Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2010
Intercostal-subcostal combined complete port-accessed video-assisted lobectomy.
Video-assisted lobectomy procedures include a broad spectrum of operative techniques that range from complete thoracoscopic surgery to minithoracotomy with a thoracoscope serving only as a light source. We describe a modified method for thoracoscopic approach for lobectomy with thoracic muscle sparing based on a combined complete port-accessed technique with a subcostal incision. We have successfully used this technique for lobectomies in stage I lung tumors. Intercostal muscles and nerve injury preservation allied to fast track rehabilitation perioperative care allowed rapid postoperative recovery.
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Interact Cardiovasc Thorac Surg · Oct 2010
Case ReportsSuccessful support and separation from veno-venous extracorporeal membrane oxygenation support in a three-month-old patient following bidirectional Glenn procedure.
While extracorporeal membrane oxygenation (ECMO) is a useful mechanism of providing support in pediatric patients with cardiopulmonary dysfunction following surgery for congenital heart disease, outcomes have varied dramatically between distinct cardiac diagnoses. Reported outcomes of ECMO support following a bidirectional Glenn procedure in patients with single ventricle physiology are uniformly poor due in part to physiological and anatomical challenges inherent to cannulation in this population. We describe a unique veno-venous cannulation that can be applied to this patient population and has allowed for successful decannulation in our practice.
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Interact Cardiovasc Thorac Surg · Oct 2010
Case ReportsThrombosis of the ascending aorta during mechanical circulatory support in a patient with cardiogenic shock.
Cardiogenic shock after percutaneous coronary intervention (PCI) is a life-threatening complication and is most often related to abrupt vessel closure. We present the case of a patient who developed cardiogenic shock after PCI and was supported with intra-aortic balloon counterpulsation and the Levitronix CentriMag short-term mechanical circulatory support. ⋯ Preoperative transesophageal echocardiography revealed a massive thrombus of the aortic root and ascending aorta despite optimal anticoagulation regimen. The patient succumbed due to multiorgan failure.
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Interact Cardiovasc Thorac Surg · Oct 2010
Improved outcomes of paediatric extracorporeal support associated with technology change.
This study aims to evaluate the impact of a change in extracorporeal membrane oxygenation (ECMO) technology on patient and circuit outcomes. A retrospective single-centre study of all ECMO runs from 1988 to 2006 was performed. Predictors of survival to hospital discharge (primary outcome measure) were evaluated in the entire cohort by univariate and multivariate analysis. ⋯ There was a significant reduction in mechanical circuit complications in the respiratory ECMO subgroup. A significant improvement in patient survival outcomes and reduction in mechanical circuit complications was noted in the current era. This improvement was associated with a change in ECMO technology.
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Interact Cardiovasc Thorac Surg · Oct 2010
Does the use of non-steroidal anti-inflammatory drugs after cardiac surgery increase the risk of renal failure?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief post-cardiac surgery increases the risk of renal failure. Altogether 53 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. ⋯ In contrast, one RCT assessing these COX-2 inhibitors detected a significant increase in the incidence of oliguria in this group compared to controls (parecoxib/valdecoxib: 14.5%, controls: 9.9%, P=0.187) as well as renal dysfunction (parecoxib/valdecoxib: 1.9%, controls: 0%, P=0.184). Three retrospective studies within paediatric populations, including one cohort study and two chart reviews, found various parameters of renal function, such as serum creatinine and blood urea nitrogen, to be similar between ketorolac and control groups. We conclude that NSAIDs are not associated with an increased risk of renal failure after cardiac surgery when administered at optimal 'renal' doses, within early postoperative settings, to patients at low-risk of renal dysfunction in whom NSAIDs are not contraindicated.