Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Oct 2012
Comparative StudyOutcomes of aortic valve repair according to valve morphology and surgical techniques.
The aim of this study was to assess the impact of aortic valve morphology and different surgical aortic valve repair techniques on long-term clinical outcomes. ⋯ Aortic valve repair including aortic annulus stabilization is a safe surgical option with either tricuspid or bicuspid valves; even more so if associated with root re-implantation. Patients with calcified bicuspid valves have poor results.
-
Interact Cardiovasc Thorac Surg · Oct 2012
Case ReportsDelayed visceral malperfusion after Bentall procedure for type A acute aortic dissection.
Rapid restoration of flow into the true lumen and obliteration of a false lumen is considered the optimal approach to treating malperfusion syndrome due to acute aortic dissection. However, organ malperfusion can occasionally persist after proximal aortic graft replacement despite redirecting blood flow into the true lumen. A 35-year old man underwent the modified Bentall procedure for Stanford type A acute aortic dissection without organ malperfusion. ⋯ We immediately performed a left axillary-to-bilateral femoral artery bypass. The patient recovered uneventfully and was discharged on postoperative day 28. Although organ malperfusion persisting after proximal aortic graft replacement despite redirecting blood flow into the true lumen is rare, close observation remains imperative after central repair of type A dissection.
-
Interact Cardiovasc Thorac Surg · Oct 2012
ReviewIs there benefit in smoking cessation prior to cardiac surgery?
A best evidence topic was written according to a structured protocol. The question addressed was whether smoking cessation prior to cardiac surgery would result in a greater freedom from postoperative complications. A total of 564 papers were found using the reported searches, of which five represented the best evidence to answer the clinical question. ⋯ There were also reductions in duration of intubation (P < 0.0001), intensive care unit stay (P < 0.0001) and hospital stay (P < 0.0013). Another small cohort study reporting outcomes of heart transplantation demonstrated significant improvement in non-smokers in terms of survival (P = 0.031), duration of intubation (P = 0.05) and intensive care unit stay (P = 0.021). We conclude that there is strong evidence demonstrating superior outcomes in non-smokers following cardiac surgery and advocate the necessity of smoking cessation as soon as possible prior to cardiac surgery.
-
Interact Cardiovasc Thorac Surg · Oct 2012
ReviewIs routine postoperative enteral feeding after oesophagectomy worthwhile?
A best evidence topic in surgery was written according to a structured protocol. The question addressed was whether, in patients undergoing an oesophagectomy for cancer, immediate postoperative enteral feeding (via percutaneous jejunostomy or nasojejunostomy) provides better patient outcomes as compared to waiting until oral feeding can be instituted. Four randomized controlled trials represented the best evidence to answer the clinical question. ⋯ Mortality was higher in the jejunostomy group, although the team did not attribute the deaths to the catheter. They found both methods equally effective in providing postoperative nutrition. In summary, all the trials concluded that routine postoperative enteral nutrition was feasible, but there was no evidence suggesting that it conferred any clinical benefits.
-
Interact Cardiovasc Thorac Surg · Oct 2012
Simple preoperative computed tomography image analysis shows good predictive performance for pathological vessel invasion in clinical stage IA non-small cell lung cancer.
Pathological vessel invasion is a well-known prognostic factor in early-stage, non-small cell lung cancer and preoperative predicting vessel invasion may enable us to improve prognosis by additional interventions. We evaluated the importance of vessel invasion as a prognostic factor in clinical stage IA non-small cell lung cancer and predictive performance of simple diameter-based computed tomography image analysis for vessel invasion. ⋯ Vessel invasion had the greatest impact on recurrence in clinical stage IA non-small cell lung cancer. Our simple computed tomography image analysis showed good predictive performance for vessel invasion.