Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2013
Suction-irrigation drainage: an underestimated therapeutic option for surgical treatment of deep sternal wound infections.
Deep sternal wound infections are significant and severe complications following cardiac surgery and substantially influence perioperative morbidity and mortality. We present the experience of our department using two different surgical treatments over a three-year period. ⋯ Contrary to accepted opinion, the suction-irrigation drainage is an appropriate therapy for deep sternal wound infections. Nevertheless, deep sternal wound infections after cardiac surgery remain severe complications and are related to increased morbidity and mortality.
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Interact Cardiovasc Thorac Surg · Jul 2013
Randomized Controlled Trial Comparative StudyA randomized trial of early versus delayed mediastinal drain removal after cardiac surgery using silastic and conventional tubes.
Mediastinal drainage following cardiac surgery with traditional large-bore plastic tubes can be painful and cumbersome. This study was designed to determine whether prolonged drainage (5 days) with a silastic tube decreased the incidence of significant pericardial effusion and tamponade following aortic or valvular surgery. ⋯ In patients undergoing ascending aortic or valvular surgery, prolonged drainage with silastic tubes is safe and does not increase postoperative pain. There was no difference between the Blake and conventional drains with regard to significant pericardial effusion or tamponade in this cohort; however, this conclusion is limited by the low overall incidence of the primary outcome in this cohort.
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Interact Cardiovasc Thorac Surg · Jul 2013
ReviewDoes video-assisted thoracic surgery provide a safe alternative to conventional techniques in patients with limited pulmonary function who are otherwise suitable for lung resection?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: does video-assisted thoracic surgery provide a safe alternative to conventional techniques in patients with limited pulmonary function who are otherwise suitable for lung resection? Altogether, more than 280 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ Analysis suggested that VATS lobectomy was the principal driver of survival benefit in the study group. We conclude that patients with limited pulmonary function have better outcomes when surgery is performed via VATS compared with traditional open techniques. The literature also suggests that patients in whom pulmonary function is poor have similar perioperative outcomes to those with normal function when a VATS approach to resection is adopted.
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Interact Cardiovasc Thorac Surg · Jul 2013
Comparative StudyHaemodynamic comparison of a novel flow-divider Optiflo geometry and a traditional total cavopulmonary connection.
The total cavopulmonary connection (TCPC), the current palliation of choice for single-ventricle heart defects, is typically created with a single cylindrical tunnel or conduit routing inferior vena caval (IVC) flow to the pulmonary arteries. Previous studies have shown the haemodynamic efficiency of the TCPC to be sub-optimal due to the collision of vena caval flow, thus placing an extra energy burden on the single ventricle. The use of a bifurcated graft as the Fontan baffle (i.e. the 'Optiflo') has previously been proposed on the basis of theoretically improved flow efficiency; however, anatomical constraints may limit its effectiveness in some patients. ⋯ This study demonstrated proof of concept that the flow-divider has the potential to reduce power loss and streamline IVC flow through the TCPC. An appropriate size for the insert in proportion to the Fontan baffle size was identified that reduced losses compared with a TCPC control under both resting and simulated exercise flow conditions.
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Interact Cardiovasc Thorac Surg · Jul 2013
ReviewShould we perform bilateral-lung or heart–lung transplantation for patients with pulmonary hypertension?
A best evidence topic was constructed according to a structured protocol. The following question was addressed: of the following two procedures, heart–lung transplantation or bilateral-lung transplantation (BLTx), which offers the best outcome for patients with pulmonary hypertension (PH) listed for thoracic transplantation? Of the 77 papers found using a report search for PH and thoracic transplantation, 9 represented the best evidence to answer this clinical question. Overall, 1189 (67%) lung transplantations and 578 (33%) heart–lung transplantations have been reported worldwide for idiopathic PH. ⋯ In the case of lower values for RVEF and LVEF, HLTx should be performed. In all other patients with PH, the evidence demonstrated that BLTx offers a comparable outcome with the advantage of better organ sharing for other recipients. In order to reduce the waiting time on transplantation lists, cardiac repair and BLTx can be offered in experienced centres to patients with simple cardiac anomalies such as atrial septal defect, patent ductus arteriosus or perimembranous ventricular septal defect.