ABSTRACT
OBJECTIVE: Magnesium (Mg²âº) is cardioprotective and has been routinely used to supplement cardioplegic solutions during coronary artery bypass graft (CABG) surgery. However, there is no consensus about the Mg²âº concentration that should be used. The aim of this study was to compare the effects of intermittent antegrade warm-blood cardioplegia supplemented with either low- or high-concentration Mg²âº. METHODS: This study was a randomised controlled trial carried out in two cardiac surgery centres, Bristol, UK and Cuneo, Italy. Patients undergoing isolated CABG with cardiopulmonary bypass were eligible. Patients were randomised to receive warm-blood cardioplegia supplemented with 5 or 16 mmol l⻹ Mg². The primary outcome was postoperative atrial fibrillation. Secondary outcomes were serum biochemical markers (troponin I, Mg²âº, potassium, lactate and creatinine) and time-to-plegia arrest. Intra-operative and postoperative clinical outcomes were also recorded. RESULTS: Data from two centres for 691 patients (342 low and 349 high Mg²âº) were analysed. Baseline characteristics were similar for both groups. There was no significant difference in the frequency of postoperative atrial fibrillation in the high (32.8%) and low (32.0%) groups (risk ratio 1.03, 95% confidence interval, CI, 0.82-1.28). However, compared with the low group, troponin I release was 28% less (95% CI 55-94%, p=0.02) in the high-Mg²âº group. The 30-day mortality was 0.72% (n = 5); all deaths occurred in the high-Mg²âº group but there was no significant difference between the groups (p=0.06). Frequencies of other major complications were similar in the two groups. CONCLUSIONS: Warm-blood cardioplegia supplemented with 16 mmol l⻹ Mg²âº, compared with 5 mmol l⻹ Mg²âº, does not reduce the frequency of postoperative atrial fibrillation in patients undergoing CABG but may reduce cardiac injury. (This trial was registered as ISRCTN95530505.).
Subject(s)
Cardiotonic Agents/administration & dosage , Coronary Artery Bypass/methods , Heart Arrest, Induced/methods , Magnesium Sulfate/administration & dosage , Aged , Atrial Fibrillation/etiology , Atrial Fibrillation/prevention & control , Biomarkers/blood , Cardiopulmonary Bypass , Cardiotonic Agents/therapeutic use , Coronary Artery Bypass/adverse effects , Dose-Response Relationship, Drug , Female , Humans , Intraoperative Care/methods , Magnesium Sulfate/therapeutic use , Male , Middle Aged , Treatment OutcomeABSTRACT
Cardiac involvement is a recognized complication of systemic lupus erythematosus (SLE), which can involve most cardiac components, including pericardium, conduction system, myocardium, heart valves, and coronaries. Libman-Sacks (verrucous) endocarditis is the characteristic cardiac valvular manifestation. We report a patient with SLE who had severe aortic regurgitation caused by Libman-Sacks endocarditis. The patient underwent successful mechanical aortic valve replacement.
Subject(s)
Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/surgery , Endocarditis/complications , Heart Valve Prosthesis Implantation , Lupus Erythematosus, Systemic/complications , Adult , Aortic Valve/diagnostic imaging , Aortic Valve/pathology , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/pathology , Endocarditis/etiology , Female , Humans , Lupus Nephritis/complications , UltrasonographyABSTRACT
Near-infrared spectroscopy can be helpful for monitoring the adequacy of cerebral perfusion during cardiovascular surgery. We report changes seen in regional oxygen saturation due to intraoperative thrombosis of the left common carotid artery graft during hybrid aortic arch replacement for traumatic aortic injury.
Subject(s)
Aorta, Thoracic/surgery , Drug Monitoring , Monitoring, Intraoperative/methods , Spectroscopy, Near-Infrared/methods , Adult , Brain/pathology , Carotid Arteries/surgery , Cerebrovascular Circulation , Humans , Imaging, Three-Dimensional , Male , Oxygen/metabolism , Oxygen Consumption , Perfusion , Tomography, X-Ray ComputedSubject(s)
Aneurysm, False/surgery , Aortic Aneurysm, Thoracic/surgery , Aortic Diseases/etiology , Blood Vessel Prosthesis Implantation/adverse effects , Fistula/surgery , Adult , Aneurysm, False/etiology , Aortic Aneurysm, Thoracic/etiology , Aortic Coarctation/surgery , Blood Vessel Prosthesis/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Esophageal Fistula/etiology , Female , Fistula/etiology , Hematemesis/etiology , Humans , Stents/adverse effects , Vascular Fistula/etiologyABSTRACT
Endovascular repair of thoracic aneurysms has emerged as an attractive alternative especially in high-risk patients. However, the aortic curvature and potential coverage of the epiaortic vessels limit the use of stent-grafts in aneurysms located in the aortic arch. We report a case with a saccular aneurysm in the distal arch and proximal descending aorta, where we have transposed the epiaortic vessels to gain a longer proximal neck in the aortic arch to safely deploy an endovascular stent.
