Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2008
Case ReportsIs internal massage superior to external massage for patients suffering a cardiac arrest after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether open chest cardiac massage is superior to closed chest compressions in patients suffering cardiac arrest following cardiac surgery. Using the reported search, 527 papers were identified. ⋯ We conclude that over 18 good quality animal studies have consistently demonstrated the superiority of open chest cardiac massage, with the cardiac index and coronary perfusion pressures often more than doubling. There are fewer human studies but they have shown that closed chest massage generates a cardiac index of around 0.6 l/min/m(2) which rises to 1.3 l/min/m(2) or more with open-chest-CPR, accompanied by even bigger improvements in coronary perfusion pressure. ILCOR recommends prompt conversion to open-chest-cardiac massage in patient's shortly post-cardiac surgery, and we would support this intervention if simple resuscitative efforts such as defibrillation, pacing or atropine fail, in order to significantly improve the quality of cardiopulmonary resuscitation.
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Interact Cardiovasc Thorac Surg · Feb 2008
Comparative StudyMiniaturized cardiopulmonary bypass system in neonates and small infants.
Cardiopulmonary bypass (CPB) in children is associated with a capillary leak due to inflammatory response, which results in an increase in total body water. This study was designed to reveal that our miniaturized CPB system reduced the peri-operative systemic inflammatory response in small infants. In our institution, the priming volume has been reduced from 500 ml to 140 ml currently. ⋯ A combination of priming volume (coefficient: 0.015, P=0.006), and bypass time (coefficient: 0.013, P=0.028), most affected %BWG (%). A combination of priming volume (coefficient: 0.05, P=0.001) and age (coefficient: -0.02, P=0.001) most affected the MVT (days). The miniaturized circuits reduced the peri-operative inflammatory response, resulting in reduced postoperative systemic edema, and postoperative mechanical ventilation time.
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Interact Cardiovasc Thorac Surg · Feb 2008
Case ReportsExtended duration of brachially inserted intra-aortic balloon pump for myocardial protection in two patients undergoing urgent coronary artery bypass grafting.
Intra-aortic balloon pump (IABP) provides myocardial protection for patients who are at risk of myocardial injury during cardiac surgery. The haemodynamic support is crucial in patients with significant and critical coronary artery disease undergoing revascularisation procedures. ⋯ The trans-brachial route can be used as an alternative for percutaneous insertion of the IABP. We report the technique for left trans-brachial insertion of an IABP, and illustrate our experience with two patients requiring urgent coronary artery bypass grafting (CABG) and for whom the IABP duration was over 50 h.
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Interact Cardiovasc Thorac Surg · Feb 2008
Early results following the Nuss operation for pectus excavatum--a single-institution experience of 383 patients.
The prevalence of pectus excavatum is low but many patients are disabled from this thoracic deformity. The Nuss operation is a well-established surgical correction, however, until recently it has been rarely used in Europe. We have performed the Nuss operation regularly between 2001 and 2006 where a total of 383 patients were operated on for pectus excavatum. ⋯ At present the bars have been removed in 73 patients and their final result was excellent in all but one. The Nuss procedure for pectus excavatum can be implemented with excellent early results and few complications. There is a surprisingly high demand for surgical correction of pectus excavatum and the number of referred patients continues to increase as patients learn about the ease of this procedure and its excellent results.
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Interact Cardiovasc Thorac Surg · Feb 2008
Bilateral thoracoscopic sympathectomy: results and long-term follow-up.
The aim of this study is to evaluate the efficacy of bilateral thoracoscopic sympathectomy in alleviating symptoms and improving quality of life in patients with hyperhidrosis or facial blushing and to investigate the occurrence, severity and possible underlying factors to compensatory sweating after surgery. One hundred and sixty-three patients in a single institution underwent bilateral thoracoscopic sympathectomy with a mean follow-up period of 51 (5-140) months. Indications were for palmar hyperhidrosis (41%), axillary hyperhidrosis (17%), combined palmar and axillary hyperhidrosis (27%) and facial blushing+/-facial hyperhidrosis (15%). ⋯ Recurrence rates were palmar 4.6%, axillary 7.4%, palmar and axillary 9.3% and facial blushing+/-facial hyperhidrosis 4.7% at a mean of 22 (3-72) months. An improvement in quality of life was seen in 85% and a diminution of quality of life was noted in 5% due to compensatory sweating. This large mature series demonstrates that bilateral thoracoscopic division of the sympathetic chain as opposed to resection can be performed effectively in patients with success rates higher than 90% and low recurrence rates.