Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Nov 2013
ReviewIs stereotactic ablative radiotherapy equivalent to sublobar resection in high-risk surgical patients with stage I non-small-cell lung cancer?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Is stereotactic ablative radiotherapy equivalent to sublobar resection in high-risk surgical patients with Stage I non-small cell lung cancer?'. Altogether over 318 papers were found, of which 18 represented the best evidence to answer the clinical question. ⋯ Thirty-day mortality following SABR was 0%, while predicted 30-day mortality following a lung resection, using the thoracoscore predictive model ranges between 1 and 2.6%. Treatment for early-stage NSCLC should be tailored to individual patients. SABR is an acceptable alternative to SLR in high-risk patients but comparative data are required.
-
Interact Cardiovasc Thorac Surg · Nov 2013
Case ReportsFirst experience with the deltastream(R) DP3 in venovenous extracorporeal membrane oxygenation and air-supported inter-hospital transport.
Based on continuous technical innovations and recent research, extracorporeal membrane oxygenation (ECMO) has become a promising tool in the treatment of patients with acute (cardio)pulmonary failure. Nevertheless, any extracorporeal technique requires a high degree of experience and knowledge, so that a restriction to specialized centres seems to be reasonable. As a consequence of this demand, the need for inter-hospital transfer of patients with severely impaired (cardio)pulmonary function is rising. Unfortunately, most of the ECMO devices used in the clinical setting are not suitable for inter-hospital transport because of their size, weight or complexity. In this article, we describe our first experiences with the airborne transport of 6 patients on a new portable, miniaturized and lightweight extracorporeal circulation system, the Medos deltastream® DP3. ⋯ Our experience shows that the deltastream® DP3 is an absolutely reliable and safe ECMO device that could gain growing importance in the field of airborne transportation of patients on ECMO due to its unsophisticated, miniaturized and lightweight characteristics.
-
Interact Cardiovasc Thorac Surg · Nov 2013
Delirium after cardiac surgery: incidence and risk factors.
Delirium after cardiac surgery is a problem with consequences for patients and healthcare. Preventive strategies from known risk factors may reduce the incidence and severity of delirium. The present aim was to explore risk factors behind delirium in older patients undergoing cardiac surgery with cardiopulmonary bypass. ⋯ Delirium was common among older patients undergoing cardiac surgery. Both predisposing and precipitating factors contributed to delirium. When combined, the predictive strength of the model improved. Preventive strategies may be considered, in particular among the precipitating factors. Of interest, delirium was strongly associated with an increased volume load during surgery.
-
Interact Cardiovasc Thorac Surg · Nov 2013
Comparative StudyPredictive factors for complications of anatomical pulmonary segmentectomies.
The role of anatomical pulmonary segmentectomy is increasing, but there are few data about its complication rate. We have analysed the postoperative morbidity, mortality and risk factors in a consecutive series of 228 segmentectomies performed in our department. ⋯ Pulmonary anatomical segmentectomies have an acceptable morbidity rate. Postoperative complications are more likely to develop in male gender patients, with FEV1 ≤ 60% and operated by open surgery.
-
Interact Cardiovasc Thorac Surg · Nov 2013
Case ReportsLung perfusion and ventilation during implantation of left ventricular assist device as a strategy to avoid postoperative pulmonary complications and right ventricular failure.
Right ventricular failure is a major contributor to increased morbidity and mortality in patients undergoing left ventricular assist device implantation. Cardiopulmonary bypass is associated with increased pulmonary ischaemia and pulmonary vascular resistance. Continuous pulmonary perfusion and ventilation represents an emerging strategy for pulmonary protection during cardiac surgery. We hypothesize that this technique may have a pivotal role in reducing postoperative right ventricular dysfunction in high-risk patients undergoing LVAD placement.