Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2015
Multicenter Study Observational StudyRed blood cell transfusion is a determinant of neurological complications after cardiac surgery.
The aim of this study was to evaluate the impact of red blood cell (RBC) transfusions on the occurrence of stroke and transient ischaemic attack (TIA) after cardiac surgery. ⋯ Transfusion of more than 2 units of RBCs after cardiac surgery is associated with a significantly increased risk of postoperative stroke and TIA.
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Interact Cardiovasc Thorac Surg · Feb 2015
Comparative StudyPatients with multiple nodules and a dominant lung adenocarcinoma have similar outcomes and survival compared with patients who have a solitary adenocarcinoma.
Lepidic growth pattern lung adenocarcinoma commonly presents as a dominant lesion (DL) with associated pulmonary nodules either in the ipsilateral or contralateral lung fields, posing a challenge in clinical decision-making. These tumours may be clinically upstaged compared with those who present with solitary lesions and, as a result, may be offered different therapies. The purpose of this study is to compare recurrence rates, the development of new lesions and survival in patients with adenocarcinoma with a lepidic component presenting with a DL with or without additional nodules. ⋯ We observed that patients with lepidic growth pattern adenocarcinoma presenting with a DL with associated secondary nodules appear to behave similarly to patients with a solitary lesion. Multiple nodules including those that are malignant in this specific subset of non-small-cell lung cancer should not be upstaged as advanced disease and patients should be treated with the same curative intent as those presenting with uninodular disease.
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Interact Cardiovasc Thorac Surg · Feb 2015
Comparative StudyThe validity of the original EuroSCORE and EuroSCORE II in patients over the age of seventy.
EuroSCORE II, despite improving on the original EuroSCORE system, has not solved all the calibration and predictability issues. We investigated the sensitivity, specificity and predictability of original EuroSCORE and EuroSCORE II system in elderly patients. ⋯ The original EuroSCORE and the EuroSCORE II risk models should be used with caution in patients aged 70 or older undergoing cardiac surgery in the modern era. Below the age of 70, both models are sensitive, specific and have good predictive power. Our work needs validation by other large groups.
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Interact Cardiovasc Thorac Surg · Jan 2015
Randomized Controlled Trial Multicenter Study Comparative StudyPreoperative atrial fibrillation and outcome in patients undergoing on-pump or off-pump coronary bypass surgery: lessons learned from the GOPCABE trial.
Patients undergoing coronary bypass grafting (CABG) are at higher risk if they suffer from atrial fibrillation (AF). It was suggested that performing CABG without the use of cardiopulmonary bypass (off-pump) would reduce perioperative risk. We assessed the influence of preoperative AF on outcome in a randomized cohort of patients above the age of 75 undergoing either on-pump or off-pump CABG. ⋯ AF at admission is a significant risk factor for elderly patients undergoing coronary bypass grafting. However, this risk is not altered by performing bypass grafting off pump.
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Interact Cardiovasc Thorac Surg · Jan 2015
ReviewIs extended arch replacement justified for acute type A aortic dissection?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed is whether patients with acute type A aortic dissection have a better outcome after total arch replacement. Altogether, 138 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. ⋯ Evidence for long-term outcomes, albeit limited, has proved that better results of thrombosis of the false lumen can be achieved with a more extensive total arch repair. Although the literature shows no advantage of the total arch over a more limited approach, the more extensive approach may be required to achieve this goal when the entry tear extends to, or is localized in, this segment of the aorta. This suggests that a more extensive surgical strategy can be justified when it is based on circumstances, on the individual patient's clinical condition, and on the anatomical and pathological features of the dissection.