Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2012
Review Case ReportsDoes a conservative fluid management strategy in the perioperative management of lung resection patients reduce the risk of acute lung injury?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether a conservative fluid management strategy in the perioperative management of lung resection patients is associated with a reduced incidence of postoperative acute lung injury (PALI) and/or acute respiratory distress syndrome (ARDS) in the recovery period. Sixty-seven papers were found using the reported search, of which 13 level III and 1 level IV evidence studies represented the best evidence to answer the question. ⋯ On this best evidence, we recommend intra- and postoperative maintenance fluid to be administered at 1-2 ml/kg/h and that a positive fluid balance of 1.5 l should not be exceeded in the perioperative period with caution being exercised with regard to the adequacy of oxygen delivery. If the fluid balance exceeds this threshold, a high index of suspicion for PALI/ARDS should be adopted and escalation of the level of care should be considered. If a patient develops signs of hypoperfusion after these thresholds are exceeded, inotropic/vasopressor support should be considered.
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Interact Cardiovasc Thorac Surg · Sep 2012
Case ReportsSimultaneous complex single ventricle palliation and tracheoplasty for heterotaxy syndrome.
Although isomerism of the bronchial tree is an integral part of hetrotaxy syndrome, the association of congenital tracheal stenosis is rare in this group of disorders, and it has not yet been thoroughly described in the literature. This condition is potentially life-threatening and precludes single ventricle palliation. This report presents the case of a 5-month old infant with symptomatic congenital tracheal stenosis, functionally univentricular heart and extracardiac total anomalous pulmonary venous connection (TAPVC). The condition was successfully treated with bidirectional Glenn anastomosis, central pulmonary artery plasty, repair of TAPVC and slide tracheoplasty.
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Interact Cardiovasc Thorac Surg · Sep 2012
Comparative StudyLow preoperative cerebral oxygen saturation is associated with longer time to extubation during fast-track cardiac anaesthesia.
Fast-track cardiac anaesthesia programs aiming at early tracheal extubation have not only been linked to a decrease in intensive care unit and hospital length of stay but also to a decrease in morbidity and mortality as well as a containment of rising medical costs. General recommendations for the inclusion criteria concerning fast-track programs are not available. ⋯ Cerebral oxygen saturation assessment prior to cardiac surgery is significantly related to time to extubation and may thus be used to stratify candidates in fast-track programs.
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Interact Cardiovasc Thorac Surg · Sep 2012
Comparative StudyOutcomes after ascending aorta and proximal aortic arch repair using deep hypothermic circulatory arrest with retrograde cerebral perfusion: analysis of 207 patients.
Correction of ascending aorta and proximal aortic arch pathology with numerous surgical techniques having been proposed over the years remains a surgical challenge. This study was undertaken to identify risk factors influencing outcome after aortic arch operations, requiring deep hypothermic circulatory arrest (DHCA). ⋯ Ascending aorta and proximal aortic arch replacement with brief duration of deep hypothermic circulatory arrest combined with retrograde cerebral perfusion is a safe method with acceptable short- and long-tem results.
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Interact Cardiovasc Thorac Surg · Sep 2012
Comparative StudyUse of prothrombin complex concentrate for excessive bleeding after cardiac surgery.
Prothrombin complex concentrates (PCCs) are sometimes used as 'off label' for excessive bleeding after cardiopulmonary bypass (CPB). The main objective of this study was to retrospectively evaluate the clinical and biological efficacy of PCC in this setting. ⋯ Administration of low-dose of PCC significantly decreased postoperative bleeding after CPB.