Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2013
Comparative Study Controlled Clinical TrialContinuous renal replacement therapy versus furosemide for management of kidney impairment in heart transplant recipients with volume overload.
It is unknown whether continuous renal replacement therapy or furosemide therapy is superior in heart transplant recipients who are in postoperative kidney insufficiency and volume overload. This prospective non-randomized, controlled trial investigated the efficacy of the two methods after transplantation. ⋯ In this study, continuous renal replacement therapy in heart transplant recipients with reduced kidney function was associated with an improvement in estimated glomerular filtration rate status in comparison with furosemide.
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Interact Cardiovasc Thorac Surg · Mar 2013
Multicenter StudyEarly and long-term results of pulmonary resection for non-small-cell lung cancer in patients over 75 years of age: a multi-institutional study.
Older lung cancer patients with multiple morbidities are increasingly referred to thoracic surgery departments. The aim of this multicenter study was to analyse the prognostic factors for in-hospital morbidity and mortality and to elucidate the predictors of long-term survival and oncological outcomes. ⋯ Nowadays, we can consider surgery a safe and justifiable option for elderly patients. Careful preoperative work-up and selection are mandatory to gain satisfactory results. Good long-term results were achieved in elderly patients with early stage who underwent lobar or sublobar lung resection. The role of surgery or other alternative therapies, in patients with advanced stages, extensive nodal involvement and/or requiring extensive surgical resection for curative intent, is still unclear and further studies are certainly needed.
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Interact Cardiovasc Thorac Surg · Mar 2013
ReviewWhat is the optimum prophylaxis against gastrointestinal haemorrhage for patients undergoing adult cardiac surgery: histamine receptor antagonists, or proton-pump inhibitors?
A best evidence topic was written according to a structured protocol. The question addressed was what is the optimum prophylaxis against gastrointestinal haemorrhage for patients undergoing adult cardiac surgery: histamine receptor antagonists (H(2)RA) or proton-pump inhibitors? A total of 201 papers were found; of which, 8 represented the best evidence. The authors, date, journal, study type, population, main outcome measures and results were tabulated. ⋯ Two RCTs showed that H(2)RAs may augment the immune system and reducing stress following cardiac surgery. Proton-pump inhibitors appear to be the superior agent for prophylaxis against gastrointestinal bleed in patients undergoing cardiac surgery, although rigorous comparative data are sparse. Furthermore, level-I evidence would confirm this.
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Interact Cardiovasc Thorac Surg · Mar 2013
Short-term independent mortality risk factors in patients with cirrhosis undergoing cardiac surgery.
Cirrhosis represents a serious risk in patients undergoing cardiac surgery. Several preoperative factors identify cirrhotic patients as high risk for cardiac surgery; however, a patient's preoperative status may be modified by surgical intervention and, as yet, no independent postoperative mortality risk factors have been identified in this setting. The objective of this study was to identify preoperative and postoperative mortality risk factors and the scores that are the best predictors of short-term risk. ⋯ We conclude that central venous pressure could be a valuable predictor of short-term outcome in patients with cirrhosis undergoing cardiac surgery. The model for end-stage liver disease score is the best predictor of cirrhotic patients who are at high risk for cardiac surgery. Sequential organ failure assessment and simplified acute physiology score III are also valuable predictors.
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Interact Cardiovasc Thorac Surg · Mar 2013
Comparative StudyThe effect of lung-size mismatch on mechanical ventilation tidal volumes after bilateral lung transplantation.
Mechanical ventilation tidal volumes are usually set according to an estimate of patient size in millilitres (ml) per kilogram (kg) body weight. We describe the relationship between donor-recipient lung-size mismatch and postoperative mechanical ventilation tidal volumes according to recipient- and donor-predicted body weights in a cohort of bilateral lung transplant patients. ⋯ During mechanical ventilation after bilateral lung transplantation, undersized allografts received relatively higher tidal volumes compared with oversized allografts when the tidal volumes were related to donor-predicted body weights.