Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2021
Does erector spinae plane block result in improved postoperative analgesia and enhanced recovery in adult patients after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether erector spinae plane block (ESPB) resulted in improved postoperative analgesia and enhanced recovery in adult cardiac surgical patients. A total of 333 papers were found using the reported search of which, 7 papers represented the best evidence to answer the clinical question. ⋯ With ESPB, there was significant improvement in postoperative pain scores (4 studies), decreased opioid requirement/rescue analgesia (3 studies), increased duration of analgesia (1 study), decreased time to extubation (3 studies), less increase in postoperative Troponin T (1 study), earlier ambulation (2 studies), earlier oral intake (1 study), earlier chest drain removal (1 study), better patient satisfaction (1 study), reduced adverse events (1 study) and decreased intensive care unit stay (3 studies). We conclude that ESPB may be associated with improved postoperative analgesia and enhanced recovery after adult cardiac surgery based on the available evidence. However, there is a need for better quality randomized controlled trials to consolidate these findings.
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Interact Cardiovasc Thorac Surg · May 2021
Meta AnalysisModified ultrafiltration reduces postoperative blood loss and transfusions in adult cardiac surgery: a meta-analysis of randomized controlled trials.
Cardiopulmonary bypass in cardiac surgery has been associated with several deleterious effects including haemodilution and systemic inflammation. Modified ultrafiltration (MUF) has been well established in paediatric cardiac surgery in counteracting postperfusion syndrome. However, MUF is less commonly used in adult cardiac surgery. In this meta-analysis, we compared clinical outcomes in adult patients who underwent cardiopulmonary bypass with and without MUF. ⋯ MUF is a safe and feasible option in adult cardiac patients, with significant benefits including improved postoperative haematocrit, as well as reduced postoperative chest tube bleeding, transfusion requirements and duration of ICU stay.
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Interact Cardiovasc Thorac Surg · May 2021
Outcomes of Liu's aortic root repair and valve preservation in patients with type A dissection and aortic regurgitation.
To evaluate short- and medium-term outcomes following Liu's aortic root repair and valve preservation in patients with acute type A aortic dissection complicated by moderate-to-severe aortic regurgitation (AR). ⋯ Liu's aortic root repair and valve preservation is a safe and effective operative strategy that achieves favourable short- and medium-term outcomes for acute type A aortic dissection with moderate-to-severe AR.
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Interact Cardiovasc Thorac Surg · May 2021
Initiation of an inter-hospital extracorporeal membrane oxygenation transfer programme for critically ill patients with coronavirus disease 2019: bringing extracorporeal membrane oxygenation support to peripheral hospitals.
Extracorporeal membrane oxygenation (ECMO) is a resource-intensive, highly specialized and expensive therapy that is often reserved for high-volume centres. In recent years, we established an inter-hospital ECMO transfer programme that enables ECMO implants in peripheral hospitals. During the pandemic, the programme was expanded to include ECMO support in selected critically ill patients with coronavirus disease 2019 (COVID-19). ⋯ Out-of-centre ECMO implants in well-selected patients with COVID-19 is feasible and safe if a well-established organization is available and if the implantation is done by an experienced and regularly trained team.