Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2010
ReviewIn patients with severe active aortic valve endocarditis, is a stentless valve as good as the homograft?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients with severe active aortic valve endocarditis, is a stentless valve as good as a homograft?' The scientific literature was reviewed by searching Medline, using the OVID interface, from 1950 to March 2010. One hundred and eight papers were found. ⋯ He finds the reinfection rate to be lower for the homograft and stentless groups than for the patients treated with standard prostheses, respectively, 5.8%, 3.7% and 33%. The stentless valve offers a reinfection rate and postoperative echocardiographic data comparable to those achieved with homografts. Further follow-up is required to determine the stentless valve durability and long-term freedom from valve-related complications.
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Interact Cardiovasc Thorac Surg · Sep 2010
ReviewDoes the prophylactic administration of N-acetylcysteine prevent acute kidney injury following cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'does prophylactic administration of N-acetylcysteine (NAC) prevent acute kidney injury (AKI) following cardiac surgery?' More than 60 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ The RCTs have investigated the use of NAC to prevent AKI in low-risk patients, high-risk patients and high-risk patients with pre-existing chronic kidney disease. The meta-analyses and RCTs demonstrated that the prophylactic administration of NAC did not reduced the incidence of AKI, postoperative complications, postoperative interventions, mortality or length of ICU stay. We conclude that prophylactic administration of NAC does not prevent AKI or reduce mortality following cardiac surgery.
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Interact Cardiovasc Thorac Surg · Sep 2010
Case ReportsAcute aortic syndrome: a 'last glance' before incision.
Acute aortic syndrome (AAS) (aortic dissection, intramural aortic haematoma, or penetrating atherosclerotic ulcer) is a surgical emergency. Computed tomography (CT) is the reference technique for the diagnosis of this critical situation. ⋯ We describe the case of a 76-year-old man with clinical signs of AAS and a CT-scan compatible with a diagnosis of aortic intra-mural haematoma, leading to emergency surgery. The peroperative findings revealed a normal aortic wall with the presence of an unusual pericardial recess at the right side of the aorta.
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Interact Cardiovasc Thorac Surg · Sep 2010
Comparative StudyElectrothermal bipolar vessel sealing device LigaSureV for pulmonary artery ligation--burst pressure and clinical experiences in complete video-assisted thoracoscopic major lung resection for lung cancer.
Intraoperative bleeding is one of the main severe complications in complete video-assisted thoracoscopic surgery (c-VATS). We investigated whether one sealing device, the LigaSureV (LSV) vessel sealing system (Valleylab, Tyco Healthcare, Boulder, CO, USA) was experimentally and clinically safe and effective for c-VATS. The burst pressures (BP) of each pulmonary artery (PA) in resected lungs were measured and were compared between a thin PA group (<5 mm) and a thick PA group (> or =5 mm). ⋯ However, average BP was physiologically high enough to inhibit a burst even for thick PA sealed in a wet state. There was single case of delayed bleeding sealed PA resulted from seal contact with a sucton device. These studies demonstrated the safety and efficacy of the LSV to sealed PA in c-VATS.
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Interact Cardiovasc Thorac Surg · Sep 2010
Case ReportsPrimary pleomorphic liposarcoma of pericardium.
We report a case of a 42-year-old man, who presented with a three-weeks' history of dyspnea and chest oppression induced by light activity, who had a large mass in the pericardium. Computed tomography showed a non-homogeneous density lobulated mass in the pericardial sac. ⋯ The patient is still alive 18 months after the diagnosis was made. The rare incidence of the liposarcoma of the pericardium can easily lead to a misdiagnosis clinically, and the final diagnosis here was made histopathologically.