European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Feb 2009
Review Meta AnalysisEndovascular versus open repair for descending thoracic aortic rupture: institutional experience and meta-analysis.
Rupture of thoracic aneurysm, acute type B dissection, blunt thoracic trauma, and penetrating aortic ulcer can present with a similar clinical profile of thoracic aortic rupture. We report a meta-analysis of comparative studies evaluating endoluminal graft versus open repair of these lesions as well as the early experience from our institution. We searched the following databases for reports of endovascular versus open repair of acute descending thoracic aortic rupture: Medline/PubMed, OVID, EMBASE, CINAHL, ClinicalTrials.gov, the Cochrane central register of controlled trials and the Cochrane database of systematic reviews. ⋯ There were no spinal cord ischemic complications. Our experience and meta-analysis indicate that thoracic endograft repair has low mortality and spinal cord complication rates for treatment of acute thoracic aortic rupture. If this method proves to be durable, it could replace open repair as the treatment of choice for these critically ill patients.
-
Eur J Cardiothorac Surg · Feb 2009
ReviewManagement of diastolic heart failure following cardiac surgery.
A considerable number of patients who undergo cardiac surgery have a variety of comorbid conditions that includes diastolic dysfunction. Abnormalities of diastolic function may lead to diastolic heart failure that can complicate their postoperative course. ⋯ In spite of it being a common cause of heart failure it remains underreported in the postoperative heart. We reviewed relevant literature analysing the different therapeutic approaches and formulated a management plan for diastolic heart failure in the postoperative heart in the intensive care environment based on the most current understanding of this form of cardiac failure.
-
Eur J Cardiothorac Surg · Feb 2009
Cardiopulmonary bypass and left ventricular systolic dysfunction impacts operative mortality differently in elderly and young patients.
Cardiac surgery is higher risk in the elderly. It has been suggested that preoperative left ventricular systolic dysfunction (LVSD) and cardiopulmonary bypass (CPB) affect elderly and young patients differently. This study investigates the predictive risk of preoperative LVSD and CPB time for operative mortality in the two groups of patients. ⋯ Differences in the significance of risk factors between elderly and young patients contribute to the disproportionate operative mortalities. Our data showed that age and CPB duration increased the risk of operative mortality only in the elderly, but the impact of moderate, unlike severe, LVSD was tempered. Further studies are warranted to investigate more biocompatible bypass systems in elderly patients, and if current risk stratification should, perhaps, be revised for elderly patients.
-
Eur J Cardiothorac Surg · Feb 2009
Case ReportsSurfactant as salvage therapy in life threatening primary graft dysfunction in lung transplantation.
Impaired surfactant activity may contribute to primary graft dysfunction after lung transplantation. We assessed the role of surfactant treatment in lung transplant recipients with severe life threatening primary lung graft dysfunction. ⋯ Surfactant treatment improves oxygenation and may be life saving in patients with primary lung graft dysfunction.
-
Eur J Cardiothorac Surg · Feb 2009
Endobronchial ultrasound-guided needle aspiration in the non-small cell lung cancer staging.
The aim of the study was to assess the diagnostic yield of the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-NA) in the mediastinal staging in non-small cell lung cancer (NSCLC) patients. ⋯ (1) EBUS-NA is an effective and safe technique for mediastinal staging in NSCLC patients. (2) In patients with negative results of EBUS-NA, surgical exploration of the mediastinum should be performed.