Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2008
Papillary muscle realignment and mitral annuloplasty in patients with severe ischemic mitral regurgitation and dilated heart.
Chronic ischemic mitral regurgitation (IMR) is one of the leading causes of congestive heart failure and death. It is controversial whether mitral annuloplasty (MAP) per se can improve the long-term survival because IMR has been considered a disease of the left ventricle. We reviewed our experience of papillary muscle realignment in conjunction with MAP in patients with IMR. ⋯ Furthermore, a six-month echocardiographic examination demonstrated that these improvements remained unchanged. The combination of papillary muscle realignment and MAP seems to be effective in patients with IMR. The duration of the effect may be expected to be long-term with these methods.
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Interact Cardiovasc Thorac Surg · May 2008
ReviewShould additional antibiotics or an iodine washout be given to all patients who suffer an emergency re-sternotomy on the cardiothoracic intensive care unit?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is beneficial to give additional antibiotics or an iodine washout after an emergency re-sternotomy on the intensive care unit. Using the reported search, 527 papers were identified. ⋯ The other two papers did not report whether this was done. We conclude that even though the incidence of subsequent infection is low in the cardiac arrest situation, full aseptic technique including gown and gloves might be regarded as best practice. It is common practice also to give additional antibiotics and a povodine-iodine washout although we could identify no studies other than uncontrolled cohort studies in support of this.
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Interact Cardiovasc Thorac Surg · May 2008
ReviewIs blood cardioplegia superior to crystalloid cardioplegia?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether blood cardioplegia is clinically superior to crystalloid cardioplegia for myocardial protection. Altogether 501 papers were identified. ⋯ Of these, 10 reported some statistically significant clinical outcomes in favour of blood cardioplegia and five reported statistically significant differences in enzyme release in favour of blood cardioplegia. A recent survey of UK practice found that 56% of surgeons use cold blood cardioplegia, 14% use warm blood cardioplegia, 14% use crystalloid cardioplegia, 21% use retrograde infusion and 16% do not use any cardioplegia. The papers presented in our review support most of these practices!
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Interact Cardiovasc Thorac Surg · May 2008
Comparative StudyExercise capacity after lobectomy in patients with chronic obstructive pulmonary disease.
The aim of this study is to clarify whether patients with chronic obstructive pulmonary disease (COPD) lose less exercise capacity after lobectomy than do those without COPD, to the same extent as ventilatory capacity and lobectomy for selected patients with severe emphysema improve exercise capacity like ventilatory capacity. Seventy non-COPD patients (N group), 16 mild COPD patients (M group), and 14 moderate-to-severe COPD patients (S group) participated. Pulmonary function and exercise capacity tests were performed on the same day preoperatively and six months to one year after lobectomy. ⋯ However, their loss of exercise capacity was equivalent to that for the N and M groups. For the S group, there was a significant, negative correlation between preoperative FEV(1) % of predicted and percentage change in FEV(1) and maximum oxygen consumption (VO2 max) after lobectomy (r=-0.93, P<0.0001 and r=-0.64, P=0.01). In moderate-to-severe COPD patients, patients with a lower preoperative FEV(1) % of predicted experienced a smaller decrease in FEV(1) and VO2 max after lobectomy.
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Interact Cardiovasc Thorac Surg · May 2008
Use of tissue microdialysis to investigate hyperlactataemia following paediatric cardiac surgery.
We investigated tissue lactate, pyruvate and lactate:pyruvate (LP) ratio post cardiac surgery and the relationship of cardiac index and oxygen delivery to late onset hyperlactataemia in ICU. It involved a prospective study of 10 children, mean age 4.9 (0.4) years, post-Fontan operation admitted with normo-lactataemia. Tissue lactate, pyruvate and LP ratio were monitored postoperatively every 30 min for 12 h via subcutaneous microdialysis in the abdominal wall. ⋯ Cardiac index increased from 2.83 (0.63) to 3.77 (1.34) l min(-1) m(-2) over the same period (P=0.05), with a corresponding increase in oxygen delivery from 4556 (1094) to 6076 (2322) ml min(-1) (P=0.04). Tissue microdialysis provides near-continuous measurement of tissue lactate and pyruvate, post cardiac surgery. Blood lactate rise post-Fontan is mirrored by tissue lactate and pyruvate concentrations, and not associated with a low or falling cardiac index or with tissue oxygen debt.