Aims: Cardiac surgery patients are prone to bleeding postoperatively owing to the extensive sternotomy wound, multiple vessel and heart sutures, and disorders of hemostasis. In this study we retrospectively analyzed the outcomes for all patients in our department who were re-operated for bleeding, over a 5 year period.Methods: A total of 4297 patients underwent heart surgery between February 2002 and January 2007, of which 98 (2.3 %) were emergency reoperations for bleeding. We analyzed the process of indication for repeat surgery, possible source of bleeding, and postoperative complications.Results: Most (85.7 %) of the reoperated patients had undergone their fi rst operation as an elective cardiac procedure. The mean blood loss before the reoperation was 1557 ml. The studied group was characterized by increased mortality (11.2 %), longer ventilation period (35.1 hours) and ICU (4.5 days) and hospital (13.3 days) stays. The postoperative outcomes did not diff er signifi cantly between patients with TEG-detected coagulation disorder and the rest of the patients, or between patients treated with antilysin and those who did not receive antifi brinolytics.Conclusions: It is vital for the indication process leading to reoperation of the bleeding patient to be as short as possible so as to minimize the delay to repeat surgery. Echocardiography including ultrasound of both pleural spaces, and TEG could shorten that time delay, and should always be included when evaluating patients. Platelets should be administered more often, with the use of antifi brinolytics reserved for cases with confi rmed fi brinolysis.
There is high occurrence of early and delayed restrictive annuloplasty failure, particularly in patients with increased anterior leaflet tethering.
Background: Aortic dissection is a dangerous condition with a high mortality in the acute stage. Aortic dissection requires early diagnosis and treatment.Methods and Results: This short review discusses and focuses on known complications of aortic dissection and its natural mortality applying data from already published reports and from cohorts and registers, especially IRAD. Survival data of patients with type A and type B of dissection are presented and treatment options are proposed. The review presents three interesting cases from our database pointing out mistakes made in the diagnostic process and in dealing with the patient even after establishing the correct diagnosis. In one case, a patient with chest pain + "immeasurable" BP was suspected to suff er from an acute myocardial infarction and cardiogenic shock instead of AoD + aortic branch obstruction. In another patient with chest pain + V1V2 ST elevation, again the acute coronary syndrome was suspected. In fact, AoD with a perforation to cardiac chambers through the interventricular septum was the explanation. In the third case, the correct diagnosis of AoD was established. This patient was at a signifi cant risk of aortic rupture because of his uncontrolled blood pressure. Instead of sedation administration and eff ective BP lowering, the patient was stressed even more by detailed information about this life threatening disease. This led to an aortic rupture with cardiac tamponade. Other mistakes made when dealing with all these presented cases are also discussed. Conclusion:The high mortality in patients suff ering from aortic dissection is often potentiated by misdiagnosing and mishandling of these patients in clinical scenario.
Aim. We sought to evaluate our experience with endoscopic radial artery harvesting for coronary artery bypass grafting (CABG). Methods. From October 2005 to June 2010, 50 patients who underwent endoscopic radial artery harvesting for an elective CABG were prospectively assessed for harvesting characteristics, complications, postoperative and mid-term outcomes.Results. There were 34 (68%) males and 16 (32%) females, average age 60.8±9.2 years. All but two RA grafts (96%) were successfully harvested endoscopically. Mean harvesting time was 46.2±9.3 min and mean length of harvested grafts was 23.4±2.2 cm. In the post-operative period there were no wound-healing complications; residual forearm edema was recorded in 6 patients (12%) and peripheral neuropathy in 4 patients (8%). At 3 months after the surgery, peripheral neuropathy and residual edema persisted in 2 patients (4%). A significant drop of overall harvesting time (56.2± 18.6 vs. 38.6±8.6 min, P<0.05) and forearm ischemia time (41.8±12.7 vs. 24.2±3.2 min, P<0.01) was found between first and last ten cases in the group. Conclusion. Endoscopic radial artery harvesting was associated with low risk of post-harvesting complications and most of these disappeared within a 3 months follow-up. However, there was a significant learning curve.
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