9 +/- 4.46 vs 14.6 +/- 3.67, P < 0.001) and during DSE (20.9 +/- 4.16 vs 11.9 +/- 3.60, P < 0.001). RVS' also decreased after CABG both at rest (11.9 +/- 2.40 vs 8.5 +/- 1.93, P < 0.001) and during DSE (15.6 +/- 4.30 vs 10.5 +/- 3.21, P <0.001). On the other hand, exercise capacity improved after CABG compared with baseline (128.4 +/- 40.12 W vs 142.1 +/- 46.73 W, P = 0.014). CONCLUSIONS: RIMP improved after CABG both at rest and during DSE. The reduction in TAPSE and RVS' after CABG indicate reduced regional mechanical RV function along the long axis rather than reduced global RV function.
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| 32. |
- Ivert, T, et al.
(författare)
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Dismal outcome if delayed cardiac surgery because of coronavirus disease 2019
- 2022
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Ingår i: Interactive cardiovascular and thoracic surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 35:2
-
Tidskriftsartikel (refereegranskat)abstract
- The coronavirus disease 2019 (COVID-19) pandemic was a great burden for health care worldwide. We encountered 21 non-infected adult patients during 2020 who deferred to seek medical treatment since they thought that their difficulties to breathe were due to COVID-19. They were diagnosed late with cardiac disease with the indication for surgery. Deferred surgery for aortic stenosis was the cause of death in 1 patient. Long-standing not-treated endocarditis had caused severe aortic root pathology in 3 patients. Late-diagnosed ST-elevation myocardial infarction in 2 patients had caused papillary muscle and ventricular wall rupture. Eighteen of the patients finally underwent heart surgery at our tertiary care centre with early mortality of 22%. We conclude that late diagnosis of subjects requiring surgical treatment for heart disease was a risk for dismal outcomes during the COVID-19 pandemic.
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| 33. |
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| 34. |
- Janiec, Mikael, et al.
(författare)
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Long-term outcome after coronary endarterectomy adjunct to coronary artery bypass grafting
- 2019
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press. - 1569-9293 .- 1569-9285. ; 29:1, s. 22-27
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Coronary endarterectomy (CE) in coronary artery bypass grafting (CABG) is occasionally required to achieve revascularization in diffusely diseased vessels. Its beneficial effect has been questioned because of an increased risk of perioperative mortality and morbidity; however, its influence on the long-term outcome remains uncertain. The purpose of the study was to evaluate the impact of adjunct CE on the incidence of a first postoperative angiogram and the need for repeat intervention and on late deaths after CABG.METHODS: Two propensity-matched cohorts of patients undergoing CABG with CE (537 patients) and without adjunct CE (no CE) (537 patients) in Sweden over the period 2000-2015 were used to compare long-term outcomes. Mortality rates, postoperative incidence of coronary angiography and the need for reintervention were determined using the Kaplan-Meier method.RESULTS: The mean follow-up time (standard deviation) was 9.9 (4.6) years for CE and 10.0 (4.6) years for no CE. Overall survival, clinically driven angiography and coronary reintervention during follow-up (95% confidence interval) at 10 years were 65.8% (60.8-70.3), 28.2% (23.8-34.3) and 11.6% (8.7-15.3), respectively, for CE and 70.7% (65.9-74.9), 21.7% (17.8-26.3) and 12.7% (9.7-16.6), respectively, for no CE. There was a significant difference in the use of postoperative angiography between the 2 groups (P = 0.02).CONCLUSIONS: Although patients are subjected to an increased risk of repeat angiography, CE seems to be an acceptable treatment alternative in patients who have diffuse coronary artery disease that cannot be treated effectively by CABG alone.
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| 35. |
- Johansson, Mats, et al.
