Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2008
Comparative StudyQuality of life evolution after surgery for primary or secondary spontaneous pneumothorax: a prospective study comparing different surgical techniques.
The objective of the present study is to evaluate quality of life (QoL) evolution after video-assisted thoracic surgery (VATS) and anterolateral thoracotomy (AT) for primary and secondary spontaneous pneumothorax, which has not been studied prospectively until now. From January 2003 to December 2004, QoL was prospectively recorded in 20 consecutive patients, using the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire-C30 and the lung specific module LC-13. Questionnaires were administered before surgery and 1, 3, 6 and 12 months postoperatively (MPO) with response rates of 100%, 85%, 80%, 65% and 60%, respectively. ⋯ Comparing VATS and AT in QoL evolution, significant differences are seen in thoracic pain evolution in favour of VATS (6 MPO P=0.037). After surgery, AT and VATS are comparable in QoL subscales with exception of a significant difference at 1 MPO in favour of VATS. Dyspnoea and coughing improved after surgery.
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Interact Cardiovasc Thorac Surg · Feb 2008
Comparative StudyMatrix metalloproteinase expression in the ascending aorta and aortic valve.
Extracellular matrix degradation and increased proteolytic enzyme (matrix metalloproteinase (MMP)) activity characterise abdominal aortic aneurysm formation. Post-stenotic dilatation of ascending aorta is associated with aortic stenosis and regurgitation, haemodynamically normal bicuspid aortic valve (BAV) and following AV replacement. We aimed to determine an association between ascending aortic pathology and abnormal AV, with particular reference to MMPs, and ascertain differences between BAV and tricuspid (TAV) AV. ⋯ No difference exists in gene expression of MMPs in ascending aorta and AV between patients with BAV and TAV. However, patients with larger aortic diameters have increased MMP-2/TIMP-1. Modifying MMP expression may have a role in development of aneurysms.
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Interact Cardiovasc Thorac Surg · Feb 2008
Comparative StudyMiniaturized cardiopulmonary bypass system in neonates and small infants.
Cardiopulmonary bypass (CPB) in children is associated with a capillary leak due to inflammatory response, which results in an increase in total body water. This study was designed to reveal that our miniaturized CPB system reduced the peri-operative systemic inflammatory response in small infants. In our institution, the priming volume has been reduced from 500 ml to 140 ml currently. ⋯ A combination of priming volume (coefficient: 0.015, P=0.006), and bypass time (coefficient: 0.013, P=0.028), most affected %BWG (%). A combination of priming volume (coefficient: 0.05, P=0.001) and age (coefficient: -0.02, P=0.001) most affected the MVT (days). The miniaturized circuits reduced the peri-operative inflammatory response, resulting in reduced postoperative systemic edema, and postoperative mechanical ventilation time.
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Interact Cardiovasc Thorac Surg · Feb 2008
Early results following the Nuss operation for pectus excavatum--a single-institution experience of 383 patients.
The prevalence of pectus excavatum is low but many patients are disabled from this thoracic deformity. The Nuss operation is a well-established surgical correction, however, until recently it has been rarely used in Europe. We have performed the Nuss operation regularly between 2001 and 2006 where a total of 383 patients were operated on for pectus excavatum. ⋯ At present the bars have been removed in 73 patients and their final result was excellent in all but one. The Nuss procedure for pectus excavatum can be implemented with excellent early results and few complications. There is a surprisingly high demand for surgical correction of pectus excavatum and the number of referred patients continues to increase as patients learn about the ease of this procedure and its excellent results.
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Interact Cardiovasc Thorac Surg · Feb 2008
Case ReportsIs internal massage superior to external massage for patients suffering a cardiac arrest after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether open chest cardiac massage is superior to closed chest compressions in patients suffering cardiac arrest following cardiac surgery. Using the reported search, 527 papers were identified. ⋯ We conclude that over 18 good quality animal studies have consistently demonstrated the superiority of open chest cardiac massage, with the cardiac index and coronary perfusion pressures often more than doubling. There are fewer human studies but they have shown that closed chest massage generates a cardiac index of around 0.6 l/min/m(2) which rises to 1.3 l/min/m(2) or more with open-chest-CPR, accompanied by even bigger improvements in coronary perfusion pressure. ILCOR recommends prompt conversion to open-chest-cardiac massage in patient's shortly post-cardiac surgery, and we would support this intervention if simple resuscitative efforts such as defibrillation, pacing or atropine fail, in order to significantly improve the quality of cardiopulmonary resuscitation.