Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2009
Case ReportsRetrograde cerebral perfusion and delayed hyperbaric oxygen for massive air embolism during cardiac surgery.
We report a case of massive air embolism from a ventricular vent line during cardiac surgery successfully treated with emergent retrograde cerebral perfusion and delayed hyperbaric oxygen therapy. The etiologies of this rare but potentially devastating complication are discussed along with prevention and treatment options.
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Interact Cardiovasc Thorac Surg · Mar 2009
Comparative StudyComparison of graft patency for off-pump and conventional coronary arterial bypass grafting using 64-slice multidetector spiral computed tomography angiography.
Off-pump coronary artery bypass graft surgery (OPCAB) has been performed for many years and its use is increasing frequently, but it remains an open question whether OPCAB provides similar patency to conventional coronary artery bypass graft (CCABG) surgery with cardiopulmonary bypass. The present study assessed the graft patency in patients that had coronary arterial bypass grafting (CABG) performed on-pump and off-pump. ⋯ Patency of left internal mammary artery (LIMA) was higher than that of saphenous vein (SVG) in both groups; no significant difference was seen in LIMA patency and SVG patency in both groups. Results of 64-slice MSCTA indicate that OPCAB provides similar patency to CCABG surgery with CPB.
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Interact Cardiovasc Thorac Surg · Mar 2009
Review Meta AnalysisRetrograde autologous priming and allogeneic blood transfusions: a meta-analysis.
A literature review and meta-analysis were undertaken to assess the clinical effectiveness of retrograde autologous priming of the cardiopulmonary bypass circuit to reduce allogeneic packed red blood transfusions in adult cardiac surgery. Structured searches of Medline, Embase, Cochrane Collaboration Library, Scopus, Cumulative Index to Nursing and Allied Health Literature and Science Direct were performed to identify randomized trials comparing retrograde autologous priming to a prospective control group. A total of 21,643 studies were identified and eighteen trials were retrieved for full-text review. ⋯ Retrograde autologous priming, however, did not provide a clinical benefit in reducing the number of units transfused of intraoperative packed red blood cells (WMD=-0.29; 95% CI: -0.59, 0.01; P=0.05). The combined patient population studied in the six trials was mainly primary isolated coronary artery bypass surgery. Assessing the safety of retrograde autologous priming was not possible due to limited data.
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Interact Cardiovasc Thorac Surg · Mar 2009
ReviewDoes lobectomy achieve better survival and recurrence rates than limited pulmonary resection for T1N0M0 non-small cell lung cancer patients?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'Does lobectomy achieve better survival and recurrence rates than limited pulmonary resection for T1N0M0 non-small cell lung cancer patients?' Altogether 225 papers were found using the reported search, of which nineteen represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ Segmental resection is comparable to lobectomy for small peripheral tumors. Sublobar resection is associated with shorter hospital stay. For bronchioalveolar carcinoma sublobar resection is recommended provided intra-operative pathologic consultation confirms pure bronchioalveolar histology without evidence of invasion, and surgical margins are free of disease.