European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 2011
Randomized Controlled TrialPulsatile pulmonary perfusion with oxygenated blood ameliorates pulmonary hemodynamic and respiratory indices in low-risk coronary artery bypass patients.
Acute lung injury still accounts for postoperative mortality after cardiopulmonary bypass (CPB). The safety and the efficacy of pulsatile pulmonary perfusion (PPP) during CPB were analyzed. Preliminary results of the first PPP trial in human beings are reported. ⋯ Oxygenated blood PPP proved safe and significantly ameliorated pulmonary hemodynamic parameters and respiratory indices in low-risk CABG.
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Eur J Cardiothorac Surg · Oct 2011
The management of post-intubation tracheal stenoses with self-expandable stents: early and long-term results in 11 cases.
The optimal management of post-intubation tracheal stenoses is surgical reconstruction of the airway. Stenting of the trachea using silastic T-tubes or one of the various types of tracheal stents are the alternative ways to surgical reconstruction for the management of post-intubation tracheal stenoses. The early and long-term results of 11 patients with post-intubation tracheal stenosis, who underwent tracheal stenting with self-expandable metallic stents (SEMSs), are presented. ⋯ The application of SEMS in post-intubation tracheal stenoses results in immediate improvement of obstructive symptoms without significant perioperative complications. SEMSs have the potential risks of migration and of granulation tissue formation at the end of the stent. SEMS should be applied only in strictly selected patients with post-intubation tracheal stenosis, who are considered unfit for surgery and/or with limited life expectancy.
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Eur J Cardiothorac Surg · Oct 2011
ReviewA competency framework in cardiothoracic surgery for training and revalidation - an international comparison.
The conventional methods of education, certification and recertification in cardiothoracic surgery face a paradigm shift in line with recent innovations in diagnostics and therapeutics. The attributes of a competent clinician entail proficiency in knowledge, communication, teamwork, management, health advocacy, professionalism and technical skills. This article investigates the skills required for a cardiothoracic surgeon to be competent. ⋯ Validated and competency-based curricula should be designed to develop core competencies to successfully integrate them into practice. Challenges to the implementation of such curricula and potential solutions are explored. Patient safety remains the ultimate aim to ensure excellence of both competency and performance.
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Eur J Cardiothorac Surg · Oct 2011
Multicenter StudyTraining in mitral valve surgery need not affect early outcomes and midterm survival: a multicentre analysis.
Mitral valve surgery may be regarded as less favourable for training, due to greater mortality risk, technical complexity, and difficulty for the supervisor to observe. We examined this perception by reviewing a multicentre experience. ⋯ Trainee outcomes are not inferior even when corrected for risk. This suggests that excellent operative training and supervision can be achieved in mitral valve surgery.
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Eur J Cardiothorac Surg · Oct 2011
Is flexible bronchoscopy necessary to confirm the position of double-lumen tubes before thoracic surgery?
Flexible bronchoscopy is recommended to confirm correct placement of double-lumen tubes used for thoracic anesthesia. However, there is still controversy over routine bronchoscopic confirmation of their position. This study aimed to verify the usefulness of flexible bronchoscopy for confirming the position of double-lumen tubes after blind intubation. ⋯ After blind intubation, 37% of double-lumen tubes required repositioning by means of flexible bronchoscopy, despite positive evaluation made by the anesthesiologist. Our data suggests that initial bronchoscopic assessment should be made with the patient still in the supine position, and confirms that flexible bronchoscopy is useful in verifying the correct position of double-lumen tubes or adjusting possible misplacements, before starting thoracic surgery.