Background Based on our previous pilot study, systemic inflammatory response syndrome is more common in off-pump compared to on-pump coronary artery bypass. Therefore, we conducted a clinical trial of dexamethasone in patients undergoing off-pump coronary artery bypass. Methods Sixty consecutive patients undergoing off-pump coronary artery bypass were enrolled from August 2018 to January 2019 and randomized to a dexamethasone or placebo group of 30 each. Clinical outcomes were analyzed. Results There was a lower incidence of major adverse cardiac events in the dexamethasone group compared to the placebo group (17% versus 43%, p = 0.024). Clinical outcomes in the dexamethasone group were better than those in the placebo group, in terms of duration of mechanical ventilation ( p = 0.029), intensive care unit stay ( p = 0.028), hospital stay ( p = 0.04), and vasoactive-inotropic score ( p = 0.045). There were significant differences in inflammatory markers between the two groups: interleukin-6 ( p = 0.0001), procalcitonin ( p = 0.0001), and C-reactive protein ( p = 0.0001) were lower in the dexamethasone group. There was a significant association between the incidence of major adverse cardiac events and both interleukin-6 ( p = 0.005) and procalcitonin ( p = 0.007). Conclusion Preoperative dexamethasone in patients undergoing off-pump coronary artery bypass is effective in improving clinical outcomes and controlling the postoperative inflammatory reaction.
ABSTRACT BACKGROUND: Acute on chronic limb ischemia is a condition caused by acute disruption in chronic vessel disease. The major cause is peripheral arterial disease or embolism. Treating the acute phase while considering the origin of disease is important to treat acute on chronic limb ischemia. CASE DESCRIPTION: 3 cases were described on this serial case report. The first and second case represent acute on chronic limb ischemia conditions with history of intermittent claudication (IC) and signs of acute limb ischemia (ALI) upon arrival. They were both treated with surgical intervention for ALI. Despite of adequate surgical intervention, both cases showed suboptimal limb recovery. Both patients were referred for further evaluation of chronic vessel disease with angiography. Third case represent chronic limb ischemia as end point of treatment from the first and second case. Patient with worsening IC despite adequate medical and exercise treatment underwent angiography examination. Angiography result found two sites of total occlusion of right common iliac artery and superficial femoral artery. Angioplasty and primary stenting were done on common iliac artery. Drug coated balloon and stenting was also performed on superficial femoral artery. CONCLUSION: Patients with acute on chronic limb ischemia need to be treated during acute phase and the remaining chronic vessel disease. Consideration and care should be taken when managing similar cases for optimal treatment. KEYWORDS: Acute on chronic limb ischemia, Thrombectomy, Angioplasty, Drug-coated Balloon.
Background: Retention of central venous catheters (CVC) is one complication that may occur when open-heart surgery is performed (such as mitral valve replacement). In this case report, we describe case retention of CVC in a patient with Mitral Valve Replacement (MVR) related to sutured of Superior Vena Cava (SVC) wall on cannulation site. Case Presentation: A 15-year-old boy was admitted to Sanglah Hospital with a history of Heart failure with severe regurgitation of the mitral valve, severe tricuspid regurgitation, and left ventricular dysfunction due to rheumatic heart disease. Mitral valve replacement, tricuspid valve repair and left atrial reduction was performed. After five days of postoperative observation, the CVC could be removed. However, there is resistance when removing the catheter. After diagnostic examination, it was found that the CVC was sutured to the superior vena cava wall. The patient was then scheduled for a redo sternotomy to evacuate the CVC. The patient was discharged seven days after redo sternotomy was performed without any further postoperative complications. Conclusions: Retention of CVC during open-heart surgery is one complication that increases the risk for morbidity or mortality to the patient after heart surgery.
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