Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2009
Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience.
Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this retrospective study, we present our 10-year experience in the management and clinical outcome of 4205 cases with chest trauma associated with blunt and penetrating injuries in a level I trauma hospital in Turkey. In 66% of the cases, blunt injury mostly related to traffic accidents was the cause of chest trauma. ⋯ Mortality and injury severity score (ISS) increased in patients having early surgery (P=0.001). Although most patients could be managed with conservative approaches, early thoracotomy was required in some cases. We believe that urgent hospital admission, early diagnosis, and multidisciplinary approach are very important to improve outcome.
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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.