Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2011
Triclosan-coated sutures for the reduction of sternal wound infections? A retrospective observational analysis.
Sternal wound infections are an infrequent but serious complication of cardiac surgery, leading to a prolonged hospital stay, increased costs and greater morbidity. To prevent bacterial colonisation of the suture material, which disables local mechanisms of wound decontamination, sutures coated with triclosan were developed. The current study set out to evaluate the effectiveness of such sutures against the development of sternal wound infections after cardiac surgery. ⋯ Triclosan-coated sutures therefore showed no advantage in avoiding or reducing sternal wound infections. As the cost of these new materials is higher, the rationale for using these sutures remains to be determined.
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Interact Cardiovasc Thorac Surg · Sep 2011
ReviewIs surgery indicated in patients with stage IIIa lung cancer and mediastinal nodal involvement?
The role of surgery in the treatment of patients with stage IIIa non-small cell lung cancer (NSCLC) and mediastinal node involvement is examined in this best evidence topic according to a structured protocol. A total of 579 papers were identified using the outlined search, 12 of which were deemed to represent the best available evidence. From the data summarized, we conclude that surgery, as part of a multimodality therapeutic approach, offers a survival benefit for patients with resectable N2 NSCLC. ⋯ All studies evaluated reported a better outcome in patients with ypN0 (i.e. postinduction N0 disease). However, surgery should not be denied to patients with ypN1-N2, as there is evidence to demonstrate a significant improvement in survival time in all patients able to undergo surgery after induction chemo-radiotherapy. In conclusion, although some of the evidence available is equivocal regarding the survival benefit of resection for stage IIIa N2 disease, the authors believe surgery should be considered as part of a multimodality therapeutic strategy for patients with advanced nodal disease.
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Interact Cardiovasc Thorac Surg · Sep 2011
Case ReportsEarly stenotic prosthesis failure after implantation of a stentless porcine aortic valve prosthesis.
Stentless biological aortic prostheses are used routinely in aortic valve replacement surgery, offering beneficial hemodynamics compared to stented biological valves of similar size. We report here a rare case of early stenotic prosthesis failure of a RootElan stentless porcine aortic valve prosthesis due to swelling at the bottom of the right coronary cusp of the prosthesis.
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Interact Cardiovasc Thorac Surg · Aug 2011
ReviewIdiopathic thrombocytopenic purpura and coronary artery disease: comparison between coronary artery bypass grafting and percutaneous coronary intervention.
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a low platelet count and an increased risk of bleeding. At the same time, ITP patients present an increased risk of thrombosis and atherosclerosis related to the high presence of haemostatic factors and chronic steroid therapy. ⋯ In particular, no recommendations exist regarding the best management approach. We reviewed the literature making a comparison between coronary artery bypass grafting and percutaneous coronary intervention.
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Interact Cardiovasc Thorac Surg · Aug 2011
Comparative StudyPlasma neutrophil gelatinase-associated lipocalin measured in consecutive patients after congenital heart surgery using point-of-care technology.
Neutrophil gelatinase-associated lipocalin (NGAL) is an early predictive biomarker of acute kidney injury. Plasma NGAL was measured in 218 consecutive patients aged three days to 21.1 years after admission to the intensive care unit after cardiopulmonary bypass surgery using a commercially available point-of-care test to evaluate its diagnostic value in daily practice. Plasma NGAL was between 60 and 644 ng/ml in all patients [median 134 (interquartile range 94-194) ng/ml]. ⋯ However, NGAL values were substantially scattered. Plasma NGAL levels early after congenital heart surgery are correlated to acute kidney injury, but the severity of kidney injury cannot be deduced from an individual NGAL value. Therefore, the value of one single plasma NGAL measurement performed early after cardiac bypass surgery for congenital heart disease is limited.