Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Sep 2011
ReviewIs preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether preoperative physiotherapy/pulmonary rehabilitation is beneficial for patients undergoing lung resection. Ten papers were identified using the reported search, of which five represented the best evidence to answer the clinical question. ⋯ A prospective randomised controlled study in 1997, showed that two weeks of PRP followed by two months of postoperative rehabilitation produced a better predicted postoperative forced expiratory volume in one second in the study group than in the control group at three months (lobectomy + 570 ml vs. -70 ml; pneumonectomy + 680 ml vs. -110 ml). We conclude that preoperative physiotherapy improves exercise capacity and preserves pulmonary function following surgery. Whether these benefits translate into a reduction in postoperative pulmonary complication is uncertain.
-
Interact Cardiovasc Thorac Surg · Sep 2011
ReviewDo patients with haemophilia undergoing cardiac surgery have good surgical outcomes?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether patients with haemophilia undergoing cardiac surgery have good surgical outcomes. Haemophilia A and haemophilia B are sex-linked recessive inherited diseases affecting males only, with females acting as carriers. ⋯ Intraoperative plasma factor levels can be easily measured before heparin and after protamine sulphate administration, whereas during cardiopulmonary bypass this will require a chromogenic method. Exposure to factor concentrates early in the life might predispose a patient with severe haemophilia to the development of inhibitors. Moreover, the absence of inhibitors should be confirmed before any surgical procedure.
-
Interact Cardiovasc Thorac Surg · Sep 2011
Surgery for hemoptysis in various pulmonary tuberculous lesions: a prospective study.
Hemoptysis due to pulmonary tuberculous lesions is a common cause of morbidity, and occasionally mortality. The aim of this study is to evaluate the surgical outcome of hemoptysis in patients with various tuberculous pulmonary lesions. A total of 45 cases who underwent surgical procedures for various pulmonary tuberculous lesions with hemoptysis were included in this study. ⋯ There was one case (6.2%) of mortality in group A. Tuberculous cavity is the common pulmonary lesion which can result in major and massive hemoptysis, therefore, we recommend early surgical resection of tuberculous cavities to avoid life-threatening hemoptysis. Limited resection should be avoided to prevent recurrence.
-
Interact Cardiovasc Thorac Surg · Sep 2011
Comparative StudyComparing the outcome of on-pump versus off-pump coronary artery bypass grafting in patients with preoperative atrial fibrillation.
Around 5-15% of patients undergoing coronary artery bypass grafting (CABG) suffer from preoperative/pre-existing atrial fibrillation (PAF). This is a benign arrhythmia but can affect the outcome of the surgery. The aim of this study was to assess the effect of PAF on the immediate postoperative course of patients undergoing on-pump (ONCAB) vs. off-pump (OPCAB) CABG. ⋯ PAF is associated with a higher incidence of postoperative complications. Our results have demonstrated that patients in PAF undergoing ONCAB are more susceptible to the postoperative complications compared to those in SR. However, there were no differences in mid- and long-term outcomes.
-
Interact Cardiovasc Thorac Surg · Sep 2011
Left ventricle unloading by percutaneous pigtail during extracorporeal membrane oxygenation.
Arterial-venous extracorporeal membrane oxygenation (ECMO) is more and more used as first line mechanical support in acute cardiopulmonary failure. Important pitfall of this technique is the inappropriate unloading of left ventricle (LV) in case of myocardial insufficiency, leading to pulmonary stasis and inadequate myocardial recovery. ⋯ Echographic guidance is sufficient to pigtail positioning and follow-up monitoring avoiding catheterization laboratory transport. With this approach we were able to support three different patients, resolving LV distension and preventing lung congestion, without major complication.