Aortic valve replacement through left thoracotomy ...[Ann Thorac Surg. 2008] - PubMed Result:
Paciente con cirugía de esófago 14 años atrás, con tubo gástrico subesternal. Se abordó la válvula aórtica por toracotomía izquierda.
A 67-year-old man was referred for aortic valve surgery due to aortic valve regurgitation. He underwent an aortic valve replacement through a left thoracotomy, since he had a history of esophageal surgery with substernal gastric tube reconstruction and lymph node dissection through a right thoracotomy 14 years ago. The aortic valve was successfully replaced with excellent visualization using vacuum-assisted venous drainage on a cardiopulmonary bypass. Although exposing the aortic valve through a left thoracotomy is difficult, the application of vacuum-assisted venous drainage helps visualize the aortic valve in this approach."
24/1/09
Mismatch aórtico de prótesis mecánica y stented bioprótesis
Validity of identifying patient-prosthesis mismatc...[J Artif Organs. 2008] - PubMed Result:
Pibarot and Dumesnil demostraron que el índice de área efectiva,IAE, ( indexed effective orifice area) de las prótesis mecánicas debe ser mayor a 0.85 - 0.90' cm2/m2 para prevenir un gradiente elevado después de la cirugía cardiaca.
Este IAE debe ser mayor de 1.25 cm2/m2 en las stented bioprótesis.
The main problem that arises from patient-prosthesis mismatch after aortic valve replacement is a residual high transvalvular pressure gradient, resulting in left ventricular overload. It was demonstrated by Pibarot and Dumesnil that the indexed effective orifice area should be larger than 0.85-0.90 cm2/m2 to prevent any significant transvalvular pressure gradient after operation. However, we have encountered a higher residual transvalvular pressure gradient than expected in some patients with an aortic stented bioprosthesis with an indexed effective orifice area greater than 0.85 cm2/m2. Based on our data, an indexed effective orifice area of less than 1.25 cm2/m2 might be considered the threshold for patient-prosthesis mismatch in patients with a stented bioprosthesis because this indexed effective orifice area is associated with a low mean transvalvular pressure gradient (less than 10 mmHg). The practical implications include the necessity to consider the hemodynamic performance of each prosthesis type when seeking to define patient-prosthesis mismatch and abnormally or significant high postoperative gradients that lead to an increased left ventricular workload, so as to avoid residual significant transvalvular pressure gradients and higher rates of morbidity and mortality."
Pibarot and Dumesnil demostraron que el índice de área efectiva,IAE, ( indexed effective orifice area) de las prótesis mecánicas debe ser mayor a 0.85 - 0.90' cm2/m2 para prevenir un gradiente elevado después de la cirugía cardiaca.
Este IAE debe ser mayor de 1.25 cm2/m2 en las stented bioprótesis.
The main problem that arises from patient-prosthesis mismatch after aortic valve replacement is a residual high transvalvular pressure gradient, resulting in left ventricular overload. It was demonstrated by Pibarot and Dumesnil that the indexed effective orifice area should be larger than 0.85-0.90 cm2/m2 to prevent any significant transvalvular pressure gradient after operation. However, we have encountered a higher residual transvalvular pressure gradient than expected in some patients with an aortic stented bioprosthesis with an indexed effective orifice area greater than 0.85 cm2/m2. Based on our data, an indexed effective orifice area of less than 1.25 cm2/m2 might be considered the threshold for patient-prosthesis mismatch in patients with a stented bioprosthesis because this indexed effective orifice area is associated with a low mean transvalvular pressure gradient (less than 10 mmHg). The practical implications include the necessity to consider the hemodynamic performance of each prosthesis type when seeking to define patient-prosthesis mismatch and abnormally or significant high postoperative gradients that lead to an increased left ventricular workload, so as to avoid residual significant transvalvular pressure gradients and higher rates of morbidity and mortality."
Control de la anticoagulación en el perioperatorio de cirugía cardiaca
Perioperative coagulation management and blood con...[J Cardiothorac Vasc Anesth. 2008] - PubMed Result:
CONCLUSIONS: The majority of Canadian institutions do not use point-of-care tests other than ACT. Most institutions do not have algorithms for management of bleeding following cardiac surgery and at least 30% do not monitor their transfusion practice perioperatively. Cardiac surgery patients in Canada may benefit from a standardized approach to blood conservation in the perioperative period."
CONCLUSIONS: The majority of Canadian institutions do not use point-of-care tests other than ACT. Most institutions do not have algorithms for management of bleeding following cardiac surgery and at least 30% do not monitor their transfusion practice perioperatively. Cardiac surgery patients in Canada may benefit from a standardized approach to blood conservation in the perioperative period."
