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Engin M, Onur T, Onur A. Intra‑aortic balloon pump in heart surgery. Gen Thorac Cardiovasc Surg 2024; 72:426-427. [PMID: 38438824 DOI: 10.1007/s11748-024-02023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Mesut Engin
- Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery, University of Health Sciences, Mimar Sinan Town. Emniyet Street, Yıldırım, Bursa, Turkey.
| | - Tuğba Onur
- Department of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Anıl Onur
- Department of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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Iacona GM, Bakhos JJ, Tong MZ, Bakaeen FG. Coronary artery bypass grafting in left ventricular dysfunction: when and how. Curr Opin Cardiol 2023; 38:464-470. [PMID: 37751395 DOI: 10.1097/hco.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW The surgical management of patients undergoing coronary artery bypass grafting (CABG) with low ejection fraction presents unique challenges that require meticulous attention to details and good surgical technique and judgement. This review details the latest evidence and best practices in the care of such patients. RECENT FINDINGS CABG in patients with low ejection fraction carries a significant risk of perioperative mortality and morbidity related to the development of postcardiotomy shock. Preoperative optimization with pharmacological or mechanical support is required, especially in patients with cardiogenic shock. Rapid and complete revascularization is what CABG surgeons aim to achieve. Multiple arterial revascularization should be reserved to selected patients. Off-pump CABG, on-pump breathing heart CABG, and new cardioplegic solutions remain of uncertain benefit compared with traditional CABG. SUMMARY Tremendous advancements in CABG allowed surgeons to offer revascularization to patients with severe left ventricular dysfunction and multivessel disease with acceptable risk. Despite that, there is a lack of comprehensive and robust studies particularly on long-term outcomes. Individualized patient assessment and a heart team approach should be used to determine the optimal surgical strategy for each patient.
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Affiliation(s)
- Gabriele M Iacona
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Raos D, Prkačin I, Delalić Đ, Bulum T, Lovrić Benčić M, Jug J. Postoperative Hyperuricemia-A Risk Factor in Elective Cardiosurgical Patients. Metabolites 2023; 13:metabo13050590. [PMID: 37233631 DOI: 10.3390/metabo13050590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Hyperuricemia is a well-known cardiovascular risk factor. The aim of our study was to investigate the connection between postoperative hyperuricemia and poor outcomes after elective cardiac surgery compared to patients without postoperative hyperuricemia. In this retrospective study, a total of 227 patients after elective cardiac surgery were divided into two groups: 42 patients with postoperative hyperuricemia (mean age 65.14 ± 8.9 years) and a second group of 185 patients without it (mean age 62.67 ± 7.45 years). The time spent on mechanical ventilation (hours) and in the intensive care unit (days) were taken as the primary outcome measures while the secondary measure comprised postoperative complications. The preoperative patient characteristics were similar. Most of the patients were men. The EuroSCORE value of assessing the risk was not different between the groups nor the comorbidities. Among the most common comorbidities was hypertension, seen in 66% of all patients (69% in patients with postoperative hyperuricemia and 63.7% in those without it). A group of patients with postoperative hyperuricemia had a prolonged time of treatment in the intensive care unit (p = 0.03), as well as a prolonged duration of mechanical ventilation (p < 0.01) and a significantly higher incidence of the following postoperative complications: circulatory instability and/or low cardiac output syndrome (LCOS) (χ2 = 4486, p < 0.01), renal failure and/or continuous venovenous hemodiafiltration (CVVHDF's) (χ2 = 10,241, p < 0.001), and mortality (χ2 = 5.22, p < 0.01). Compared to patients without postoperative hyperuricemia, elective cardiac patients with postoperative hyperuricemia have prolonged postoperative treatment in intensive care units, extended durations of mechanically assisted ventilation, and a higher incidence of postoperative circulatory instability, renal failure, and death.
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Affiliation(s)
- Dominik Raos
- Institute of Emergency Medicine of Zagreb County, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ingrid Prkačin
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Internal Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Điđi Delalić
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Bulum
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology, and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Martina Lovrić Benčić
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department for Ischemic Heart Disease, University Clinic of Cardiovascular Diseases, Clinical Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Juraj Jug
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Center Zagreb-West, 10000 Zagreb, Croatia
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Welker CC, Mielke JAR, Ramakrishna H. Levosimendan and Low Cardiac Output After Cardiac Surgery: Analysis of Trial Data. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00182-9. [PMID: 37028989 DOI: 10.1053/j.jvca.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Carson C Welker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jr Arthur R Mielke
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
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