Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2014
ReviewIs perioperative corticosteroid administration associated with a reduced incidence of postoperative atrial fibrillation in adult cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Is perioperative corticosteroid administration associated with a reduced incidence of postoperative atrial fibrillation (POAF) in adult cardiac surgery? A total of 70 papers were identified using the search as described below. Of these, eight were identified to provide best evidence to answer the clinical question. ⋯ Although the optimal dose, dosing interval and duration of therapy are unclear, meta-analysis suggests that a single dose can be as effective as multiple doses. No statistically significant complications associated with the use of corticosteroids were reported in any of the studies. We conclude that a single prophylactic moderate dose of corticosteroid (50-210 mg of dexamethasone equivalent or 200-1000 mg/day hydrocortisone) can significantly reduce the risk of POAF with no significant increase in morbidity or mortality.
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Interact Cardiovasc Thorac Surg · Feb 2014
Randomized Controlled Trial Comparative StudyAssessment of concomitant paroxysmal atrial fibrillation ablation in mitral valve surgery patients based on continuous monitoring: does a different lesion set matter?
The efficacy of concomitant ablation techniques in patients with paroxysmal atrial fibrillation (AF) undergoing mitral valve surgery remains under debate. The aim of this prospective, randomized, single-centre study was to compare pulmonary vein isolation (PVI) only versus a left atrial maze (LAM) procedure in patients with paroxysmal AF during mitral valve surgery. ⋯ According to continuous ECG monitoring data, freedom from AF was significantly higher after the concomitant LAM procedure than after PVI in patients with paroxysmal AF who underwent mitral valve surgery.
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Interact Cardiovasc Thorac Surg · Feb 2014
Case ReportsLeft lower sleeve lobectomy by uniportal video-assisted thoracoscopic approach.
Endobronchial tumours requiring sleeve resection have been usually considered a contraindication for video-assisted thoracoscopic surgery (VATS). However, with new technical advances and the experience gained in VATS, sleeve lobectomy has been performed by thoracoscopy in experienced VATS centres. ⋯ Most surgeons use a 3 to 4 incision VATS technique for sleeve anastomosis but the surgery can be performed by using only one incision. This is the first report of a left-sided sleeve lobectomy by uniportal approach.
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Interact Cardiovasc Thorac Surg · Feb 2014
Long-term results after aortic root replacement using self-assembled valve composite grafts in patients with small aortic annulus.
The study was aimed to evaluate operative and long-term results after complete root replacement using self-assembled valve composite grafts in patients with a small aortic annulus. ⋯ In patients with a small aortic annulus who need complete aortic root replacement, an oversizing of the valve can be easily achieved using modified, self-assembled composite grafts. Offering excellent haemodynamic characteristics, these grafts lead to prevention of prosthesis-patient mismatch and result in very good and durable functional and clinical results.