The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Jan 2015
Practice Guideline[S3-Guideline: Recommendations for intra-aortic balloon pumping in cardiac surgery].
Although intra-aortic balloon pumping (IABP) is the most frequently used mechanical cardiac assist device in cardiothoracic surgery, there are only guidelines for substantive sections of aortic counterpulsation including prophylactic and postoperative use. In contrast, evidence-based recommendations are still lacking concerning intraoperative use, management, contraindication and other relevant issues. According to international surveys, important aspects of IABP usage show a wide variation in clinical practice. ⋯ Therefore, the presented multidisciplinary S-3-guideline was developed under the direction of the German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG) to make evidence-based recommendations for the usage of aortic counterpulsation after cardiothoracic surgery according to the requirements of the Association of the Scientific Medical Societies in Germany (AWMF) and the Medical Centre for Quality (Ärztliches Zentrum für Qualität - (ÄZQ)). Main topics discussed in this guideline involve IABP support in the prophylactic, preoperative, intraoperative and postoperative setting as well as the treatment of right heart failure, contraindications, anticoagulation, monitoring, weaning, and limitations of IABP therapy. The presented 15 key messages of the guideline were approved after two consensus meetings under moderation of the AWMF with participation of the German Society of Cardiology (DGK), German Society of Anaesthesiology and Intensive Care Medicine (DGAI), German Interdisciplinary Association for Intensive Care (DIVI) and the German Society for Cardiovascular Engineering (DGfK).
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Thorac Cardiovasc Surg · Dec 2014
Need for psychosocial assistance in patients undergoing cardiothoracic surgery evaluated by a seven-item questionnaire.
Cardiothoracic surgery can have adverse effects on the patients' psychosocial well-being which may influence the overall prognosis. In this study, we tested the use of a seven-item screening instrument for the preoperative identification of need for psychosocial assistance in cardiothoracic patients. Methods and ⋯ We found the HSI to be a suitable tool to identify psychosocial need in cardiothoracic patients. The relatively high incidence of these patients in our study concurs with previous studies, which generally used more complex instruments. In addition, we found that preoperative scores were associated with prolonged length of stay. Therefore, the use of this questionnaire could represent an alternative, more rapid tool for the psychosocial assessment of cardiothoracic patients in daily routine.
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Thorac Cardiovasc Surg · Dec 2014
[Commentary by the German Society for Thoracic and Cardiovascular Surgery on the positions statement by the German Cardiology Society on quality criteria for transcatheter aortic valve implantation (TAVI)].
Surgical aortic valve replacement is still considered the first-line treatment for patients suffering from severe aortic valve stenosis. In recent years, transcatheter aortic valve implantation (TAVI) has emerged as an alternative for selected high-risk patients. According to the latest results of the German external quality assurance program, mandatory by law, the initially very high mortality and procedural morbidity have now decreased to approximately 6 and 12%, respectively. ⋯ Contrary to this statement and concerned about the safety of patients treated this way, the German Society for Thoracic and Cardiovascular Surgery (DGTHG) still fully endorses the European (ESC/EACTS) and other actual international guidelines and consensus statements. Only the concomitance of departments for cardiac surgery and cardiology on site can provide optimal TAVI care. This commentary by the DGTHG delineates the data and resources upon which its opinion is based.
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Thorac Cardiovasc Surg · Dec 2014
A new suture technique avoids rib fractures and intercostal nerve trauma in thoracotomy.
This article describes an alternative suture technique for thoracotomy incisions. A modified mattress suture technique is used to fix the intercostal muscles. The described technique can prevent rib fractures and reduce the incidence of intercostal nerve injury. Also, this technique is easy to perform and is effective.
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Thorac Cardiovasc Surg · Dec 2014
Comparative StudyProtective effect of hypothermia in a blunt thoracic trauma and hemorrhagic shock model.
The aim of this study was to investigate the effect of volume-controlled hemorrhage and hypothermia on rats with blunt chest trauma, evaluating bacterial translocation (BT), lung tissue malondialdehyde (MDA), nitric oxide (NO) levels, and erythrocyte deformability (ED). ⋯ Hypothermia seems to demonstrate protective effects on ED and BT by reducing oxidative stress. The protective effects of therapeutic hypothermia on ED may be due to the effect of reducing NO and/or MDA. There was no difference in effect between mild and moderate hypothermia in terms of the formation of ED and BT.