Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jan 2015
ReviewIs low serum albumin associated with postoperative complications in patients undergoing oesophagectomy for oesophageal malignancies?
A best evidence topic was written according to a structured protocol. The question addressed was: in patients undergoing oesophagectomy for oesophageal malignancy, is low serum albumin associated with postoperative complications? Altogether, 87 papers were found using the reported search, of which 16 demonstrated 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. ⋯ Instead, these studies found other factors responsible for postoperative complications such as: CRP, smoking, disease duration, malnutrition and low T-cell levels. Taken together, while low serum albumin is associated with postoperative complications, opinion regarding the prognostic value of low serum albumin and nutritional support remains conflicted. Because of the confounding factors encountered in these studies, the clinician should consider the finding of low serum albumin in patients, together with disease and surgical factors to provide optimal care for these patients.
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Interact Cardiovasc Thorac Surg · Jan 2015
ReviewIs endovascular repair of ruptured abdominal aortic aneurysms associated with improved in-hospital mortality compared with surgical repair?
A best evidence topic in vascular surgery was constructed according to a structured protocol. The question addressed was whether patients with ruptured abdominal aortic aneurysm (AAA) treated with endovascular aneurysm repair (EVAR) have improved in-hospital outcomes compared with conventional surgical repair. The reported search retrieved 1398 reports, of which 6 papers were thought to represent the best available evidence to answer the study question. ⋯ In contrast, a systematic review and meta-analysis, mainly of observational, cohort studies, and another large, nationwide study demonstrated EVAR to be associated with improved in-hospital results compared with open repair, as expressed by mortality, severe complications, length of hospital stay and proportion of patients discharged home. Even though randomized trials demonstrate equivalent in-hospital mortality with EVAR and open repair, large-scale, nationwide, observational studies and meta-analyses have shown EVAR to confer improved in-hospital mortality and morbidity in patients with favourable aneurysm morphology stable enough to undergo imaging. Reconfiguration of acute aortic services and establishment of standardized institutional protocols might be advisable for improvements in the management of ruptured AAA.
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Interact Cardiovasc Thorac Surg · Jan 2015
ReviewDoes concomitant tricuspid annuloplasty increase perioperative mortality and morbidity when correcting left-sided valve disease?
A best evidence topic in adult valvular surgery was written according to a structured protocol. The question addressed was 'Does concomitant tricuspid annuloplasty increase the perioperative mortality and morbidity when correcting left-sided valve disease?' A total of 561 papers were found using the reported search, of which 12 presented the best evidence to answer the clinical question. The authors, country, journal, date of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ One study retrospectively analysed a large number of patients undergoing either isolated left-sided valve surgery or a concomitant TV repair, and there were no statistically significant differences regarding major complications (bleeding, pacemaker, respiratory insufficiency, and renal failure). Moreover, another three studies also found no statistically significant differences in terms of bleeding, pacemaker, wound infection, neurological deficit, pericardial effusion, low cardiac output syndrome and dialysis. In conclusion, there is good evidence to support that tricuspid annuloplasty is a low-risk procedure and concomitant TV repair does not significantly increase the perioperative mortality and morbidity when correcting left-sided valve disease.
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Interact Cardiovasc Thorac Surg · Jan 2015
Preoperative platelet dysfunction predicts blood product transfusion in children undergoing cardiac surgery.
Excessive bleeding can be a problem during or after cardiac surgery. While cardiopulmonary bypass-associated platelet dysfunction is an important inducer of coagulopathy, preoperative platelet dysfunction can also contribute to this bleeding. We investigated the relationship between preoperative platelet dysfunction and transfusion of blood products given to children undergoing cardiac surgery. ⋯ In children who have undergone cardiac surgery, when age and cardiopulmonary bypass time are accounted for, a prolonged preoperative closure time is significantly associated with increased odds of red blood cells and fresh-frozen plasma transfusion in the operation theatre. This may have implications for planning and utilization of blood products.
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Interact Cardiovasc Thorac Surg · Jan 2015
My aortic root simulator: if I can build it, you can build it.
Simulation has become an integral part of thoracic surgical training that has been proven to improve residents' skills. The purpose of the current study was to develop a low-fidelity and low-cost simulator for aortic root surgery that could provide training in multiple aortic valve and root procedures. ⋯ This is a simple and cost-effective aortic root simulator that can be built by the thoracic surgical resident to provide training in multiple aortic valve and aortic root procedures. Such low-fidelity portable simulators are beneficial to young trainees and may contribute to improvement of technical skills and procedural knowledge that ultimately leads to improved performance in the operative field.