(författare)
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Arterial baroreflex dysfunction after coronary artery bypass grafting
- 2009
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - Oxford : Oxford University Press. - 1569-9293 .- 1569-9285. ; 8, s. 426-430
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Tidskriftsartikel (refereegranskat)abstract
- Although uncommon, the incidence of ventricular arrhythmia is high in certain subsets of patients after coronary artery bypass grafting. Arterial baroreflex dysfunction has been linked to increased risk of ventricular arrhythmia and sudden cardiac death. The aim of the current study was to explore arterial baroreflex function during the early recovery phase and up to five months after surgery. Electrocardiogram and beat-to-beat blood pressures were registered in patients (n=92) undergoing coronary artery bypass grafting five weeks and five months after surgery. Healthy subjects (n=31) were examined for comparison. The arterial baroreflex sensitivity and the baroreflex effectiveness index were calculated. The baroreflex sensitivity and the baroreflex effectiveness index were reduced by 36% and 64%, respectively (P<0.01 for both) in patients five weeks after coronary artery bypass grafting compared to healthy subjects (HS). Values increased during follow-up but the baroreflex effectiveness index remained reduced by 55% in patients compared to HS five months after cardiac surgery (P<0.01). Arterial baroreflex dysfunction prevails both early and long-term after coronary artery bypass grafting. Reduced modulation of cardiac parasympathetic nervous activity could contribute to the increased risk of ventricular arrhythmia observed during the early recovery phase after cardiac surgery.
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| 36. |
- Jonsson, Ove, et al.
(författare)
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Selective antegrade cerebral perfusion at two different temperatures compared to hypothermic circulatory arrest : an experimental study in the pig with microdialysis
- 2009
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 8:6, s. 647-653
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Tidskriftsartikel (refereegranskat)abstract
- Hypothermic arrest and selective antegrade cerebral perfusion (SACP) is widely used during aortic arch surgery. The microdialysis technique monitors biomarkers of cellular metabolism and cellular integrity over time. In this study, the cerebral changes during hypothermic circulatory arrest (HCA) at 20 degrees C and HCA with SACP at two different temperatures, 20 and 28 degrees C, were monitored. Twenty-three pigs were divided into three groups. A microdialysis probe was fixated into the forebrain. Circulatory arrest started at a brain and body temperature of 20 degrees C or 28 degrees C. Arrest with/without cerebral perfusion (flow 10 ml/kg, max carotid artery pressure 70 mmHg) lasted for 80 min followed by reperfusion and rewarming during 40 min and an observation period of 120 min. The microdialysis markers were registered at six time-points. The lactate/pyruvate ratio (L/P ratio) and the lactate/glucose ratio (L/G ratio) increased significantly (P<0.05), during arrest, in the HCA group. The largest increase of glycerol was found in the group with tepid cerebral perfusion (28 degrees C) and the HCA group (P<0.05). This study supports the use of SACP over arrest. It also suggests that cerebral metabolism and cellular membrane integrity may be better preserved with SACP at 20 degrees C compared to 28 degrees C.
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| 37. |
- Lindblom, Rickard P F, et al.
(författare)
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Even small aneurysms can bleed : a ruptured small idiopathic aneurysm of the internal thoracic artery
- 2013
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 17:3, s. 583-585
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Tidskriftsartikel (refereegranskat)abstract
- Internal thoracic artery (ITA) aneurysms are rare, but a rupture is potentially fatal. Most cases of ITA aneurysms are iatrogenic, caused by, for instance, previous sternotomy or pacemaker implantation. Other known aetiologies are vasculopathies, either of inflammatory origin or as part of connective tissue disorders like Marfan's syndrome, Ehler-Dahnlos syndrome or neurofibromatosis Type 1. Idiopathic ITA aneurysms are exceedingly scarce. The present case illustrates an unusual scenario, which posed diagnostic challenges, where spontaneous rupture of an idiopathic or possibly very late post-traumatic aneurysm of the left ITA led to a life-threatening bleeding, successfully treated by endovascular coiling with standby preparation for conversion to open surgery. This case demonstrates the importance of the careful interpretation of radiological findings and the significance of multidisciplinary collaboration between radiologist and clinician.
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| 38. |
- Lindqvist, Per, et al.
