Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Aug 2009
Multicenter Study Comparative StudyThe first Latin-American risk stratification system for cardiac surgery: can be used as a graphic pocket-card score.
This study aims to develop the first Latin-American risk model that can be used as a simple, pocket-card graphic score at bedside. The risk model was developed on 2903 patients who underwent cardiac surgery at the Spanish Hospital of Buenos Aires, Argentina, between June 1994 and December 1999. Internal validation was performed on 708 patients between January 2000 and June 2001 at the same center. ⋯ Recalibration was done in 2007, showing excellent level of agreement between the observed and predicted mortality rates on all patients (P=0.92). This is the first risk model for cardiac surgery developed in a population of Latin-America with both internal and external validation. A simple graphic pocket-card score allows an easy bedside application with acceptable statistic precision.
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Interact Cardiovasc Thorac Surg · Aug 2009
ReviewDoes use of intra-operative cerebral regional oxygen saturation monitoring during cardiac surgery lead to improved clinical outcomes?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of cerebral regional oxygen saturation (rSO(2)) monitoring during cardiac surgery can lead to improved clinical outcomes. Altogether 488 papers were found using the reported search, of which eight presented the best evidence to answer the clinical question. ⋯ Further, interventions carried out by thoughtful use of the cerebral oximeter are associated with significant reduction in neurologic injury, major organ morbidity and mortality (MOMM) and duration of hospital stay. Some studies have indicated decreased ventilation and intensive care unit (ICU) stay times as well. Clinical benefit and the lack of use-associated risk of injury at a modest expense support the use of this device routinely in patients undergoing cardiac surgery.
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Interact Cardiovasc Thorac Surg · Aug 2009
ReviewIs a minimally invasive approach for re-operative mitral valve surgery superior to standard resternotomy?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is a minimally invasive approach superior to standard sternotomy for re-operative mitral valve surgery?'. Altogether 48 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. ⋯ We conclude that minimally invasive mitral valve re-operation can be performed with an operative mortality similar to standard sternotomy approach but with a higher patient satisfaction. Less postoperative bleeding, reduced need for blood transfusion and absence of sternal wound infection are the main advantages of this technique. Mean hospital stays and ventilation time appear to be reduced with this approach.
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Interact Cardiovasc Thorac Surg · Aug 2009
Multicenter StudyPneumonectomy for bronchogenic carcinoma: analysis of factors predicting short- and long-term outcome.
The objective of this study was to analyse predictive factors for postoperative and long-term outcome after pneumonectomy. From 1 January 2000 to 1 January 2005 a total of 91 (31%) pneumonectomies were performed. Multivariable analysis for postoperative morbidity, mortality, and long-term survival was performed. ⋯ Most patients who died postoperatively were 70 years or older, had cardiovascular comorbidity and underwent right-sided pneumonectomy (n=6). Patients over 70 years had three times higher risk of complications compared to younger patients (OR=3.1, 95% CI=1.1-8.2), and patients undergoing right-sided pneumonectomy had 2.4 times higher risk compared to left-sided pneumonectomy (OR=2.4, 95% CI=0.9-6.4). Pneumonectomy is accompanied by high postoperative mortality and morbidity rates, the highest risk in patients over 70 years and right-sided pneumonectomy, and consequently should lead to meticulous patient selection and perioperative care.
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Interact Cardiovasc Thorac Surg · Aug 2009
Clinical significance of anastomotic leak in ascending aortic replacement for acute aortic dissection.
'Anastomotic leak' after ascending aortic replacement for acute aortic dissection, which is determined as direct forward blood flow into the false lumen at the distal anastomosis, prevents the false lumen from being thrombosed. The aim of this study is to determine whether the leak influences on residual aortic growth. Between October 1999 and May 2006, 100 patients presenting for acute type A aortic dissection underwent surgery at our institution. ⋯ Initial maximum diameter just after ascending aortic replacement was greater in patients with anastomotic leak than without anastomotic leak in aortic arch and descending aorta (P=0.013, P=0.06). Anastomotic leak after ascending aortic replacement for acute type A aortic dissection contributed to remnant aortic growth. More sophisticated method for reapproximation of dissected aorta should be dictated.