Obstrucción de cánula venosa por vegetación de endocarditis / Venous cannula obstruction due to vegetative endocarditis

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Postoperative bleeding in cardiac surgery: the role of tranexamic acid in patients homozygous for the 5G polymorphism of the plasminogen activator inhibitor-1 gene.

BACKGROUND: Plasminogen activator inhibitor 1 (PAI-1) attenuates the conversion of plasminogen to plasmin. Polymorphisms of the PAI-1 gene are associated with varying PAI-1 levels and risk of prothrombotic events in nonsurgical patients. The purpose of this study, a secondary analysis of a clinical trial, was to investigate whether PAI-1 genotype affects the efficacy of tranexamic acid (TA) in reducing postoperative chest tube blood loss of patients undergoing cardiopulmonary bypass. METHODS: Fifty patients were classified according to PAI-1 genotype (4G/4G, 4G/5G, or 5G/5G). Twenty-four received 2 g TA before and after cardiopulmonary bypass, whereas 26 received placebo. The authors recorded data related to coagulation, fibrinolysis, and bleeding before surgery, at admission to the intensive care unit (0 h), and 4 and 24 h later. RESULTS: In patients not receiving TA, those with the 5G/5G genotype had significantly higher chest tube blood loss and transfusion requirements compared with patients with the other genotypes at all time points. Patients with the 5G/5G genotype receiving TA showed significantly lower blood loss compared with the placebo group. There were no significant differences in blood loss or transfusion requirements between patients with the 4G/4G genotype when TA was used. CONCLUSIONS: Plasminogen activator inhibitor-1 5G/5G homozygotes who did not receive TA showed significantly greater postoperative bleeding than patients with other PAI-1 genotypes. 5G/5G homozygotes who received TA showed the greatest blood-sparing benefit.

[Small flexible drains after cardiac surgery. Efficacy and safety of a new system]. / Drenajes torácicos flexibles de pequeño calibre en cirugía cardíaca. Eficacia y seguridad de un nuevo sistema.

INTRODUCTION: The use of thoracic drains after cardiac surgery is distressing to patients and can cause a local inflammatory response. The objective of this study was to demonstrate the efficacy and safety of the flexible Blake drain for mediastinal and pleural drainage following cardiac surgery. MATERIAL AND METHOD: We retrospectively studied 292 consecutive patients who underwent open heart surgery. The patients were divided in 2 groups: group A: 152 patients (Blake drain, 19 Ch) and group B: 140 patients (semi-flexible drains, 32 Ch). There were no significant differences in gender (56 males and 96 females in group A vs 49 males and 91 females in group B), age (67 +/- 14 in group A vs 65 +/- 14 in group B) or type of intervention (group A: 90 coronary, 59 valvular, 3 other; group B: 82 coronary, 53 valvular, 6 other). Preoperative parameters were similar in both groups. All patients received tranexamic acid as anti-fibrinolytic treatment. RESULTS: Postoperative bleeding was lower in group A (742 +/- 368) than in group B (872 +/- 439) (p = 0.042). The number of transfusions and re-operations for bleeding re-exploration was similar in both groups. Patient satisfaction was significantly greater in the group with flexible drains (p < 0.005). CONCLUSIONS: The use of flexible Blake drains reduced drainage after cardiac surgery without increasing the risk of bleeding or tamponade and can therefore be systematically used in cardiac surgery. Because of their flexibility, these drains produce less irritation, with accelerated recovery and lower analgesic use.

Multiple overlapped conical endoprostheses in a patient with aneurysmatic right aortic arch and aortic coarctation.

An aortic neck with a nonconstant diameter represents a challenge for endovascular treatment. We report our experience in a patient with right aortic arch, aneurysmatic aberrant subclavian artery, aortic coarctation, and a precoarctation aneurysm that was treated with surgery and endoprothestic procedures in two stages.