(författare)
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Aortic valve replacement normalizes left ventricular twist function
- 2011
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 12:5, s. 701-706
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess the effect of aortic valve replacement (AVR) on left ventricular (LV) twist function. We studied 28 severe aortic stenosis (AS) patients with normal LV ejection fraction (EF) before and six months after AVR. LV long axis function was assessed using M-mode and tissue Doppler and twist function using speckle tracking echocardiography. The data were compared with 28 age and sex-matched normal controls. In patients, LVEF remained unchanged after AVR. LV long axis function was reduced before surgery but normalized after AVR. LV twist was increased before (19.7 ± 5.7° vs. 12.9 ± 3.2°, P<0.001) and normalized after AVR (14.4 ± 5.2 °, P < 0.001). In normals, LV twist correlated with LV fractional shortening (r = 0.81, P<0.001) but not with EF. This relationship was reversed in patients before ( r= 0.52, P < 0.01) and after AVR (r = 0.34, P = ns). In patients with severe AS and normal EF, LV twist is exaggerated suggesting potential compensation for the reduced long axis function. These disturbances normalize within six months of AVR but lose their relationship with basal LV function.
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| 39. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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Comparative outcome of double lung transplantation using conventional donor lungs and non-acceptable donor lungs reconditioned ex vivo.
- 2010
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293.
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Tidskriftsartikel (refereegranskat)abstract
- A method to evaluate and recondition lungs ex vivo has been tested on donor lungs that have been rejected for transplantation. In the present paper, we compare early postoperative course between the six patients who received reconditioned lungs and the patients who received conventional donor lungs during the same period of time. During 2006 and 2007, a total of 21 patients underwent double sequential lung transplantation at the University Hospital of Lund. Six of those patients received reconditioned lungs. The other 15 patients received conventional donor lungs for transplantation without reconditioning ex vivo. The results are presented as median and interquartile range. Time in intensive care unit (days) between recipients of reconditioned lungs [13 (5-24) days], and recipients of conventional donor lungs [7 (5-12) days], P=0.44. Total hospital stay after transplantation (days) between recipients of reconditioned lungs [52 (47-60) days] and recipients of conventional donor lungs [44 (37-48) days], P=0.9. Ex vivo lung evaluation and reconditioning might not prolong early postoperative course in double lung transplantation. However, given the small number of patients, there might be a failure to detect a difference between the two groups. Keywords: Double lung transplantation; Reconditioned lungs; Clinical outcome.
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| 40. |
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| 41. |
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| 42. |
- Malmsjö, Malin, et al.
(författare)
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Effects of foam or gauze on sternum wound contraction, distension and heart and lung damage during negative pressure wound therapy of porcine sternotomy wounds.
- 2010
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293.
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Tidskriftsartikel (refereegranskat)abstract
- The study was performed to compare the effects of negative-pressure wound therapy (NPWT) using gauze and foam on wound edge movement and the macroscopic appearance of the heart and lungs after NPWT. Sternotomy wounds were created in 6 kg pigs. Negative pressures of -40, -70, -120 and -160 mmHg were applied and the following were evaluated: wound contraction, distension and the macroscopic appearance of the heart and lungs after NPWT. Wound contraction was greater when using foam than gauze (3.5±0.3 cm and 1.3±0.2 cm, respectively, P<0.01). The application of traction to the lateral edges of the sternotomy resulted in greater wound distention with foam than with gauze (5.3±0.3 cm and 3.6±0.2 cm, respectively, P<0.001). After using foam, the surface of the heart was red and mottled, and lung emphysema and sometimes, lung rupture were observed. After using gauze, the organ surface had no markings. The study shows that foam allows greater wound contraction and distension than gauze. This movement of the wound edges may cause damage to the underlying organs. There is less damage to the heart and lungs when using gauze than foam. Keywords: Animal model; Wound contraction; Experimental surgery; Heart rupture; Negative-pressure wound therapy; Sternotomy wound.
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| 43. |
- Nielsen, Niels Erik, et al.
