Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2021
Case ReportsTransient upper limb ischaemia during veno-arterial extracorporeal membrane oxygenation in a child.
Neck cannulation is the most common cannulation strategy performed to provide veno-arterial extracorporeal membrane oxygenation support in paediatric patients, especially in small children. Upper limb ischaemia is a rare complication of neck cannulation and is likely caused by arterial cannula malposition. We describe a case of right arm ischaemia caused by extrinsic compression of the right subclavian artery by the venous drainage cannula inserted through the right internal jugular vein. Upper limb hypoperfusion was resolved immediately after changing the venous drainage cannula from the right jugular vein to the right femoral vein.
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Interact Cardiovasc Thorac Surg · Aug 2021
Mechanical circulatory support in coronavirus disease-2019-positive patients with severe respiratory failure.
Treatment of severe acute respiratory distress syndrome (ARDS) induced by severe acute respiratory syndrome coronavirus 2 has been heavily debated. Our goal was to describe our findings in patients with severe ARDS due to severe coronavirus disease 2019 (sCOVID-19) treated with venovenous extracorporeal membrane oxygenation (vv-ECMO). ⋯ The use of vv-ECMO in patients with sCOVID-19-induced ARDS is safe and associated with improved respiratory ventilation settings. The rate of immune system involvement plays a pivotal role in the development and outcome of sCOVID-19.
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Interact Cardiovasc Thorac Surg · May 2021
Does erector spinae plane block result in improved postoperative analgesia and enhanced recovery in adult patients after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether erector spinae plane block (ESPB) resulted in improved postoperative analgesia and enhanced recovery in adult cardiac surgical patients. A total of 333 papers were found using the reported search of which, 7 papers represented the best evidence to answer the clinical question. ⋯ With ESPB, there was significant improvement in postoperative pain scores (4 studies), decreased opioid requirement/rescue analgesia (3 studies), increased duration of analgesia (1 study), decreased time to extubation (3 studies), less increase in postoperative Troponin T (1 study), earlier ambulation (2 studies), earlier oral intake (1 study), earlier chest drain removal (1 study), better patient satisfaction (1 study), reduced adverse events (1 study) and decreased intensive care unit stay (3 studies). We conclude that ESPB may be associated with improved postoperative analgesia and enhanced recovery after adult cardiac surgery based on the available evidence. However, there is a need for better quality randomized controlled trials to consolidate these findings.
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Interact Cardiovasc Thorac Surg · May 2021
Meta AnalysisModified ultrafiltration reduces postoperative blood loss and transfusions in adult cardiac surgery: a meta-analysis of randomized controlled trials.
Cardiopulmonary bypass in cardiac surgery has been associated with several deleterious effects including haemodilution and systemic inflammation. Modified ultrafiltration (MUF) has been well established in paediatric cardiac surgery in counteracting postperfusion syndrome. However, MUF is less commonly used in adult cardiac surgery. In this meta-analysis, we compared clinical outcomes in adult patients who underwent cardiopulmonary bypass with and without MUF. ⋯ MUF is a safe and feasible option in adult cardiac patients, with significant benefits including improved postoperative haematocrit, as well as reduced postoperative chest tube bleeding, transfusion requirements and duration of ICU stay.
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Interact Cardiovasc Thorac Surg · May 2021
Outcomes of Liu's aortic root repair and valve preservation in patients with type A dissection and aortic regurgitation.
To evaluate short- and medium-term outcomes following Liu's aortic root repair and valve preservation in patients with acute type A aortic dissection complicated by moderate-to-severe aortic regurgitation (AR). ⋯ Liu's aortic root repair and valve preservation is a safe and effective operative strategy that achieves favourable short- and medium-term outcomes for acute type A aortic dissection with moderate-to-severe AR.