Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2009
Sorin Bicarbon bileaflet valve: a 9.8-year experience. Clinical performance of the prosthesis after heart valve replacement in 587 patients.
To determine early and mid-term clinical performance of the Sorin Bicarbon bileaflet prosthesis. ⋯ Sorin Bicarbon prosthesis provides excellent clinical results and mid-term survival with very low complication rates comparable with those of other bileaflet prostheses currently in use.
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Interact Cardiovasc Thorac Surg · Feb 2009
Case ReportsEndovascular stent placement for acute type-B aortic dissection with malperfusion--an intentional surgical delay and a possible 'bridging therapy'.
Acute aortic dissection frequently causes life-threatening organ ischemia. The optimal therapy for acute type-B aortic dissection is still controversial. Early surgery for acute dissections with organ malperfusion is known to carry a high morbidity and mortality. ⋯ It immediately relieved the abdominal and lower limb ischemic symptoms. The advantage of small-sized stent placement is its easiness and being gentle to fragile intima. The small-sized stent placement for patients with acute aortic dissection with visceral organ ischemia may be a promising 'bridging therapy' before they undergo traditional central repair.
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Interact Cardiovasc Thorac Surg · Feb 2009
Case ReportsCardiac arrest as a major complication of bilateral cervico-dorsal sympathectomy.
Severe palmar and/or axillary hyperhidrosis can be socially and psychologically very disturbing. We present a case of a patient who suffered from a 43 s asystolic cardiac arrest the night following a second contralateral thoracoscopic T(2)-T(3) sympathectomy for severe axillary and truncal hyperhidrosis. The cardiovascular effects of cervico-dorsal sympathectomy will be reviewed. Evaluation required to prevent such a serious cardiac complication will also be discussed.
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Interact Cardiovasc Thorac Surg · Jan 2009
ReviewCould we use abdominal compressions rather than chest compression in patients who arrest after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether abdominal cardiopulmonary resuscitation (CPR) could be used instead of external cardiac massage either to protect the recent sternotomy or while chest compressions are not possible whilst a sternotomy is being performed. Altogether 386 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. ⋯ We found only one paper in a porcine model that looked at the effectiveness of abdominal only CPR although it did show that abdominal CPR was actually 60% better than chest CPR. Interposed abdominal and chest compressions has been much more extensively studied and has been shown to be significantly better in return of spontaneous circulation than chest compressions alone. We conclude that currently there is very little evidence to support abdominal only CPR although these studies may support the concept that it may potentially increase the coronary and cerebral perfusion pressure.
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Interact Cardiovasc Thorac Surg · Jan 2009
ReviewIs aortic valve-sparing operation or replacement with a composite graft the best option for aortic root and ascending aortic aneurysm?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is better to preserve the aortic valve in patients with aortic root or ascending aortic aneurysms. Altogether 380 papers were found using the reported search, of which 23 represented the best evidence to answer the clinical question. ⋯ Sixteen papers reported a 10-year reoperative-free survival from 54% to 98% for valve-sparing operations and 67-81% for replacement operations in two further studies. Six papers reported their 10-year freedom from re-operation as 75-97% for valve-sparing operations. Our findings suggest that the results of both techniques are excellent and comparable, and the operating surgeon may safely make his decision as to which technique to select based on patient factors and his own experience without compromising the long-term outcomes of the patient.