(författare)
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Minimizing the risk for left ventricular rupture during transcatheter aortic valve implantation by reducing the presence of stiff guidewires in the ventricle
- 2019
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : OXFORD UNIV PRESS. - 1569-9293 .- 1569-9285. ; 29:3, s. 365-370
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The presence of a stiff guidewire in the apex of the left ventricle (LV) is a known risk factor for LV perforation. Our goal was to minimize the risk of LV rupture during transcatheter aortic valve implantation (TAVI) by omitting the interaction between the stiff guidewire and the LV apex using a modified procedure. METHODS: A TAVI protocol designed to allow minimal interaction between a stiff guidewire and the LV was developed in Linkoping University Hospital in Sweden. A total of 316 patients were treated exclusively by this approach between March 2014 and May 2018. RESULTS: All procedures were completed successfully. There were no cases (0%) of ventricular perforation. Only 1 patient (0.3%) had a pericardial effusion, and it was due to annulus rupture. There was 1 case of acute kidney injury (0.3%). Five patients (1.6%) required a new permanent pacemaker. Stroke occurred in 3 patients (0.9%). No patient had valve embolization. Vascular complications were experienced by 6 patients (1.9%). A mild paravalvular leak occurred in 27 (8.5%) patients. At 30 days post-TAVI, 6 patients (2%) had died. The mortality rate at 1 year was 8.6% (n = 20/232). CONCLUSIONS: Our series shows that TAVI without the prolonged use of a stiff guidewire in the LV apex is feasible. The risk of LV perforation is eliminated by this approach, and other procedural complications are limited.
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| 44. |
- Nilsson, Johan, et al.
(författare)
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A randomized study of coronary artery bypass surgery performed with the Resting Heart™ System utilizing a low vs a standard dosage of heparin.
- 2012
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 15:5, s. 834-839
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Allogeneic blood transfusion and reoperation for postoperative bleeding after the coronary artery bypass grafting have a negative impact on the patient outcome. This study aimed at evaluating the effects of reduced doses of heparin and protamine on the patient outcome, using a heparin-coated mini-cardiopulmonary bypass (CPB) system. METHODS: Sixty patients undergoing elective first-time CPB were prospectively randomized either to have a reduced systemic heparinization [activated clotting time (ACT) = 250 s] or to a control group perfused with a full heparin dose (ACT = 420 s). Blood transfusions, ventilation time, early postoperative bleeding, ICU stay, reoperations for bleeding, postoperative cognitive status and the level of mobilization were registered. RESULTS: Twenty-nine patients were randomized to the control group, 27 patients to the low-dose group and 4 patients were excluded because of protocol violations. Four patients in the control group received a total of 10 units of packed red blood cells, and in the low-dose group, no transfusions were given, P = 0.046. No patient was reoperated because of bleeding. The ICU stay was significantly shorter in the low-dose group (8.4 vs 13.7 h, P = 0.020), less dependent on oxygen on the first postoperative day (78 vs 97%, P = 0.034), better mobilized (89 vs 59%, P = 0.006) and had less pain (visual analogue scale 2.0 vs 3.5, P = 0.019) compared with the control group. CONCLUSIONS: The use of a mini-CPB system combined with a low dose of heparin reduced the need for blood transfusions and may facilitate the faster mobilization of the patients.
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| 45. |
- Norlander, Louise, 1990-, et al.
(författare)
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Health-related quality of life after Nuss procedure for pectus excavatum : a cross-sectional study
- 2022
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press. - 1569-9293 .- 1569-9285. ; 35:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Pectus excavatum (PE) can cause both physical and psychosocial symptoms and affect patients' health-related quality of life. Previous international studies have shown that the Nuss procedure increases both self-esteem and body image. The aim of the study was to evaluate the health-related quality of life in patients who have undergone the Nuss procedure for PE.METHODS: The study had a cross-sectional multicentre design. All patients (N = 420) who underwent the Nuss procedure for PE in 3 cardiothoracic departments in Sweden from 2000 to 2019 were invited to answer the RAND-36 and Nuss Questionnaire modified for adults. Genders were compared using the Mann-Whitney U-test. Patients were divided into groups based on age at time of surgery (<20, 20-30 or >30 years) and analysed by the Kruskal-Wallis H-test with post-hoc analyses.RESULTS: A total of 236 patients returned the questionnaires; 82.2% were males. Men scored significantly better on the modified Nuss Questionnaire total (P = 0.01) and psychosocial (P = 0.02) subscales. Patients who had surgery at <20 years of age had significantly better scores on the same scales (P = 0.007 and 0.006, respectively) compared to patients aged 20-30 years at the time of surgery. However, no significant difference was seen in comparison with patients >30 years. Patients who had their bar removed had significantly better values on both scales.CONCLUSIONS: Male gender, young age at surgery and bar removal seem to be associated with better health-related quality of life after the Nuss procedure for PE.
