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 2015
Index of prolonged air leak score validation in case of video-assisted thoracoscopic surgery anatomical lung resection: results of a nationwide study based on the French national thoracic database, EPITHOR.
The incidence rate of prolonged air leak (PAL) after lobectomy, defined as any air leak prolonged beyond 7 days, can be estimated to be in between 6 and 15%. In 2011, the Epithor group elaborated an accurate predictive score for PAL after open lung resections, so-called IPAL (index of prolonged air leak), from a nation-based surgical cohort constituted between 2004 and 2008. Since 2008, video-assisted thoracic surgery (VATS) has become popular in France among the thoracic surgical community, reaching almost 14% of lobectomies performed with this method in 2012. This minimally invasive approach was reported as a means to reduce the duration of chest tube drainage. The aim of our study was thus to validate the IPAL scoring system in patients having received VATS anatomical lung resections. ⋯ The IPAL score is valid for the estimation of the predictive risk of PAL after VATS lung resections. It may thus a priori be used to characterize any surgical population submitted to potential preventive measures.
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Eur J Cardiothorac Surg · Oct 2015
Comparative StudyThe effects of hydrogen gas inhalation during ex vivo lung perfusion on donor lungs obtained after cardiac death.
Lung transplantation is a well-established treatment of end-stage lung disease; however, it is limited by a shortage of donor lungs. To overcome this problem, donation after cardiac death (DCD) and ex vivo lung perfusion (EVLP) are being widely investigated. In this study, the effect of hydrogen gas, a known antioxidant, was investigated on a DCD lung model during EVLP. ⋯ Hydrogen gas inhalation during EVLP improved the function of DCD lungs, which may increase the utilization of DCD lungs.
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Eur J Cardiothorac Surg · Sep 2015
Randomized Controlled TrialPreventive analgesia in thoracic surgery: controlled, randomized, double-blinded study.
Preventive analgesia is defined as a treatment that is commenced before the surgical procedure in order to diminish the physiological consequences of afferent nociceptive transmission caused by the procedure and prevent central sensitization. The analysis of randomized studies of preventive analgesia is controversial. The aim of this study was to check the analgesic efficacy of preoperative administration of dextromethorphan associated with intercostal nerve block with levobupivacaine in thoracotomy patients who refused or had a contraindication to epidural analgesia. ⋯ Results indicate that preoperative administration of dextromethorphan associated with preoperative IB with levobupivacaine provided preventive analgesia, decreasing analgesic administration during the early postoperative period compared with placebo and/or postoperative IB. This study failed in detecting any effect of preventive analgesia on functional items and post-thoracotomy syndrome.
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Eur J Cardiothorac Surg · Sep 2015
Review Meta Analysis Comparative StudyOutcomes of mitral valve repair compared with replacement in patients undergoing concomitant aortic valve surgery: a meta-analysis of observational studies.
Long-term superiority of mitral valve (MV) repair compared with replacement is well established in degenerative MV disease. In rheumatic heart disease, its advantages are unclear and it is often performed in conjunction with aortic valve (AV) replacement. Herein, we performed a systematic review and meta-analysis comparing outcomes of MV repair vs replacement in patients undergoing concomitant AV replacement. ⋯ In a separate analysis of studies with exclusively rheumatic patients (n = 1106), the early as well as late mortality benefit of MV repair was lost (RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P = 0.199, respectively), whereas the MV reoperation rate became significantly higher (RR: 5.10, 95% CI: 1.62-16.05, P = 0.005) with MV repair. In patients undergoing concomitant mitral and AV surgery, MV repair is associated with improved early and late survival without any increased risk for mitral valve reoperation. However, in patients with rheumatic heart disease MV repair does not impart any survival advantage while the risk for MV reoperation remains significantly higher.
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Eur J Cardiothorac Surg · Sep 2015
Comparative StudyOutcomes after aortic arch reconstruction for infants: deep hypothermic circulatory arrest versus moderate hypothermia with selective antegrade cerebral perfusion.
Optimal cerebral and visceral protection is crucial in aortic arch surgery. The main method for this protection has traditionally been deep hypothermic circulatory arrest (DHCA). Recently, antegrade cerebral perfusion with moderate hypothermia has become the preferred strategy for adult patients and some children undergoing aortic arch surgery. Continuous cerebral perfusion should reduce the incidence of neurological complications, but the degree of damage to organs and systems resulting from the lack of blood flow distal to the aortic arch remains unclear. Here, we aimed to evaluate the efficacy and safety of methods of protecting the brain and internal organs during aortic arch surgery in infants. ⋯ Aortic arch reconstruction accompanied by SACP has a lower risk of neurological complications compared with DHCA. However, the high incidence of renal complications with SACP requires further study.