Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2014
ReviewReview of the evidence supports role for routine prophylaxis against postoperative supraventricular arrhythmia in patients undergoing pulmonary resection.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Is there an indication for routine prophylaxis against postoperative supraventricular arrhythmia in patients undergoing pulmonary resection surgery?' Altogether almost 150 papers were found as a result of the reported search, of which 14 represented the best evidence to reach conclusions regarding the issues of interest for this review. The major outcome of interest that was investigated was the incidence of supraventricular arrhythmia (SVA), notably atrial fibrillation (AF). ⋯ We conclude that there is an indication for routine prophylaxis against postoperative supraventricular arrhythmia in patients undergoing pulmonary resection. However, further data are needed to ascertain the impact of said anti-arrhythmic medications on the length of postoperative hospital stay, intensive care unit stay and cost. Those patients deemed high-risk need to be promptly identified, so the anti-arrhythmic therapy can be tailored to the cohort thus optimizing on cost and safety.
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Interact Cardiovasc Thorac Surg · Jul 2014
Comparative StudyEstablishment of right ventricle-pulmonary artery continuity as the first-stage palliation in older infants with pulmonary atresia with ventricular septal defect may be preferable to use of an arterial shunt.
Right ventricle-pulmonary artery (RV-PA) conduit and systemic-to-pulmonary artery (S-PA) shunt in younger infants for the first-stage palliation with pulmonary atresia with ventricular septal defect (PAVSD) obtained good results. However, the pulmonary arteries (PA) grow slow in older infants undergoing an S-PA shunt. We compared the clinical outcomes of the two procedures in older infants with PAVSD. ⋯ In older infants with PAVSD who underwent the first-stage palliative procedure, early outcomes showed no difference between the RV-PA conduit group and the S-PA shunt group. The RV-PA conduits were associated with better growth of the PA and higher rates of second-stage biventricular repair. Autologous pericardium is a good choice for RV-PA conduits, and there is a correlation between body weight and size of conduit.
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Interact Cardiovasc Thorac Surg · Jul 2014
Negative pressure therapy for post-sternotomy wound infections in young children.
Post-sternotomy wound infection remains a significant morbidity in congenital and paediatric cardiac surgery. However, the techniques used for this complication in children are not optimal in terms of mortality, morbidity and the use of medical resources. Negative pressure therapy is an effective modality in the treatment in adults, but reports of its use in children are limited. This study evaluated the use of negative pressure therapy in young children for post-sternotomy wound infections. ⋯ Negative pressure therapy is an effective treatment modality for wound infections in paediatric cardiac surgery and results in low morbidity, mortality and medical resource use.
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Interact Cardiovasc Thorac Surg · Jul 2014
Case ReportsDouble lung procurement from a donor supported by a left ventricular assist device.
Over the past several years, the selection criteria for marginal donor lungs have been extended. However, brain-dead patients with implanted mechanical circulatory support systems have not yet been considered as potential organ donors for lung transplantation. Our report presents the first successful procurement and transplantation of donor lungs from a patient supported by a left ventricular assist device. ⋯ The subsequent sequential bilateral lung transplantation was performed without complications. Postoperative course and follow-up were uneventful. This case demonstrates the feasibility of lung transplantations from organ donors supported by a mechanical circulatory support system.
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Interact Cardiovasc Thorac Surg · Jul 2014
Selective reduction of afterload in right heart assist therapy: a mock loop study†.
The treatment of right ventricular failure is closely linked to effects on pulmonary vascular resistance and thus the right ventricular (RV) afterload. Medical therapy includes afterload-decreasing drugs such as nitric oxide and prostacycline. However, current devices for mechanical unloading of the right ventricle aim at a decrease in preload increasing the pulmonary volume loading. In our concept study, we tested a minimally invasive right ventricular assist device (MIRVAD) that specifically reduces the afterload. ⋯ The feasibility of RV unloading by a selective decrease in RV afterload was proved in principle. By alternation of the pump speed, gradual reloading in sense of a myocardial training may be achieved. The results will be validated by future animal trials where the relationship between the level of support and pulmonary vascular pressure can be investigated in vivo. Further device design concerning foldable impeller leaflets will be carried out. At a final stage, the crimped version is supposed to reach a size below 1 cm to facilitate minimally invasive insertion.