Uso del Cell Saver en la cirugía cardiaca
A randomized controlled trial of cell salvage in r...[Anesth Analg. 2008] - PubMed Result:
"CONCLUSION: In patients undergoing routine first-time cardiac surgery in an institution with a rigorous blood conservation program, the routine use of cell salvage does not further reduce the proportion of patients exposed to allogeneic blood transfusion. However, patients who do not have excessive bleeding after surgery receive significantly fewer units of blood with cell salvage. Although the use of cell savage may reduce the demand for blood products during cardiac surgery, this comes at an increased cost to the institution."
"CONCLUSION: In patients undergoing routine first-time cardiac surgery in an institution with a rigorous blood conservation program, the routine use of cell salvage does not further reduce the proportion of patients exposed to allogeneic blood transfusion. However, patients who do not have excessive bleeding after surgery receive significantly fewer units of blood with cell salvage. Although the use of cell savage may reduce the demand for blood products during cardiac surgery, this comes at an increased cost to the institution."
Implante de válvula aórtica por cateter
Transcatheter valve implantation for patients with aortic stenosis...[Eur Heart J. 2008] - PubMed Result:
"CONCLUSION: Transcatheter aortic valve implantation is a promising technique, which may offer an alternative to conventional surgery for high-risk patients with aortic stenosis. Today, careful evaluation is needed to avoid the risk of uncontrolled diffusion."
"CONCLUSION: Transcatheter aortic valve implantation is a promising technique, which may offer an alternative to conventional surgery for high-risk patients with aortic stenosis. Today, careful evaluation is needed to avoid the risk of uncontrolled diffusion."
Guías clínicas ACC/AHA 2008 en enfermedad valvular cardiaca
ACC/AHA 2008 guideline update on valvular heart di...[Catheter Cardiovasc Interv. 2008] - PubMed Result
Guías Clínicas de la enfermedad Valvular cardiaca.
Guías Clínicas de la enfermedad Valvular cardiaca.
23/1/09
Transfusión sanguínea en cirugía cardiaca. Actualización
Transfusion dependency of cardiac surgery--update ...[Swiss Med Wkly. 2006] - PubMed Result
Descripción de las técnicas empleadas para la disminución del uso de sangre homóloga en la cirugía cardiaca, llegando a requerir solamente 2 paquetes globulares.
Descripción de las técnicas empleadas para la disminución del uso de sangre homóloga en la cirugía cardiaca, llegando a requerir solamente 2 paquetes globulares.
Eficacia de una sola amp de eritropoyetina en el preoperatorio
The efficacy of preoperative administration of a single dose of recombinant human erythropoietin...[Heart Surg Forum. 2007] - PubMed Result
CONCLUSIONS: Although the effectiveness for avoiding transfusion was not clear, the administration of a single dose of rHuEPO without autologous blood donations had an effect by increasing hematocrit levels.
CONCLUSIONS: Although the effectiveness for avoiding transfusion was not clear, the administration of a single dose of rHuEPO without autologous blood donations had an effect by increasing hematocrit levels.
15/1/09
Clopidrogel con Aspirina en la Insuf Art Periférica
Patients with peripheral arterial disease in the CHARISMA trial.
Conclusion Dual therapy provided some benefit over aspirin alone in PAD patients for the rate of MI and the rate of hospitalization for ischaemic events, at the cost of an increase in minor bleeding.
Conclusion Dual therapy provided some benefit over aspirin alone in PAD patients for the rate of MI and the rate of hospitalization for ischaemic events, at the cost of an increase in minor bleeding.
13/1/09
Contenido Vol 136, Issue 6, December 2008
JTCS -- Table of Contents (136 [6])
Contenido de la Journal Of Thoracic And Cardiovascular Surgery (JTCS)
Técnica para el cierre de un esternón dehiscente, inestable
Transverse sternal plating in secondary sternal reconstruction -- Huh et al. 136 (6): 1476 -- The Journal of Thoracic and Cardiovascular Surgery:
"Conclusion: The transverse sternal plating system successfully achieved stability in all cases and is valuable in complex sternal reconstructions. Sternal plating is an effective alternative to wire closure in sternum with fractures, chronic and acute instability, or poor bone quality."
Técnica para el cierre de un esternón dehiscente.
"Conclusion: The transverse sternal plating system successfully achieved stability in all cases and is valuable in complex sternal reconstructions. Sternal plating is an effective alternative to wire closure in sternum with fractures, chronic and acute instability, or poor bone quality."
Técnica para el cierre de un esternón dehiscente.
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