Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2015
Multicenter Study Observational StudyRed blood cell transfusion is a determinant of neurological complications after cardiac surgery.
The aim of this study was to evaluate the impact of red blood cell (RBC) transfusions on the occurrence of stroke and transient ischaemic attack (TIA) after cardiac surgery. ⋯ Transfusion of more than 2 units of RBCs after cardiac surgery is associated with a significantly increased risk of postoperative stroke and TIA.
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Interact Cardiovasc Thorac Surg · Feb 2015
Randomized Controlled Trial Comparative StudyRole of sevoflurane in organ protection during cardiac surgery in children: a randomized controlled trial.
The protective effects of volatile anaesthetics against ischaemia-reperfusion injury have been shown in vitro, but clinical studies have yielded variable results. We hypothesized that, in children, sevoflurane provides superior cardioprotection after cardiac surgery on cardiopulmonary bypass (CPB) compared with totally intravenous anaesthesia (TIVA). ⋯ Sevoflurane did not provide superior myocardial protection in our general paediatric cardiac surgical population. In children under 6 months, however, sevoflurane might be beneficial in comparison with midazolam. The conditioning effects of sevoflurane in specific paediatric subgroups need to be further investigated.
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Interact Cardiovasc Thorac Surg · Feb 2015
Surgical embolectomy for intermediate-risk acute pulmonary embolism.
Recent series reported excellent results of surgical embolectomy in patients with acute pulmonary embolism with mortality rates of about 5-9% (range 0-13%). However, very low mortality of patients receiving medical treatment for intermediate-risk pulmonary embolism (1.5 and 2.8% at 7 and 30 days, respectively) was recently reported. Thus, we would like to challenge the indication for surgical embolectomy in the subset of intermediate-risk patients.
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Interact Cardiovasc Thorac Surg · Feb 2015
Review Meta AnalysisProphylactic treatment with coenzyme Q10 in patients undergoing cardiac surgery: could an antioxidant reduce complications? A systematic review and meta-analysis.
Coenzyme Q10 (CoQ10) is a lipid-soluble antioxidant that could have beneficial effects in patients undergoing cardiac surgery with cardiopulmonary bypass. There is no clear evidence about its clinical effects or a systematic review published yet. We aimed to conduct a systematic review and meta-analysis of the literature to elucidate the role of coenzyme Q10 in preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. ⋯ However, CoQ10 treatment was not associated with Cardiac index 24 h after surgery [mean difference (95% CI) 0.06 (-0.30 to 0.43)], hospital stay (days) [mean difference (95% CI) -0.61 (-4.61 to 3.39)] and incidence of atrial fibrillation [OR (95% CI) 1.06 (0.19-6.04)]. Since none of the clinical trials included in this review report any adverse effects associated to CoQ10 administration, and coenzyme Q10 has been demonstrated to be safe even at much higher doses in other studies, we conclude that CoQ10 should be considered as a prophylactic treatment for preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. However, better quality randomized, controlled trials are needed to clarify the role of CoQ10 in patients undergoing cardiac surgery with cardiopulmonary bypass.
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Interact Cardiovasc Thorac Surg · Feb 2015
Randomized Controlled Trial Comparative StudyA home-made animal model in comparison with a standard manikin for teaching percutaneous dilatational tracheostomy.
As airway management specialists, thoracic surgeons should be familiar with percutaneous dilatational tracheostomy. To optimize the learning curve, we propose a home-made pig model obtained from a slaughterhouse for training residents in the technical aspects of performing percutaneous dilatational tracheostomy. The satisfaction of the residents' training experience using this model was compared with that using a standard manikin model. ⋯ Our pig model allowed residents to develop the skills required for successful percutaneous dilatational tracheostomy. In particular, they developed confidence with certain manoeuvres such as needle and guide-wire placement, dilatation of the trachea and insertion of a cannula, before attempting the procedure on a live patient.