Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2014
Randomized Controlled Trial Comparative StudyLow protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy.
Owing to the great absorption capability of the pleura for transudates, the protein content of draining pleural fluid may be considered as a more adequate determinant than its daily draining amount in the decision-making for earlier chest tube removal. In an a priori pilot study, we observed that the initially draining protein-rich exudate converts to a transudate quickly in most patients after lobectomies. Thus, chest tubes draining high-volume but low-protein fluids can safely be removed earlier in the absence of an air leak. This randomized study aims to investigate the validity and clinical applicability of this hypothesis as well as its influence on the timing for chest tube removal and earlier discharge after lobectomy. ⋯ Regardless of the daily drainage, chest tubes can safely be removed earlier than anticipated in most patients after lobectomy if the protein content of the draining fluid is low.
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Interact Cardiovasc Thorac Surg · Oct 2014
Case ReportsThoracoscopic anatomical subsegmentectomy of the right S2b + S3 using a 3D printing model with rapid prototyping.
Thoracoscopic segmentectomies and subsegmentectomies are more difficult than lobectomy because of the complexity of the procedure; therefore, preoperative decision-making and surgical procedure planning are essential. In the literature, we could successfully perform thoracoscopic anatomical subsegmentectomy of the right S2b + S3 using a 3D printing model with rapid prototyping. This innovative surgical support model is extremely useful for planning a surgical procedure and identifying the surgical margin.
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Interact Cardiovasc Thorac Surg · Sep 2014
ReviewIn surgeons performing cardiothoracic surgery is sleep deprivation significant in its impact on morbidity or mortality?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is there a difference in cardiothoracic surgery outcomes in terms of morbidity or mortality of patients operated on by a sleep-deprived surgeon compared with those operated by a non-sleep-deprived surgeon? Reported search criteria yielded 77 papers, of which 15 were deemed to represent the best evidence on the topic. Three studies directly related to cardiothoracic surgery and 12 studies related to non-cardiothoracic surgery. ⋯ There is little direct evidence in the literature demonstrating the effect of sleep deprivation in cardiothoracic surgeons on morbidity or mortality. However, overall the non-cardiothoracic studies have demonstrated that operative time and sleep deprivation can have a significant impact on overall morbidity and mortality. It is likely that other confounding factors concomitantly affect outcomes in out-of-hours surgery.
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Interact Cardiovasc Thorac Surg · Sep 2014
Randomized Controlled Trial Comparative StudySub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trial.
The aim of this trial was to compare functional capacity, pulmonary shunt fraction and clinical outcomes between patients undergoing pleurotomy with a pleural drain inserted in the sub-xyphoid position and patients with a pleural drain placed in the intercostal position after off-pump coronary artery bypass surgery. ⋯ Sub-xyphoid pleural drain determined better functional capacity and exercise tolerance with a smaller pulmonary shunt fraction and improved clinical outcomes compared with intercostal pleural drainage after off-pump coronary artery bypass surgery.
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Interact Cardiovasc Thorac Surg · Sep 2014
ReviewWhat type of valve is most appropriate for osteogenesis imperfecta patients?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was in osteogenesis imperfecta (OI) patients with valve disease undergoing valve replacement which type of valve (bioprosthetic or mechanical) is most appropriate in terms of safety, complications and survival. Altogether more than 77 papers were found as a result of the reported search, of which 43 represented the best evidence to answer the clinical question. ⋯ We conclude that based on the best available evidence, it appears that bioprosthetic valves have had better outcomes (mortality rate 10%) and a lower valve-related complication rate (0%) compared with mechanical valves (mortality rate 16.1%, complication rate 16.1%), even though differences were not statistically significant. Although the existing evidence is solely based on case reports of a relatively small number, we would suggest the use of bioprosthetic valves in OI patients with valve disease, as they appear to be safer according to our analysis. Moreover, considering the surgical difficulties related to the friability and weakness of the tissues in terms of suture lines and implantation of the valve as well as the high risk of perioperative bleeding which can be related to tissue friability, capillary fragility and platelet dysfunction followed by the risk of major traumatic fractures and a possible risk of aortic dissection in the future, the bioprosthetic valves seem to be safer taking into account the avoidance of lifelong anticoagulation and its secondary bleeding complications.