Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2009
Microalbuminuria and short-term prognosis in patients undergoing cardiac surgery.
To examine if preoperative microalbuminuria (MA) is associated with in increased risk of adverse outcomes in patients undergoing elective cardiothoracic surgery, and if adding information on MA could improve the accuracy of the additive EuroSCORE. ⋯ Preoperative MA in patients undergoing elective cardiothoracic surgery was not associated with most early adverse outcomes. However, risk of septicaemia was higher and patients with MA also had a marginally longer length of ICU and hospital stay. Information on preoperative MA did not improve the accuracy of the additive EuroSCORE.
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Interact Cardiovasc Thorac Surg · Sep 2009
Multicenter Study Controlled Clinical TrialCollagen-gentamicin implant for prevention of sternal wound infection; long-term follow-up of effectiveness.
In a previous randomized controlled trial (LOGIP trial) the addition of local collagen-gentamicin reduced the incidence of postoperative sternal wound infections (SWI) compared with intravenous prophylaxis only. Consequently, the technique with local gentamicin was introduced in clinical routine at the two participating centers. The aim of the present study was to re-evaluate the technique regarding the prophylactic effect against SWI and to detect potential shifts in causative microbiological agents over time. ⋯ The majority of SWI were caused by coagulase-negative staphylococci (CoNS). The incidence of deep SWI caused by Staphylococcus aureus was 0.07%. The results indicate a maintained effect of the prophylaxis over time without absolute increase in aminoglycoside resistance. (ClinicalTrials.gov NCT00484055).
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Interact Cardiovasc Thorac Surg · Sep 2009
Case ReportsSpontaneous coronary artery rupture in a young patient: a rare diagnosis for cardiac tamponade.
We report a case of spontaneous coronary artery rupture (SCAR) in a 43-year-old male who presented with symptoms of sudden onset of chest pain and hemodynamic collapse. There were no abnormal electrocardiogram changes and serum troponin was not detected. Acute aortic dissection was suspected but urgent contrast computed tomography (CT) showed a large pericardial effusion with cardiac tamponade. ⋯ The patient was successfully managed with direct repair under cardiopulmonary bypass. Postoperative multi-detector dual-source 64-slice CT coronary angiography revealed normal coronary arteries with absence of atherosclerotic plaque in all coronary arterial segments. It is concluded that, though rare, a differential diagnosis of SCAR should be considered in cases of acute chest pain with cardiac tamponade in adult patients of all ages.
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Interact Cardiovasc Thorac Surg · Sep 2009
ReviewIs patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is patient-prosthesis mismatch an independent risk factor for 30-day and mid-term overall mortality in adult patients undergoing aortic valve replacement (AVR)? Altogether, almost 400 papers were found using the reported search, of which 22 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. ⋯ An exception could be represented by patients with poor ejection fraction, a condition that can make moderate mismatch a predictor of overall mortality after AVR. On the other hand, severe mismatch is a predictor of overall 30-day or mid-term mortality for patients undergoing AVR independently from the presence of poor ejection fraction. In conclusion, our review suggests that the condition of severe PPM should be always avoided, while the presence of moderate mismatch could be tolerated in patients with normal ejection fraction without any impact on overall survival.
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Interact Cardiovasc Thorac Surg · Sep 2009
ReviewEndovascular versus open surgical repair for blunt thoracic aortic injury.
A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether patients with acute traumatic thoracic aortic injury have a better outcome with endovascular or open surgical repair. ⋯ We concluded that the peri-procedural mortality rate for patients with traumatic thoracic blunt aortic injury is lower for patients treated with an endovascular stent graft when compared to the open technique. This important benefit is at the cost of a high procedure complication rate, requirement for long-term surveillance of the stent and uncertain medium and longer-term outcome.