Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Aug 2009
Multicenter Study Clinical TrialThe role of thoracoscopy for the diagnosis of hidden diaphragmatic injuries in penetrating thoracoabdominal trauma.
Patients with a thoracoabdominal stab wound may have hidden diaphragmatic injuries that could finally lead to chronic diaphragmatic hernia. In this study, we analyzed 30 patients with penetrating thoracoabdominal injuries that were stable hemodynamically and did not need emergency exploration. They underwent thoracoscopy in order to find a probable diaphragmatic injury from March 2005 to October 2007. ⋯ We performed thoracoabdominal CT-scan 6 months later and chronic diagrammatic hernias were not reported. Diagnostic accuracy of thoracoscopy was 100%. Owing to the high diagnostic accuracy rate, minimal invasiveness and therapeutic potency of thoracoscopy we recommend it to be performed in all clinically stable patients with penetrating thoracoabdominal penetrating injury especially in the 8th intercostal space.
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Interact Cardiovasc Thorac Surg · Aug 2009
ReviewDoes use of intra-operative cerebral regional oxygen saturation monitoring during cardiac surgery lead to improved clinical outcomes?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of cerebral regional oxygen saturation (rSO(2)) monitoring during cardiac surgery can lead to improved clinical outcomes. Altogether 488 papers were found using the reported search, of which eight presented the best evidence to answer the clinical question. ⋯ Further, interventions carried out by thoughtful use of the cerebral oximeter are associated with significant reduction in neurologic injury, major organ morbidity and mortality (MOMM) and duration of hospital stay. Some studies have indicated decreased ventilation and intensive care unit (ICU) stay times as well. Clinical benefit and the lack of use-associated risk of injury at a modest expense support the use of this device routinely in patients undergoing cardiac surgery.
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Interact Cardiovasc Thorac Surg · Aug 2009
ReviewIs ministernotomy superior to conventional approach for aortic valve replacement?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is ministernotomy superior to conventional approach for aortic valve replacement (AVR)? Altogether, more than 115 papers were found using the reported search, of which six represented the best evidence to answer the clinical question. ⋯ We conclude that ministernotomy can be performed safely for AVR, without increased risk of death or other major complication; however, few objective advantages have been shown. Ministernotomy can be offered on the basis of patient choice and cosmesis rather than evident clinical benefit.
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Interact Cardiovasc Thorac Surg · Aug 2009
ReviewIs a minimally invasive approach for re-operative mitral valve surgery superior to standard resternotomy?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is a minimally invasive approach superior to standard sternotomy for re-operative mitral valve surgery?'. Altogether 48 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. ⋯ We conclude that minimally invasive mitral valve re-operation can be performed with an operative mortality similar to standard sternotomy approach but with a higher patient satisfaction. Less postoperative bleeding, reduced need for blood transfusion and absence of sternal wound infection are the main advantages of this technique. Mean hospital stays and ventilation time appear to be reduced with this approach.
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Interact Cardiovasc Thorac Surg · Aug 2009
Randomized Controlled TrialA pilot randomized study of the neutrophil elastase inhibitor, Sivelestat, in patients undergoing cardiac surgery.
The primary objective of this study was to determine the feasibility and safety of treatment with Sivelestat in humans to attenuate post-cardiopulmonary bypass lung injury. Twenty patients scheduled to undergo on-pump coronary artery bypass surgery were randomized to receive either 0.3 mg/kg/h intravenous Sivelestat sodium (Sivelestat group; n=10) or isotonic sodium chloride solution (placebo group, n=10), peri-operatively. Postoperative adverse events were recorded until hospital discharge. ⋯ The mean duration of the postoperative hospital stay was shorter in the Sivelestat group (19.0+/-3.4 vs. 25.6+/-9.1, P=0.04). The exploratory analysis of relative changes in lung functions showed trends toward attenuation of lung injury in the Sivelestat group in all three pulmonary parameters, though the inter-group difference could be due to chance (P>0.05). It is feasible to administer Sivelestat as a preventive measure against lung dysfunction after cardiopulmonary bypass.