European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jun 2008
Is post-sternotomy percutaneous dilatational tracheostomy a predictor for sternal wound infections?
Early post-sternotomy tracheostomy is not infrequently considered in this era of percutaneous tracheostomy. There is, however, some controversy about its association with sternal wound infections. ⋯ Tracheostomy, often performed in high-risk patients, may further complicate recovery with sternal wound infections, including mediastinitis, therefore, patients and timing should be carefully selected for post-sternotomy tracheostomy.
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Eur J Cardiothorac Surg · Jun 2008
Redo aortic root surgery for failure of an aortic homograft is a major technical challenge.
Aortic homografts offer many advantages over prosthetic valves. However, homograft dysfunction due to degeneration or infection may lead to reoperation. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge. To assess reoperation events a retrospective review was conducted. ⋯ Reoperation on patients with an aortic homograft as a root presents a relatively high perioperative morbidity. The surgical strategy depends on the degree of homograft wall calcification.
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Eur J Cardiothorac Surg · Jun 2008
Temporary neurological dysfunction after surgery of the thoracic aorta: a predictor of poor outcome and impaired quality of life.
Transient neurological dysfunction (TND) consists of postoperative confusion, delirium and agitation. It is underestimated after surgery on the thoracic aorta and its influence on long-term quality of life (QoL) has not yet been studied. This study aimed to assess the influence of TND on short- and long-term outcome following surgery of the ascending aorta and proximal arch. ⋯ The neurological outcome following surgery of the ascending aorta and proximal aortic arch is of paramount importance. The impact of TND on short- and long-term outcome is underestimated and negatively affects the short- and long-term outcome.
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Eur J Cardiothorac Surg · Jun 2008
Case ReportsSuccessful emergency resuscitative thoracotomy and thoracoscopy in an injured patient with impending death.
A 23-year-old man was bilaterally stabbed with knife creating 10 cm wide wounds similar to minithoracotomy incisions. Initially, the patient had no cardiac or respiratory activity. Emergency resuscitative thoracotomy was hastily performed on the right side. ⋯ The wound was explored, the hemothorax was evacuated, and a superficial non-bleeding parenchymal pulmonary laceration was discovered. The postoperative course was uneventful and the patient was discharged home 10 days later, and returned to his physically demanding work after 5 weeks. It is concluded that VATS can be cautiously performed on the less severely injured side in patients with bilateral thoracic penetrating trauma in extremis following successful emergency resuscitative thoracotomy.
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Eur J Cardiothorac Surg · Jun 2008
Spinal cord blood flow and ischemic injury after experimental sacrifice of thoracic and abdominal segmental arteries.
Spinal cord blood flow (SCBF) after sacrifice of thoracoabdominal aortic segmental arteries (TAASA) during thoracoabdominal aortic aneurysm (TAAA) repair remains poorly understood. This study explored SCBF for 72 h after sacrifice of all TAASA. ⋯ This study suggests that critical spinal cord ischemia after complete TAASA sacrifice does not occur immediately (intraoperatively), but is delayed 1-5h or longer after clamping, and represents failure to mount a hyperemic response to rewarming and awakening. The short duration of low SCBF associated with spinal cord injury suggests that hemodynamic and metabolic manipulation lasting only 24-72 h may allow routine preservation of normal cord function despite sacrifice of all TAASA secondary to surgical or endovascular repair of large TAAA.