Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jan 2009
ReviewCould we use abdominal compressions rather than chest compression in patients who arrest after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether abdominal cardiopulmonary resuscitation (CPR) could be used instead of external cardiac massage either to protect the recent sternotomy or while chest compressions are not possible whilst a sternotomy is being performed. Altogether 386 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. ⋯ We found only one paper in a porcine model that looked at the effectiveness of abdominal only CPR although it did show that abdominal CPR was actually 60% better than chest CPR. Interposed abdominal and chest compressions has been much more extensively studied and has been shown to be significantly better in return of spontaneous circulation than chest compressions alone. We conclude that currently there is very little evidence to support abdominal only CPR although these studies may support the concept that it may potentially increase the coronary and cerebral perfusion pressure.
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Interact Cardiovasc Thorac Surg · Jan 2009
ReviewIs aortic valve-sparing operation or replacement with a composite graft the best option for aortic root and ascending aortic aneurysm?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is better to preserve the aortic valve in patients with aortic root or ascending aortic aneurysms. Altogether 380 papers were found using the reported search, of which 23 represented the best evidence to answer the clinical question. ⋯ Sixteen papers reported a 10-year reoperative-free survival from 54% to 98% for valve-sparing operations and 67-81% for replacement operations in two further studies. Six papers reported their 10-year freedom from re-operation as 75-97% for valve-sparing operations. Our findings suggest that the results of both techniques are excellent and comparable, and the operating surgeon may safely make his decision as to which technique to select based on patient factors and his own experience without compromising the long-term outcomes of the patient.
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Interact Cardiovasc Thorac Surg · Jan 2009
Randomized Controlled Trial Comparative StudyThe impact of allogenic red cell transfusion and coated bypass circuit on the inflammatory response during cardiopulmonary bypass: a randomized study.
This study is designed to determine and compare the effects of transfusion and coated circuits on the inflammatory response during cardiopulmonary bypass. ⋯ Allogenic red cell transfusion enhances inflammatory response during CPB; coated circuit systems have a limiting effect on this inflammatory reaction.
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Interact Cardiovasc Thorac Surg · Jan 2009
Randomized Controlled TrialClinical benefit of cardiac ischemic postconditioning in corrections of tetralogy of Fallot.
The postoperative course of cyanotic patients is generally more complicated than in acyanotic patients. The ischemic postconditioning provides protection from myocardial injury. We conducted a randomized trial to evaluate the clinical benefits of postconditioning in patients undergoing repair of tetralogy of Fallot. ⋯ The ventilation time was significantly reduced in postconditioned patients compared with control (14+/-15 h vs. 25+/-28 h, P=0.024). There was a significant decrease in the ICU stay in the postconditioned patients (P=0.048). The study suggests that ischemic postconditioning may provide clinical benefits with respect to the morbidity, ventilation time, ICU stay, requirement of inotrope in patients undergoing repair for tetralogy of Fallot.
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Interact Cardiovasc Thorac Surg · Jan 2009
Changing risk of patients undergoing coronary artery bypass surgery.
The aim of the present study was to evaluate the changing risk of patients undergoing coronary artery bypass grafting (CABG). Residents of Oulu who underwent coronary angiography and/or revascularization from 1993 to 2006 formed the basis of this community-wide study. One thousand three hundred and forty-nine consecutive patients who underwent CABG have been included in the analysis on changing operative risk and results after CABG. ⋯ Despite the increased operative risk, off-pump coronary surgery was associated with lower immediate postoperative mortality rates. Contrary to on-pump surgery, immediate postoperative death occurred after off-pump surgery only in patients with additive EuroSCORE >or=6. The results of this study suggest that improved perioperative care as well as changes in operative strategy are positively faced with the increased burden of comorbidities and operative risk of patients currently undergoing CABG.