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| 46. |
- Nozohoor, Shahab, et al.
(författare)
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A case-controlled evaluation of the Medtronic Resting Heart System compared with conventional cardiopulmonary bypass in patients undergoing isolated coronary artery bypass surgery.
- 2012
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 14:5, s. 599-604
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Tidskriftsartikel (refereegranskat)abstract
- The Medtronic Resting Heart System (RHS) is a heparin-coated, closed perfusion circuit. Clinical results indicate less haemodilution and reduced complement activation, when compared with a traditional circuit leading to fewer postoperative blood transfusions. We evaluated the potential clinical benefits, including reduced transfusion requirements, when using the RHS compared with conventional cardiopulmonary bypass (cCPB). The study group (n = 330) consisted of patients undergoing isolated coronary artery bypass grafting (CABG) using the RHS system during 2005-2009, matched with a control group (n = 609) including patients operated for isolated CABG during 2002-2009, utilizing cCPB. Significantly fewer patients received peri- and postoperative blood transfusions in the RHS group (25 vs. 37%, P < 0.001; mean 1.0 ± 2.6 vs. mean 1.6 ± 2.9 units of packed red blood cells). The incidence of reoperations due to bleeding was low, RHS 2% (n = 8) vs. cCPB 5% (n = 29), with a trend towards no significant difference between groups (P = 0.079). The duration of mechanical ventilation was shorter (mean 7 ± 16 vs. 9 ± 12 h, P < 0.001) for patients in the RHS group. This study demonstrates that CABG performed with the RHS reduces the incidence and magnitude of allogenic blood transfusion and results in a satisfactory clinical outcome.
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| 47. |
- Olofsson, Cecilia Kjellberg, et al.
(författare)
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Treatment of valvular aortic stenosis in children: a 20-year experience in a single institution
- 2018
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9293 .- 1569-9285. ; 27:3, s. 410-416
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES This study presents short- and long-term follow-up after treatment for isolated valvular aortic stenosis in children with surgical valvotomy as the preferred 1st intervention. METHODS All patients aged 0–18years treated between 1994 and 2013 at our centre were reviewed regarding the mode of first treatment, mortality, reinterventions and the need for aortic valve replacement. RESULTS A total of 113 patients were identified in local registries. There were 44 neonates, 31 infants and 38 children. The mean follow-up period was 11years (range 2–22years). No early deaths and only 2 late deaths were reported. Of the 113 patients, 92 patients had open surgical valvotomy as the 1st intervention. Freedom from reintervention was 80%, 69%, 61%, 57% and 56% at 1, 5, 10, 15 and 20years, respectively. The main indication for reintervention was valvular stenosis. Freedom from aortic valve replacement was 67%. CONCLUSIONS Surgical valvotomy of aortic stenosis in this long-term follow-up study resulted in no 30-day mortality and <1% late mortality. Reinterventions were common, with 38% of the patients having further surgery or catheter treatment of the aortic valve before the age of 18years. Among the 40 patients aged 18years or older at follow-up, 45% had had the aortic valve replaced. Our data do not allow comparison of catheter and surgical treatment, but, based on these results, we find no reason to change our current policy of surgical treatment as 1st intervention in patients with isolated valvular aortic stenosis.
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| 48. |
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| 49. |
- Perrotta, Sossio, 1975, et al.
