Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2014
Review Meta AnalysisAdjunct coronary endarterectomy increases myocardial infarction and early mortality after coronary artery bypass grafting: a meta-analysis.
Coronary endarterectomy (CE) may provide a useful adjunct to coronary artery bypass grafting (CABG) in patients with extensive, diffuse coronary atheroma. However, concerns regarding its morbidity and mortality have created uncertainty as to the role of CE in the current era. The aim of this study was therefore to quantitatively summarize the short- and long-term outcomes of CE. ⋯ Increased 30-day morbidity and mortality continues to raise concerns over the safety of adjunct CE. Furthermore, the procedure can be associated with worse long-term graft patency. To better determine whether CE should remain a viable adjunct to CABG, novel studies must focus on collecting prospective data with homogeneous inclusion criteria for CE as well as isolating outcomes for different coronary vessels and standardizing postoperative anticoagulation.
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Interact Cardiovasc Thorac Surg · Sep 2014
ReviewIn surgeons performing cardiothoracic surgery is sleep deprivation significant in its impact on morbidity or mortality?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is there a difference in cardiothoracic surgery outcomes in terms of morbidity or mortality of patients operated on by a sleep-deprived surgeon compared with those operated by a non-sleep-deprived surgeon? Reported search criteria yielded 77 papers, of which 15 were deemed to represent the best evidence on the topic. Three studies directly related to cardiothoracic surgery and 12 studies related to non-cardiothoracic surgery. ⋯ There is little direct evidence in the literature demonstrating the effect of sleep deprivation in cardiothoracic surgeons on morbidity or mortality. However, overall the non-cardiothoracic studies have demonstrated that operative time and sleep deprivation can have a significant impact on overall morbidity and mortality. It is likely that other confounding factors concomitantly affect outcomes in out-of-hours surgery.
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Interact Cardiovasc Thorac Surg · Sep 2014
ReviewDo patients with haematological malignancy who need cardiopulmonary bypass have a short-term higher mortality or a higher chance of disease progression?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether patients with haematological malignancy (HM) who need cardiopulmonary bypass (CPB) have a higher short-term mortality or a higher chance of disease progression secondary to CPB. Altogether, 107 papers were found using the reported search terms, but ultimately only eight were relevant to our subject. ⋯ No paper reported an acute change in blood disorders. Long-term mortality rates were not mentioned in some papers, but when it was stated, the HM patients' long-term mortality seemed not increased by using CPB surgery, with more than 80% survival at 3 years and 20-25% progression of the disease at 3 years. Although these study limitations are linked to the low-evidence levels in some of the papers used, haematological malignancies should not be considered a contraindication for cardiac CPB surgery.
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Interact Cardiovasc Thorac Surg · Sep 2014
Randomized Controlled Trial Comparative StudyComparative evaluation of high-flow nasal cannula and conventional oxygen therapy in paediatric cardiac surgical patients: a randomized controlled trial.
The aim of this study was to compare high-flow nasal cannula (HFNC) and conventional O2 therapy (OT) in paediatric cardiac surgical patients; the primary objective of the study was to evaluate whether HFNC was able to improve PaCO2 elimination in the first 48 h after extubation postoperatively. ⋯ HFNC had no impact on PaCO2 values. The use of HFNC appeared to be safe and improved PaO2 in paediatric cardiac surgical patients.
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Interact Cardiovasc Thorac Surg · Sep 2014
Randomized Controlled Trial Comparative StudySub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trial.
The aim of this trial was to compare functional capacity, pulmonary shunt fraction and clinical outcomes between patients undergoing pleurotomy with a pleural drain inserted in the sub-xyphoid position and patients with a pleural drain placed in the intercostal position after off-pump coronary artery bypass surgery. ⋯ Sub-xyphoid pleural drain determined better functional capacity and exercise tolerance with a smaller pulmonary shunt fraction and improved clinical outcomes compared with intercostal pleural drainage after off-pump coronary artery bypass surgery.