European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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To examine the outcomes of surgery for active infective endocarditis with paravalvular abscess. ⋯ Surgery for active endocarditis with paravalvular abscess was associated with high operative mortality, particularly in patients in shock and abscess of both mitral and aortic annuluses. Long-term survival was adversely affected by age and recurrent bouts of endocarditis.
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Eur J Cardiothorac Surg · Dec 2006
Case ReportsBlunt tracheal transection and long tear in posterior membranous trachea.
Blunt tracheobronchial injuries are rare, but can be life-threatening. A precise preoperative diagnosis and a well-recognised plan of surgical treatment, which may be unique for each patient, are needed to restore the continuity of tracheobronchial tree in a one-stage intervention. We encountered a patient with complete tracheal transection and 15 cm tear in the posterior membranous trachea and right bronchus, and whose tracheal injury was difficult to repair using direct intubation of distal airway by bronchoscopy. We achieved a good result of one-stage repair using a percutaneous cardiopulmonary support (PCPS).
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Eur J Cardiothorac Surg · Dec 2006
Clinical outcome of patients 20 years after Fontan operation--effect of fenestration on late morbidity.
The Fontan operation has been proposed as definitive palliation for an increasing variety of hearts with complex univentricular anatomy, but late morbidity after Fontan operation is still a matter of concern. This retrospective study evaluates the late outcome in patients with Fontan circulation. ⋯ Long-term survival after Fontan procedure is encouraging, but late morbidity remains suboptimal. During follow-up, emerging complications should be managed by surgical and interventional procedures. Fenestration in Fontan circulation provided better cardiac output and lower incidence of late tachyarrhythmias, suggesting a benefit of fenestration for late outcome.
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Eur J Cardiothorac Surg · Dec 2006
Review Meta AnalysisUltrafiltration reduces blood transfusions following cardiac surgery: A meta-analysis.
Although used routinely in pediatric patients, ultrafiltration techniques that reverse hemodilution are infrequently used in adults. Data from small, unblinded clinical trials suggest that the use of ultrafiltration can reduce inflammatory mediators, improve cardiac function, and reduce hemodilution. We conducted a meta-analysis of randomized trials to evaluate the effects of ultrafiltration on blood transfusions and blood loss following adult cardiac surgery. ⋯ Use of ultrafiltration is associated with a significant reduction in postoperative blood transfusions as well as reduced bleeding in adults undergoing cardiac surgery. The efficacy and cost-effectiveness of ultrafiltration as a blood conservations strategy should be evaluated in a large, randomized, double-blinded study.
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Eur J Cardiothorac Surg · Dec 2006
Comparative Study Controlled Clinical TrialTalc poudrage versus talc slurry in the treatment of malignant pleural effusion. A prospective comparative study.
The aim of this study was to investigate the effectiveness, safety and appropriate mode of administration of intrapleural talc for pleurodesis, in the treatment of malignant pleural effusion (MPE). ⋯ Our study confirms that intrapleural talc carries good results in the treatment of malignant pleural effusion. TP was significantly more effective than TS; both methods were safe but TS had a higher incidence of thoracic pain during the procedure. Talc pleurodesis should be offered to every patient with MPE, apart from terminally ill ones, provided that a satisfying lung re-expansion has been achieved. TP should be performed whenever possible; otherwise, a slurry bedside procedure will be worthwhile, even in patients with low performance status (PS), though poorer results have to be expected. A careful selection is essential to define the proper technique.