Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Nov 2012
ReviewHow does the right gastroepiploic artery compare with the saphenous vein for revascularization of the right coronary artery?
A best evidence topic was written according to a structured protocol. The question addressed was 'is the saphenous vein graft or right gastroepiploic artery a better conduit for revascularization of the right coronary artery?' One hundred and five articles were found using a designated search, of which 10 articles were found to represent the best available evidence to answer the clinical question. Of these 10 articles, two were reports of a randomized controlled trial and represented the highest level of evidence, whereas eight articles were retrospective observational studies. ⋯ The randomized evidence suggested that the saphenous vein had better early (6-month) and mid-term (3-year) graft patency than the right gastroepiploic artery when used for right coronary artery revascularization. The use of the saphenous vein was also found to be predictive of superior graft function using multivariate regression; however, a more recent propensity score analysis identified gastroepiploic-right coronary grafts to yield superior very long-term (>10 years) clinical outcomes. Overall, based on the best quality evidence and in view of technical limitations and flow characteristics of the right gastroepiploic artery, it appears that saphenous vein grafts may offer superior outcomes for revascularization of the right coronary artery in most cases, and should be preferentially used.
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Interact Cardiovasc Thorac Surg · Nov 2012
Randomized Controlled TrialA randomized study of coronary artery bypass surgery performed with the Resting Heart™ System utilizing a low vs a standard dosage of heparin.
Allogeneic blood transfusion and reoperation for postoperative bleeding after the coronary artery bypass grafting have a negative impact on the patient outcome. This study aimed at evaluating the effects of reduced doses of heparin and protamine on the patient outcome, using a heparin-coated mini-cardiopulmonary bypass (CPB) system. ⋯ The use of a mini-CPB system combined with a low dose of heparin reduced the need for blood transfusions and may facilitate the faster mobilization of the patients.
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Interact Cardiovasc Thorac Surg · Nov 2012
Case ReportsLarge monophasic synovial sarcoma of the mediastinum in a 15-year old boy.
We present the interesting case of a 15-year old boy with a monophasic synovial sarcoma (MSS) of the mediastinum, which was infiltrating the right heart chambers and the inferior vena cava (IVC). A radical excision was performed, with extensive reconstruction of the heart, under deep hypothermic circulatory arrest. Radical surgical excision is considered to be the treatment of choice for these lesions, as chemotherapy and radiotherapy have little effect. Unfortunately, the patient and his parents refused any further consultation with an oncologist and, although there was no recurrence at 12 months following the procedure, at 24 months we were informed of his death due to the tumour appearing on the left cardiac chambers with subsequent multi-organ failure.
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Interact Cardiovasc Thorac Surg · Nov 2012
Six-year prospective audit of 'scoop and run' for chest-reopening after cardiac arrest in a cardiac surgical ward setting.
The aim of the study was to identify which cardiac surgical ward patients benefit from 'scoop and run' to the operating room for chest reopening. ⋯ The key determinant of a favourable 'scoop and run' outcome was whether the arrest occurred during daytime or night-time hours (P < 0.05). Despite a median time to chest opening of 22 min, all five survivors were discharged neurologically intact. The median time from surgery in these survivors was 4 days. Because of the risk of hypoxic brain damage, 'scoop and run' should be restricted to patients suffering witnessed arrests. The study has potential implications for resuscitation training and out-of-hours medical staffing in cardiothoracic hospitals.
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Interact Cardiovasc Thorac Surg · Nov 2012
18F-fluorodeoxyglucose positron emission tomography/computed tomography is useful in postoperative follow-up of asymptomatic non-small-cell lung cancer patients.
Postoperative follow-up and surveillance after curative resection for non-small-cell lung cancer (NSCLC) patients are generally performed. However, there is no consensus on the best programme at this time. The aim of this study was to evaluate the diagnostic capability of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in postoperative NSCLC patients without clinical and radiological evidence of recurrence, as a follow-up and surveillance programme. ⋯ FDG-PET/CT is a useful tool that has high capability to detect recurrences in asymptomatic NSCLC patients after a potentially curative operation. However, a large-scale multi-institutional randomized control trial may be needed to ascertain the benefit of surveillance with FDG-PET/CT.