Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Jun 2012
ReviewIs cold or warm blood cardioplegia superior for myocardial protection?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of warm or cold blood cardioplegia has superior myocardial protection. More than 192 papers were found using the reported search, of which 20 represented the best evidence to answer the clinical question. ⋯ A minority of studies suggested a benefit of cold cardioplegia over warm in particular patient subgroups: One group conducted a retrospective study of 520 patients who required prolonged aortic cross-clamp times, results demonstrated less myocardial damage and reduced postoperative cardiac mortality and morbidity in the cold group. The clinical bottom line is that warm and cold cardioplegia result in similar short-term mortality. However, large studies have shown that warm cardioplegia reduces adverse post-operative events; the significance of which is unclear.
-
Interact Cardiovasc Thorac Surg · Jun 2012
Minimal traumatic aortic injuries: meaning and natural history.
OBJECTIVE Minimal aortic injuries (MAIs) are being recognized more frequently due to the increasing use of high-resolution diagnostic techniques. The objective of this case series review was to report the clinical and radiological characteristics and outcomes of a series of patients with MAI. METHODS From January 2000 to December 2011, 54 major blunt trauma patients were admitted to our institution with traumatic aortic injuries. ⋯ In contrast to SAI traumas, in-hospital mortality due to MAI is not usually related to the aortic injury, so these injuries are more amenable to a conservative management. It is mandatory to perform a close imaging surveillance to detect early any potential adverse evolution of an MAI. Nevertheless, a balance must be struck between a close serial imaging surveillance and the potentially detrimental effects of obtaining high-resolution additional images.
-
Interact Cardiovasc Thorac Surg · Jun 2012
Case ReportsSuccessful use of a military haemostatic agent in patients undergoing extracorporeal circulatory assistance and delayed sternal closure.
We report the successful control of bleeding in two patients who underwent post-cardiotomy extracorporeal circulatory support (ECMO) and then developed life-threatening bleeding due to severe coagulopathy. After the failure of conventional techniques, bleeding control was achieved using Celox Gauze (MedTrade Products Ltd, Cheshire, UK) packed on the sternal edges and pericardial cavity.
-
Interact Cardiovasc Thorac Surg · Jun 2012
Self-perceived video-assisted thoracic surgery lobectomy proficiency by recent graduates of North American thoracic residencies.
Minimally invasive surgical techniques offer several advantages over traditional open procedures, yet the pathway to minimally invasive proficiency can be difficult to navigate. As a part of an effort of the Joint Council of Thoracic Surgical Education to increase access to this skill set in the general thoracic community, recent graduates of thoracic residencies were surveyed to determine the self-reported achievement of video-assisted thoracic surgery (VATS) lobectomy proficiency and the merits of various educational opportunities. The objective of this study was to estimate the comfort level of recent graduates with the minimally invasive approach, as this demographic not only reflects the current status of training, but represents the future of the specialty. ⋯ The vast majority of the 25 dedicated general thoracic surgeons who graduate each year consider themselves proficient in VATS lobectomies, largely due to training in their thoracic residencies. On the other hand, the minority of surgeons performing general thoracic procedures as a part of a mixed practice consider themselves proficient in VATS lobectomies. Further study is warranted to enhance the VATS lobectomy experience of mixed practice surgeons particularly during their thoracic residencies.
-
Interact Cardiovasc Thorac Surg · Jun 2012
Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension.
Delayed presentation of ventricular septal defect (VSD) is common in developing countries. Such patients often have severe pulmonary arterial hypertension (PAH), which increases post-operative morbidity and mortality. To address these problems, we used our technique of unidirectional valved patch (UVP) for closure of VSD. ⋯ Mean follow-up was 30 ± 14.7 months and all patients are well without cyanosis. Echocardiography showed no shunt across the patch and all have systemic saturation >95%. We conclude that UVP is a promising technique in patients with large VSD and severe PAH.