(författare)
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In patients undergoing surgical repair of post-infarction ventricular septal defect, does concomitant revascularization improve prognosis?
- 2009
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Ingår i: Interactive cardiovascular and thoracic surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 9:5, s. 879-87
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Tidskriftsartikel (refereegranskat)abstract
- A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients undergoing surgical repair of post-infarction ventricular septal defect (VSD), does concomitant revascularization improve prognosis?'. The scientific literature was reviewed by searching Medline, using Ovid interface, from 1950 to April 2009. Four hundred and five papers were found, of which 18 were deemed relevant to the topics. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers were tabulated. Seven out of 18 papers showed statistical evidence of benefit of concomitant coronary artery bypass grafting (CABG) in patients undergoing surgical repair of VSD. They showed a benefit especially with complete revascularization. Another five papers recommended CABG with VSD even in the absence of statistical evidence. The reported papers showed a mortality benefit from 26.3% without revascularization down to 21.2% with revascularization and an actuarial survival at five years from 29 up to 72%. However, six out of 18 papers did not find any difference. The largest study in this area was by Jeppsson et al. where 119 patients underwent VSD repair with revascularization and 70 underwent VSD repair only, the mortality was 38% vs. 46% (P=0.29). Barker et al. compared a group of 23 patients undergoing repair of VSD only and 42 patients undergoing concomitant CABG. The in-hospital mortality was 39.2% vs. 26.2%, and the four-year survival rate was 33.2% and 88.2%, respectively. Lundblad et al. found that in 66 patients undergoing concomitant CABG out of 102 undergoing repair of VSD, complete revascularization and revascularization of the culprit artery, both resulted in improved 30-day survival and long-term survival. Muehrcke et al. reported on 75 patients undergoing surgical repair of post-infarction VSD. Out of those, 33 (44%) had a concomitant CABG. The authors found that concomitant CABG increases long-term survival when compared with patients with unbypassed coronary artery disease (CAD) (P=0.0015). We conclude that patients undergoing concomitant CABG to all the stenotic coronary arteries, supplying the non-infarcted area, fare better both in improved 30-day survival and long-term survival. The improvement of the collateral flow to the myocardium contributes to its better recovery.
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| 50. |
- Perrotta, Sossio, 1975, et al.
(författare)
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In patients with cardiac injuries caused by sewing needles is the surgical approach the recommended treatment?
- 2010
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Ingår i: Interactive cardiovascular and thoracic surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 10:5, s. 783-92
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Tidskriftsartikel (refereegranskat)abstract
- A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'In patients with sewing needle cardiac injuries is the surgical approach the recommended treatment?' The scientific literature was reviewed by searching Medline, using Ovid interface, from 1950 to August 2009. Six hundred and twenty-six papers were found, of which 24 were deemed relevant to this topic. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The cause of injury may delay the timing of presentation the diagnosis and consequently the therapeutic strategy. In nearly all the cases in the reviewed papers the authors surgically removed the needle from the heart. However, out of the 24 papers, four patients had a conservative treatment. Most of the authors recommend early removal of the needle to prevent migration and further anatomical damage. The early surgical removal of foreign bodies in the heart is considered an effective approach to prevent complications. The heart is more vulnerable to serious injuries when the foreign body is extracardiac than when the foreign body is completely intracardiac. The unceasing motion of the heart against the sharp point of the fixed foreign body will result in repetitive wounding with bleeding and consequent cardiac tamponade. Due to the tendency of the needle to migrate, the preoperative use of computer tomography scan, trans-thoracic and trans-oesophageal echocardiography have been advocated to locate the exact position of the needle and its correlation with the surrounding tissues. The intraoperative use of epicardial ultrasound or fluoroscopy is also recommended. However, in cases of late diagnosis, in previously untreated patients, treatment can be individualized. If the symptoms are less severe it is reasonable to adopt a conservative approach as with time most foreign bodies become safely encysted and do no harm. Patients can remain asymptomatic for many years. However, they may present many years later with complications such as pericarditis, tamponade or endocarditis. Strict follow-up is useful in those patients.
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