Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2013
Randomized Controlled Trial Comparative StudyA randomized trial of early versus delayed mediastinal drain removal after cardiac surgery using silastic and conventional tubes.
Mediastinal drainage following cardiac surgery with traditional large-bore plastic tubes can be painful and cumbersome. This study was designed to determine whether prolonged drainage (5 days) with a silastic tube decreased the incidence of significant pericardial effusion and tamponade following aortic or valvular surgery. ⋯ In patients undergoing ascending aortic or valvular surgery, prolonged drainage with silastic tubes is safe and does not increase postoperative pain. There was no difference between the Blake and conventional drains with regard to significant pericardial effusion or tamponade in this cohort; however, this conclusion is limited by the low overall incidence of the primary outcome in this cohort.
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Interact Cardiovasc Thorac Surg · Jul 2013
ReviewCan lungs be taken for transplantation from donors with a significant smoking history?
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Can lungs be taken for transplantation from donors with a significant smoking history?’. Five papers were found using the reported search that represented the best evidence to answer the clinical question. ⋯ Despite the difference in long-term results and outcome reported by these authors, all of these studies unanimously indicate that lungs from smokers should not be rejected, as survival in these patients receiving smoker lungs is still significantly higher in 3 and 5 years compared with that in those who remain on the transplant waiting list. In conclusion, the current evidence in the literature suggests that lungs from smokers can be used for transplantation. Patients should, however, be fully informed of the risks involved with these lungs and the worse outcome compared with those receiving non-smoker lungs.
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Interact Cardiovasc Thorac Surg · Jul 2013
Oxygenated shunting from right to left: a feasibility study of minimized atrio-atrial extracorporeal membrane oxygenation for mid-term lung assistance in an acute ovine model.
Right ventricular failure is often the final phase in acute and chronic respiratory failure. We combined right ventricular unloading with extracorporeal oxygenation in a new atrio-atrial extracorporeal membrane oxygenation (ECMO). ⋯ We demonstrated the efficacy of a miniaturized atrio-atrial ECMO. Right ventricular unloading was achieved, and gas exchange was well taken over by the Novalung. This allows an effective short- to mid-term treatment of cardiopulmonary failure, successfully combining right ventricular and respiratory bridging. The parallel bypass of the right ventricle and lung circulation permits full unloading of both systems as well as gradual weaning. Further pathologies (e.g. ischaemic right heart failure and acute lung injury) will have to be evaluated.
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Interact Cardiovasc Thorac Surg · Jul 2013
Case ReportsCombined transection of the left common carotid artery and delayed left main bronchus disruption after blunt chest trauma.
A 26-year old female was hit in the cervical region by a large block of ice and admitted with stable vital signs and multiple fractures. Chest radiography demonstrated an enlarged mediastinum, and CT scan revealed a transection of the left common carotid artery at its origin, with a false aneurysm. The lesion was repaired using a median sternotomy, cardiopulmonary bypass, moderate hypothermia and cerebral antegrade perfusion through the right axillary artery. The bronchial lesion was diagnosed 2 days later and successfully treated with left posterolateral thoracotomy and the use of direct bronchial anastomosis.
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Interact Cardiovasc Thorac Surg · Jul 2013
Suction-irrigation drainage: an underestimated therapeutic option for surgical treatment of deep sternal wound infections.
Deep sternal wound infections are significant and severe complications following cardiac surgery and substantially influence perioperative morbidity and mortality. We present the experience of our department using two different surgical treatments over a three-year period. ⋯ Contrary to accepted opinion, the suction-irrigation drainage is an appropriate therapy for deep sternal wound infections. Nevertheless, deep sternal wound infections after cardiac surgery remain severe complications and are related to increased morbidity and mortality.