Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2015
Observational StudyMitral repair with the sole use of a semi-rigid band in a sub-population of patients with Barlow's disease: a 4-year follow-up with stress echocardiography.
Surgical treatment of Barlow's disease is usually demanding. In a sub-population of Barlow patients with bileaflets prolapse and central regurgitant jet, we performed mitral repair using only a semi-rigid annuloplasty band. Stress echocardiography follow-up was evaluated. ⋯ In patients with severe mitral regurgitation due to Barlow's disease with multiple central jet and without chordal rupture, mitral annuloplasty is effective in restoring mitral valve function owing to profound changes in mitral valve and left ventricle geometry. At follow-up, stress echocardiography confirms the results and the stability of the repair.
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Interact Cardiovasc Thorac Surg · Sep 2015
Randomized Controlled TrialIs pre-emptive administration of ketamine a significant adjunction to intravenous morphine analgesia for controlling postoperative pain? A randomized, double-blind, placebo-controlled clinical trial.
To evaluate if the pre-emptive administration of ketamine would potentiate the effect of intravenous morphine analgesia in the management of post-thoracotomy pain. ⋯ The administration of ketamine before surgery may be an effective adjunct to intravenous morphine analgesia in acute post-thoracotomy pain management. In ketamine group, satisfaction of pain relief was significantly higher with a significant reduction of inflammatory response and morphine consumption compared with placebo group. Our results, if confirmed by larger studies, may be of clinical relevance in situations where epidural analgesia or other analgesic procedures different from systemic opioid analgesia are unavailable or contraindicated.
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Interact Cardiovasc Thorac Surg · Sep 2015
Review Case ReportsWhat dose of tranexamic acid is most effective and safe for adult patients undergoing cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: what dose of tranexamic acid is most effective and safe for adult patients undergoing cardiac surgery? Altogether 586 papers were found using the reported search, of which 12 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. ⋯ There is also evidence that this risk of seizure is dose-dependent, with the greatest risk at higher doses of tranexamic acid. We conclude that, in general, patients with a high risk of bleeding should receive high-dose tranexamic acid, while those at low risk of bleeding should receive low-dose tranexamic acid with consideration given to potential dose-related seizure risk. We recommend the regimens of high-dose (30 mg kg(-1) bolus + 16 mg kg(-1) h(-1) + 2 mg kg(-1) priming) and low-dose (10 mg kg(-1) bolus + 1 mg kg(-1) h(-1) + 1 mg kg(-1) priming) tranexamic acid, as these are well established in terms of safety profile and have the strongest evidence for efficacy.
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Interact Cardiovasc Thorac Surg · Aug 2015
Randomized Controlled TrialA prospective randomized, controlled trial deems a drainage of 300 ml/day safe before removal of the last chest drain after video-assisted thoracoscopic surgery lobectomy.
To study the feasible and safe volume threshold for chest tube removal following video-assisted thoracoscopic surgical lobectomy. ⋯ A 300-ml/day volume threshold for chest tube removal after video-assisted thoracoscopic surgery lobectomy is feasible and safe, demonstating more advantages than the 150-ml/day volume threshold. However, a 450-ml/day volume threshold for chest tube removal may increase the risk of thoracentesis compared with the 300- and the 150-ml/day volume threshold.