European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Mar 2010
Low cardiopulmonary bypass perfusion temperatures are associated with acute kidney injury following coronary artery bypass surgery.
Acute kidney injury (AKI) is a common complication after coronary artery bypass surgery (CABG). The role of hypothermia in postoperative renal function remains controversial. We set out to examine the effect of varying cardiopulmonary bypass (CPB) temperatures on early postoperative renal function. ⋯ Lower CPB perfusion temperatures are significantly associated with AKI following CABG. In addition to the known age-related decline in renal function, it appears that hypothermia may contribute to renal injury during cardiac surgery.
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Thoracoscopic (video-assisted thoracoscopic surgery (VATS)) lobectomy is a safe and effective method for treating early-stage lung cancer. Despite this, it is still not widely practised, which could be due to a shallow learning curve. We have evaluated the surgical outcome in a training programme at an institution with an established VATS lobectomy programme. We present the surgical data and outcome of the first 50 intended VATS lobectomies performed by a consultant in training as the primary surgeon. ⋯ With careful selection of patients, VATS lobectomy can be taught safely in a surgical institution experienced in VATS lobectomies. Using statistical analysis, the surgical outcome for the training consultant was acceptable in comparison to the outcome of the experienced consultant. The consultant in training did spend more time in the operating theatre (p<0.0001) and we recommend taking that into account when planning future training programmes in VATS lobectomy.
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Eur J Cardiothorac Surg · Mar 2010
Acute respiratory dysfunction after surgery for acute type A aortic dissection.
Acute respiratory dysfunction (ARD) can occur after acute type A aortic dissection, but relatively little is known about ARD in such patients. This study aims to analyse the clinical impact of ARD after surgery for acute type A aortic dissection and to assess possible treatment options. ⋯ ARD is a relatively common complication of surgery for acute type A dissection and is associated with increased morbidity and resource utilisation. Patients with preoperative malperfusion are at increased risk for development of ARD. Prone positioning is a viable treatment option that significantly improves pulmonary oxygenation.
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Eur J Cardiothorac Surg · Mar 2010
Validation of a clinical score to determine the risk of acute renal failure after cardiac surgery.
Preoperative assessment of risk factors for postoperative acute renal failure (ARF) is a key point in the management of cardiac surgery patients. A reliable evaluation of individual risk permits the efficient application of prophylactic and therapeutic measures to patients with increased risk of ARF. In 2005, Thakar published a scoring system to determine the ARF risk prior to surgery. The score allowed calculation of the incidence of postoperative ARF requiring dialysis (ARF-D) with a high level of precision. ⋯ The correlation between score values and incidence of ARF-D shows that the Thakar score is qualitatively transferable to cardiac surgery patients from other centres. Though the score allows the discrimination between patients with higher or lower risks of ARF-D within the Goettingen collective, it was not suitable to estimate the real incidence of postoperative ARF-D with sufficient precision.
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Eur J Cardiothorac Surg · Mar 2010
Neuroprotective effects of erythropoietin during deep hypothermic circulatory arrest.
Permanent mild-to-severe brain injury with neurologic sequelae remains a significant source of postoperative morbidity in cardiovascular surgery. There is increasing evidence that erythropoietin confers neuroprotective effects in various conditions of neuronal damage, such as hypoxia and cerebral ischaemia. Using a surviving porcine model, this study evaluates whether systemic treatment with erythropoietin induces brain protection in deep hypothermic circulatory arrest (DHCA). ⋯ These results suggest some beneficial neuroprotective effects of erythropoietin in this model of global brain ischaemia induced by 1h of hypothermic circulatory arrest.