Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2005
A model to predict the decline of the forced expiratory volume in one second and the carbon monoxide lung diffusion capacity early after major lung resection.
The objective of the study was to develop regression models for the prediction of the decline of the forced expiratory volume in one second (FEV1) and the carbon monoxide lung diffusion capacity (DLCO) early after major lung resection. One hundred and ninety patients submitted to pulmonary lobectomy or pneumonectomy for lung cancer performed preoperative and early postoperative (mean 10.9 after operation) pulmonary function tests. One hundred and fifty of these patients also underwent DLCO measurements by the single breath method. ⋯ The following regression equations were derived: estimated percent reduction in FEV1 = 21.34 - (0.47 x age) + (0.49 x percentage of functioning parenchyma removed during operation) + (17.91 x COPD-index); estimated percent reduction in DLCO = 35.99 - (0.31 x age) - (36.47 x FEV1/FVC ratio) + (0.33 x DLCO) + (0.54 x percentage of functioning parenchyma removed during operation). The comparison between observed and estimated losses of FEV1 and DLCO (by using these regression equations) was not significantly different. We think the regression models generated in this study may be reliably used for risk stratification purposes.
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Interact Cardiovasc Thorac Surg · Feb 2005
An introductory educational module for cardiothoracic trainees.
In an attempt to enhance training we have developed an innovative introductory educational module for cardiothoracic trainees. Newly appointed cardiothoracic trainees at the Yorkshire Heart Centre in Leeds have piloted a 6-month programme, comprising 3 months attachment to the Cardiothoracic Intensive Care Unit, and 3 months seconded to allied departments. This report describes this programme, and considers its advantages and disadvantages.
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Interact Cardiovasc Thorac Surg · Dec 2004
Does the use of topical tranexamic acid in cardiac surgery reduce the incidence of post-operative mediastinal bleeding?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of topical tranexamic acid reduces the incidence of post-operative mediastinal bleeding. ⋯ We conclude that, only 1 RCT exists to answer this question, which demonstrated a clinically small benefit in favour of topical tranexamic acid in low risk patients. Further RCTs should be performed prior to any further use of topical tranexamic acid as a strategy to reduce post-operative bleeding.
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Interact Cardiovasc Thorac Surg · Dec 2004
In aortic arch surgery is there any benefit in using antegrade cerebral perfusion or retrograde cerebral perfusion as an adjunct to hypothermic circulatory arrest?
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether patients having aortic arch surgery benefit from antegrade or retrograde cerebral perfusion in addition to hypothermic circulatory arrest to reduce neurological injury or mortality. ⋯ The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that antegrade cerebral perfusion is superior as an adjunct to hypothermic circulatory arrest when compared to retrograde cerebral perfusion or hypothermic circulatory arrest alone, although clinical evidence for this from prospective clinical trials is weak.
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Interact Cardiovasc Thorac Surg · Sep 2004
SPY: an innovative intra-operative imaging system to evaluate graft patency during off-pump coronary artery bypass grafting.
Off-pump coronary artery bypass grafting (CABG) has been rapidly increased, because of its less invasiveness with low complications. However, graft patency rate highly depends on the operators' capability due to technical difficulties. The SPY system, based on the fluorescence of indocyanine green, is an innovative device that permits validation of graft patency intra-operatively. ⋯ SPY images provide critical information to surgeons to detect non-patent grafts, allowing them to be revised while the patient is still on the operating table. Using the SPY system, technical failures could be completely resolved during surgery. The use of the SPY system for intra-operative graft validation during off-pump CABG may become the gold standard for surgical management in the near future.