Drenajes torácicos flexibles de pequeño calibre en cirugía cardíaca. Eficacia y seguridad de un nuevo sistema / Small flexible drains after cardiac surgery. Efficacy and safety of a new system

Introducción. Los drenajes torácicos en el postoperatorio de cirugía cardiovascular son molestos para el paciente y pueden derivar a una respuesta inflamatoria local. El objetivo de este estudio es demostrar la eficacia y la seguridad de los drenajes Blake® (Ethicon, Somerville, NJ, USA) de pequeño calibre en el postoperatorio de cirugía cardíaca. Material y método. Se estudió retrospectivamente a 292 pacientes consecutivos, sometidos a cirugía cardíaca, a los que se dividió en 2 grupos. Grupo A: 152 pacientes (drenaje de Blake de 19 CH), y grupo B: 140 pacientes (drenaje semiflexible de 32 CH). No hubo diferencias significativas en cuanto a sexo (A: 56 varones y 96 mujeres; B: 49 varones y 91 mujeres), edad ± desviación estándar (A: 67 ± 14; B: 65 ± 14) y tipo de intervención (A: 90 coronarios, 59 valvulares, 3 otras; B: 82 coronarios, 53 valvulares, 6 otras). Todos los parámetros preoperatorios fueron similares en ambos grupos. Todos los pacientes recibieron ácido tranexámico como tratamiento antifibrinolítico. Resultados. La hemorragia postoperatoria fue menor en el grupo A frente al B (742 ± 368 frente a 872 ± 439; p = 0,042). El número de transfusiones y las reintervenciones por hemorragia fueron similares en ambos grupos. Hubo un mayor grado de satisfacción de los pacientes en el grupo de los drenajes flexibles p < 0,005. Conclusiones. Los tubos Blake® disminuyen el drenado postoperatorio sin incrementar el riesgo de hemorragia o taponamiento cardíaco, por lo que se pueden utilizar de modo sistemático en cirugía cardíaca. Por su flexibilidad, disminuyen la irritación de las serosas y proporcionan una recuperación rápida y una necesidad de analgésicos menor (AU)

Introduction. The use of thoracic drains after cardiac surgery is distressing to patients and can cause a local inflammatory response. The objective of this study was to demonstrate the efficacy and safety of the flexible Blake® drain for mediastinal and pleural drainage following cardiac surgery. Material and method. We retrospectively studied 292 consecutive patients who underwent open heart surgery. The patients were divided in 2 groups: group A: 152 patients (Blake drain, 19 Ch) and group B: 140 patients (semi-flexible drains, 32 Ch). There were no significant differences in gender (56 males and 96 females in group A vs 49 males and 91 females in group B), age (67 ± 14 in group A vs 65 ± 14 in group B) or type of intervention (group A: 90 coronary, 59 valvular, 3 other; group B: 82 coronary, 53 valvular, 6 other). Preoperative parameters were similar in both groups. All patients received tranexamic acid as anti-fibrinolytic treatment. Results. Postoperative bleeding was lower in group A (742 ± 368) than in group B (872 ± 439) (p = 0.042). The number of transfusions and re-operations for bleeding re-exploration was similar in both groups. Patient satisfaction was significantly greater in the group with flexible drains (p < 0.005). Conclusions. The use of flexible Blake® drains reduced drainage after cardiac surgery without increasing the risk of bleeding or tamponade and can therefore be systematically used in cardiac surgery. Because of their flexibility, these drains produce less irritation, with accelerated recovery and lower analgesic use (AU)

Mitro-aortic infective endocarditis produced by Erysipelothrix rhusiopathiae: case report and review of the literature.

Endocarditis produced by Erysipelothrix rhusiopathiae is an uncommon disease in humans. This bacterial species is found worldwide as a commensal or a pathogen in many animals. Infection in humans is usually due to occupational exposure. The case is reported of a 43-year-old male parrot breeder with native aortic and mitral valve endocarditis and NYHA class II heart failure at six months after wound infection. The patient was discharged after six weeks' treatment with intravenous penicillin G and replacement of the mitral and aortic valves due to severe regurgitation. At one year after surgery the patient was asymptomatic and infection-free.