Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Aug 2011
Comparative StudyOne-year follow-up of patients undergoing elective cardiac surgery assessed with the Comprehensive Assessment of Frailty test and its simplified form.
Assessment of perioperative risk of elderly patients in cardiac surgery is demanding. Most of the commonly used cardiac surgery risk scores over-or underestimate individual risk. Therefore, we recently developed a 'frailty score', the comprehensive assessment of frailty (CAF) score that showed a good prediction of 30-day mortality. ⋯ A new, easily applicable score ('Frailty predicts death One yeaR after Elective Cardiac Surgery Test') was built out of the basic score and showed a promising ability to predict one-year mortality. CAF is a new additional tool to assess prognosis of elderly patients before cardiac surgical interventions. The 'CAF' score facilitates prediction of mid-term outcome of high-risk elderly patients.
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Interact Cardiovasc Thorac Surg · Aug 2011
Case ReportsAortic valve-sparing operations in aortic root aneurysms: remodeling or reimplantation?
A best evidence topic was written according to a structured protocol. The question addressed was whether the reimplantation (David) technique or the remodeling (Yacoub) technique provides the optimum event free survival in patients with an aortic root aneurysm suitable for an aortic valve-sparing operation. In total, 392 papers were found using the reported search criteria, of which 14 papers provided the best evidence to answer the clinical question. ⋯ Although some authors merely preferred the Yacoub technique for a bicuspid aortic valve, the accumulated evidence in the current review indicates comparable results for both techniques in a bicuspid aortic valve. Current evidence is in favour of the David rather than the Yacoub technique in pathologies such as Marfan syndrome, acute type A aortic dissection, and excessive annular dilatation that may impair aortic root integrity. Careful selection of patients for each technique and successful restoration of normal cusp geometry are the keys to success in aortic valve-sparing operations.
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Interact Cardiovasc Thorac Surg · Aug 2011
Case ReportsThe Novalung interventional lung assist as bridge to lung transplantation for self-ventilating patients - initial experience.
We report the use of the Novalung pumpless device in self-ventilating patients awaiting a lung transplantation. Two patients developed carbon dioxide retention with respiratory acidosis that did not respond to maximum medical therapy. ⋯ The second patient was weaned off the Novalung after a short period. The Novalung is a valuable device for self-ventilating patients with carbon dioxide retention being bridged to lung transplantation.
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Interact Cardiovasc Thorac Surg · Aug 2011
Case ReportsHalf-turned truncal switch operation for transposition of great arteries with ventricular septal defect and pulmonary regurgitation.
A three-month-old girl weighing 4.2 kg, diagnosed with transposition of the great arteries (TGA) and ventricular septal defect (VSD) was referred to us. She had normal-sized pulmonary annulus and moderate pulmonary regurgitation. ⋯ The postoperative course was uneventful without left or right ventricular outflow obstructions over a year of follow-up. Our report demonstrated that the TGA and VSD with normal pulmonary annulus is not contraindicated for half-turned truncal switch operation.
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Interact Cardiovasc Thorac Surg · Aug 2011
Comparative StudyThe obesity paradox in elderly obese patients undergoing coronary artery bypass surgery.
We sought to determine whether the protective role of the 'obesity paradox' was present among elderly obese patients undergoing coronary artery bypass grafting (CABG) by median sternotomy. We retrospectively analyzed 1909 consecutive patients who underwent heart surgery between January 2006 and June 2009, and identified 396 patients who were ≥ 70 years of age and had isolated CABG. Subjects were divided into three groups according to their body mass index (BMI): obese (BMI ≥ 30 kg/m(2)), overweight (BMI 25-29.99 kg/m(2)) and normal (BMI 18.5-24.99 kg/m(2)). ⋯ Re-exploration for bleeding was required in none of the obese patients, which was statistically significant (P=0.05) compared to the other groups; otherwise there was no statistical difference for all other complications, including total length hospital stay and length of stay in the intensive care unit. Despite being labeled as higher risk candidates preoperatively, obese elderly patients undergoing CABG did not demonstrate an increased risk of postsurgical complications. We conclude that the 'obesity paradox' is present in this population, and they should not be excluded from receiving the benefits of CABG.