1,721,116 research outputs found
Safety of Salvaged Blood and Risk of Coagulopathy in Cardiac Surgery.
No full textCardiac surgery patients are prone to anemia from several mechanisms: intraoperative blood loss, preexisting anemia, and hemodilution. Patients are very frequently transfused with allogeneic red blood cells (RBC), which in itself is associated with harm. The use of RBC salvage technology has been advocated to salvage blood lost in the operative field and to reduce the need of homologous blood transfusion. Direct cardiotomy suction from the surgical field and unprocessed blood retransfusion is a common practice during cardiopulmonary bypass, but which is associated with a powerful activation of the coagulation and inflammatory systems: thrombin generation, excessive fibrinolysis, and release of proinflammatory cytokines. Compared with direct cardiotomy suction, the use of RBC salvage technology is able to reduce the amount of microparticles and activated proteins of autologous blood before retransfusion. However, when compared with no retransfusion of blood from the operative field, processed blood also triggers coagulopathy and inflammation. Clinical studies are discordant regarding the benefit of RBC salvage use during and after cardiac operations. Meta-analysis suggests reduced need of homologous blood transfusion, but no effects on mortality and morbidity
Combined aortic valve and ascending aorta replacement can be performed with a minimally invasive approach
No full text[Single versus double antiplatelet therapy following coronary artery bypass grafting]
No full text: Coronary artery bypass grafting is the treatment of choice in complex obstructive coronary artery disease, particularly in diabetic patients. The long-term benefits of coronary artery bypass grafting depend on the successful execution of the anastomosis, on the appropriate choice of conduits (arterial rather than venous) but are also influenced, as for the coronary stent, by the pharmacological measures used to prevent occlusion both in the period immediately following the intervention and in the subsequent years. The use of aspirin at intermediate doses, before and after surgery, clearly improves the clinical prognosis and bypass patency but does not prevent occlusion of venous bypasses from occurring in 10-20% of cases at 1 year of follow-up and in about 50% at 10 years. The combination of aspirin with first or more recent generation thienopyridines (dual antiplatelet therapy, DAPT) has produced conflicting results in the various randomized controlled trials. However, based on the most recent meta-analyses, there seems to be reason for a wider use of DAPT for at least 6 months after surgery for patients undergoing saphenous vein revascularization with a slightly higher risk of bleeding. This strategy could serve to reduce the risk of graft thrombosis as a consequence of the pro-thrombotic and pro-inflammatory state characterizing the first postoperative weeks
Commentary: Left ventricular assist device infection: Welcome to Babel!
No full textHeart failure affects 6.5 million adults in the United States. Since heart transplantation is limited by an organ shortage, durable mechanical circulatory support has rapidly evolved, Although we have made technological improvements to mechanical circulatory support over the years, providing today a 1-year survival at of 81%,1 infection remains the cation, contributing to major morbidity and mortality postLVAD. Infections may occur in 19% to 39% of recipients, resulting in more than 10% of LVAD-related deaths.2 Driveline infection is confirmed to be the most common However, these numbers have to be managed with care, and any comparison in terms of prevalence, outcome, and management may be inapplicable, given that there is a sues of the research in this field
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