European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2011
Randomized Controlled TrialDeep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery--a randomised controlled trial.
In addition to early mobilisation, a variety of breathing exercises are used to prevent postoperative pulmonary complications after cardiac surgery. The optimal duration of the treatment is not well evaluated. The aim of this study was to determine the effect of 30 versus 10 deep breaths hourly, while awake, with positive expiratory pressure on oxygenation and pulmonary function the first days after cardiac surgery. ⋯ A significantly increased oxygenation was found in patients performing 30 deep breaths the first two postoperative days compared with control patients performing 10 deep breaths hourly. These results support the implementation of a higher rate of deep breathing exercises in the initial phase after cardiac surgery.
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Eur J Cardiothorac Surg · Jul 2011
ReviewPersistent sensitivity disorders at the radial artery and saphenous vein graft harvest sites: a neglected side effect of coronary artery bypass grafting procedures.
The use of radial artery conduits in coronary artery bypass grafting (CABG) surgery is associated with improved long-term patency and patient survival rates as compared with saphenous vein conduits. Despite increasing popularity, relative incidence of local harvest-site complications and subjective perception of adverse long-term sequelae remain poorly described. ⋯ Persistent harvest-site discomfort occurs with astonishing frequency after CABG surgery and affects arms and legs equally. Although usually considered a minor complication, long-term limitation to quality of life may be substantial, particularly in younger and relatively healthy patients. Thus, harvest-site discomfort clearly belongs to the list of possible post-CABG complications of which patients need to be aware.
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Eur J Cardiothorac Surg · Jul 2011
Predictors of postoperative outcome after pulmonary endarterectomy from a 14-year experience with 279 patients.
Postoperative outcome after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is difficult to predict. We sought to analyze specific preoperative findings to predict mortality, shorter mechanical ventilation, and hemodynamic improvement after PEA. ⋯ Preoperative factors can primarily predict postoperative outcome after PEA. Patients with underlying parenchymal lung disease will have increased risk for early mortality and prolonged mechanical ventilation. The extent of desobliterated segments as well as preoperative hemodynamic severity play a key role in predicting good hemodynamic responders.
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Eur J Cardiothorac Surg · Jul 2011
How to avoid crimping during valve sparing aortic root replacement using the Valsalva graft.
The reimplantation technique for valve sparing aortic root replacement (David I) has improved management of patients with aortic root aneurysm and structurally normal aortic valves. The Valsalva graft (Gelweave Valsalva, Sultzer Vascutek, Renfrewshire, Scotland) further simplified the procedure by offering a root prosthesis with preformed neo-sinuses that may reduce physiologic stresses on valve leaflets and improve long-term valve durability. However, in-conduit suturing of the aortic valve annulus and a small rim of sinus remnant to the graft sinuses may create folds of the sinus remnant that lead to bleeding or distortion of the prosthetic root. We report a method to minimize crimping of the aortic graft sinuses.
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Eur J Cardiothorac Surg · Jul 2011
Predictors of long intensive care unit stay following cardiac surgery in children.
Prolonged length of stay in intensive care units after congenital heart disease surgery is associated with poor outcome, places a considerable burden on the financial resources of hospitals, and is an organizational challenge as well. This research discusses the impact of perioperative factors on prolonged stay in intensive care units. ⋯ Some patients with a risk of prolonged hospitalization may be identified preoperatively, the others just after the operation. Optimizing preoperative status and aggressive treatment of complications may have significant influence on the duration of hospitalization in intensive care units. The knowledge of risk factors may facilitate organizational procedures and rational bed management.