Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Aug 2016
Systemic haemodynamics and regional tissue oxygen saturation after bidirectional cavopulmonary shunt: positive pressure ventilation versus spontaneous breathing.
Spontaneous breathing has been shown to improve global haemodynamics in patients with bidirectional cavopulmonary shunt. What has not been evaluated, however, is the effect of spontaneous breathing on the distribution of cardiac output after bidirectional cavopulmonary shunt. We investigated the effects of extubation on systemic haemodynamics and regional tissue oxygen saturation, and determined whether redistribution of cardiac output is present after extubation in these patients. ⋯ The lower values of cerebral oxygen saturation before extubation indicated that the cerebral blood flow was less satisfactory. During the early period of extubation, despite the increase in cardiac index, the mesenteric oxygen saturation is lower than that at 12 h after extubation, suggesting that the obligatory increase in respiratory muscle perfusion and the increase in cerebral oxygen saturation have utilized most of the flow from the increased cardiac index. The increase in mesenteric oxygen saturation 12 h after extubation suggests a gradual improvement in microcirculation and macrocirculation.
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Interact Cardiovasc Thorac Surg · Aug 2016
Meta AnalysisIn patients with acute flail chest does surgical rib fixation improve outcomes in terms of morbidity and mortality?
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: In patients with acute flail chest does surgical rib fixation improve outcomes in terms of morbidity and mortality? Using the reported search criteria, 137 papers were found. Of these, 11 papers (N = 1712) represent the best evidence to answer the clinical question, and include one meta-analysis, two randomized, controlled trials (RCTs), five retrospective cohort studies and two case-control series. ⋯ One retrospective case-control study described a lower risk for reintubation (n = 50, P = 0.034) and home oxygen requirements (n = 50, P = 0.034). One cohort study showed a better APACHE II score 14 days after trauma in the surgical group (P = 0.02). Surgical stabilization of flail chest in thoracic trauma patients has beneficial effects with respect to reduced ventilatory support, shorter intensive care and hospital stay, reduced incidence of pneumonia and septicaemia, decreased risk of chest deformity and an overall reduced mortality when compared with patients who received non-operative management.
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Interact Cardiovasc Thorac Surg · Aug 2016
Comparative StudyTransfusion of small amounts of leucocyte-depleted red blood cells and mortality in patients undergoing transapical transcatheter aortic valve replacement.
There is an ongoing discussion about the impact of the transfusion of red blood cells (RBCs) on clinical outcomes in cardiac surgical patients. Compared with non-transfused patients, a recent retrospective analysis in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI) indicates a dramatic increase in 30-day mortality in transfused patients, but no difference in 1-year mortality. We assessed the effect of the transfusion of 1-2 RBCs on early and late mortality in patients undergoing transapical (TA) TAVI. ⋯ The propensity score-adjusted hazard ratio of 1-year mortality was higher in the RBC+ group than in the RBC- group (1.75 [95% CI 1.08;2.82]; P = 0.023). We conclude that in the group of very high-risk patients undergoing TA-TAVI, transfusion of 1-2 RBCs is not associated with an increased early mortality. However, adverse effects of transfusions on long-term survival cannot be definitely ruled out.
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Interact Cardiovasc Thorac Surg · Aug 2016
Acute kidney injury and outcome following aortic valve replacement for aortic stenosis.
Most studies on acute kidney injury (AKI) following open-heart surgery have focused on short-term outcome following coronary artery bypass grafting. We reviewed the incidence, risk factors and outcome, including long-term survival, of AKI after aortic valve replacement (AVR) in a population-based cohort. ⋯ More than 1 in 5 patients (22.5%) who underwent AVR developed AKI postoperatively. AKI was associated with higher morbidity and was an independent predictor of operative mortality. However, AKI was not a determinant of long-term survival.
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Interact Cardiovasc Thorac Surg · Aug 2016
Multicenter Study Observational StudyNon-sutureless minimally invasive aortic valve replacement: mini-sternotomy versus mini-thoracotomy: a series of 1130 patients.
Aortic valve replacement through conventional sternotomy still represents the gold-standard surgical approach for aortic valve disease. However, given the increasing number of patients with comorbidities, strategies that can improve operative results are always sought. Minimally invasive aortic valve surgery, although related to a steep learning curve, might be associated with improved postoperative outcomes. The main aim of this study was to assess whether significant differences exist in terms of operative and early results between a mini-sternotomy and a right mini-thoracotomy approach for isolated aortic valve replacement without sutureless technologies. ⋯ Both mini-sternotomy and mini-thoracotomy could be performed safely, with low mortality and postoperative morbidity. The mini-thoracotomy approach was associated with a significantly higher rate of reoperation for bleeding. Uptake among cardiac centres was low. Sutureless technologies could potentially increase surgical volume by simplifying the mini-thoracotomy procedure.