Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Nov 2014
A structured blood conservation programme reduces transfusions and costs in cardiac surgery.
Transfusions of blood products can be lifesaving, but they are also associated with considerable risks and adverse effects, including immune response and infections. In cardiac surgery, transfusions have also been associated with increased mortality. We prospectively studied the effects of a structured programme to reduce transfusions and transfusion-associated costs in cardiac surgery. ⋯ A structured blood conservation programme reduces transfusions and costs for blood products in cardiac surgery, without any signs of compromised medical safety. The effects of introducing such a programme are maintained over at least 3 years.
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Interact Cardiovasc Thorac Surg · Nov 2014
Comparative StudyDoes body mass index impact the early outcome of surgical revascularization? A comparison between off-pump and on-pump coronary artery bypass grafting.
To investigate the effects of body mass index (BMI) on early outcomes after revascularization using either on-pump or off-pump surgery. ⋯ Our study did not detect significant differences between BMI classes with regard to mortality and morbidity. However, a slight trend towards a steadily increasing short-term mortality was detectable for patients with higher BMI values. When comparing ONCAB versus OPCAB, patients with higher BMI values appeared to have a weak tendency towards a reduced short-term morbidity and mortality in favour of OPCAB.
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Interact Cardiovasc Thorac Surg · Nov 2014
Transcatheter aortic valve implantation using a direct aortic approach: a single-centre Heart Team experience.
The transaortic (TAo) approach has been introduced as an alternative to transapical and transaxillary aortic valve implantation for patients with symptomatic severe aortic stenosis in whom a transfemoral approach is not feasible. However, only very limited data from a minimal number of specialized centres are available on this approach. Therefore, the aim of this study was to evaluate the early postoperative 30-day outcomes of the direct aortic approach performed by a single-centre multidisciplinary Heart Team. ⋯ The TAo TAVI approach is feasible and offers a safe alternative for patients in whom a transfemoral approach is not feasible or desirable.
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Interact Cardiovasc Thorac Surg · Nov 2014
Thoracic epidural anaesthesia for awake thoracic surgery in severely dyspnoeic patients excluded from general anaesthesia.
General anaesthesia (GA) carries high risks of ventilator dependency with increased morbidity and mortality in patients with severe respiratory disease. It also presents an ethical dilemma if surgery remains the only treatment option for patients with advanced terminal chronic respiratory disease. Thoracic epidural anaesthesia for awake thoracic surgery (TEATS) in high-risk patients with dyspnoea at rest could avoid ventilator dependency and speed up recovery even in patients with severe dyspnoea. This retrospective observational study analysed indications, management and outcome of patients contraindicated to GA undergoing awake thoracic surgery with thoracic epidural anaesthesia. ⋯ TEATS with/without sedation was an alternative to GA for thoracotomy/thoracoscopy in severely dyspnoeic patients (MMRC grade 4, ASA 4) without postoperative sequelae.
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Interact Cardiovasc Thorac Surg · Nov 2014
Case ReportsFatal air embolism during cardiopulmonary bypass: analysis of an incident and prevention measures.
Air embolism is a life-threatening complication during cardiopulmonary bypass. We present a case of a patient who suffered an air embolism during coronary bypass surgery, despite standard safety features and procedures. The patient died 3 days after surgery due to massive cerebral oedema. This case report gives a reconstruction of the event and the countermeasures undertaken to minimize the risk of recurrence.