Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Nov 2012
Review Meta AnalysisHaemodynamic goal-directed therapy in cardiac and vascular surgery. A systematic review and meta-analysis.
In cardiovascular surgery, reduced organ perfusion and oxygen delivery contribute to increased postoperative morbidity and prolonged intensive care unit stay. Goal-directed therapy (GDT), a perioperative haemodynamic strategy aiming to increase cardiac output, is helpful in preventing postoperative complications, but studies in the context of cardiovascular surgery have produced conflicting results. The purpose of the present meta-analysis is to determine the effects of perioperative haemodynamic goal-directed therapy on mortality and morbidity in cardiac and vascular surgery. ⋯ Perioperative GDT prevents postoperative complications in cardiac surgery patients, while it has no effect in vascular surgery. The different characteristics and comorbidities of the population enrolled could explain these conflicting results. More trials conforming to the characteristics of low-risk-of-bias studies and enrolling a larger and well-defined population of patients are needed to better clarify the effect of GDT in the specific setting of cardiovascular surgery.
-
Interact Cardiovasc Thorac Surg · Nov 2012
Comparative StudyLength of intensive care unit stay following cardiac surgery: is it impossible to find a universal prediction model?
Accurate models for prediction of a prolonged intensive care unit (ICU) stay following cardiac surgery may be developed using Cox proportional hazards regression. Our aims were to develop a preoperative and intraoperative model to predict the length of the ICU stay and to compare our models with published risk models, including the EuroSCORE II. ⋯ A universal model for prediction of ICU stay may be difficult to develop, as the distribution of length of stay may depend on both medical factors and institutional policies governing ICU discharge.
-
Interact Cardiovasc Thorac Surg · Nov 2012
Comparative StudyDiagnostic accuracy of 16- versus 64-slice multidetector computed tomography angiography in the evaluation of coronary artery bypass grafts: a comparative study.
Multidetector computed tomography (MDCT) angiography, which is used for native coronary vessels and bypass graft (CABG) imaging is a non-invasive test. Here, we aimed to compare the diagnostic accuracy of 16- and 64-slice MDCT for graft patency and stenosis. ⋯ This study showed that the 16-slice has a diagnostic accuracy comparable with the 64-slice system for graft patency and can still be used for this purpose if newer systems with improved performance are not available on-site. On the other hand, by the virtue of better image quality, the 64-slice MDCT demonstrates significant graft lesions with higher sensitivity.
-
Interact Cardiovasc Thorac Surg · Nov 2012
Case ReportsSurgical management of superior vena cava syndrome after failed endovascular stenting.
The superior vena cava syndrome encompasses a constellation of symptoms and signs resulting from obstruction of the superior vena cava. We report a successful surgical management after failed endovascular stenting for superior vena cava syndrome, caused by a postradiation fibrosis after conventional radiotherapy for breast cancer. We emphasize the rarity of this uncommon surgical procedure and the bailout procedure for failed angioplasty and intravascular stenting. Key points of superior vena cava syndrome and its management are discussed.