Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2010
ReviewDoes the prophylactic administration of N-acetylcysteine prevent acute kidney injury following cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'does prophylactic administration of N-acetylcysteine (NAC) prevent acute kidney injury (AKI) following cardiac surgery?' More than 60 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ The RCTs have investigated the use of NAC to prevent AKI in low-risk patients, high-risk patients and high-risk patients with pre-existing chronic kidney disease. The meta-analyses and RCTs demonstrated that the prophylactic administration of NAC did not reduced the incidence of AKI, postoperative complications, postoperative interventions, mortality or length of ICU stay. We conclude that prophylactic administration of NAC does not prevent AKI or reduce mortality following cardiac surgery.
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Interact Cardiovasc Thorac Surg · Sep 2010
Case ReportsOesophageal perforation complicating intraoperative transoesophageal echocardiography: suspicion can save lives.
Oesophageal injury is an extremely rare complication of intra-operative transoesophageal echocardiography (TOE) associated with cardiac surgery. We report a case of delayed presentation (19 days after surgery) of oesophageal injury that was likely due to TOE following an aortic valve replacement. Lack of suspicion led to a delay in diagnosis but the patient fortunately survived. We advocate that in the event of postoperative hydropneumothorax, the differential diagnosis must include iatrogenic oesophageal injury from transoesophageal echo.
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Interact Cardiovasc Thorac Surg · Sep 2010
Case ReportsAcute aortic syndrome: a 'last glance' before incision.
Acute aortic syndrome (AAS) (aortic dissection, intramural aortic haematoma, or penetrating atherosclerotic ulcer) is a surgical emergency. Computed tomography (CT) is the reference technique for the diagnosis of this critical situation. ⋯ We describe the case of a 76-year-old man with clinical signs of AAS and a CT-scan compatible with a diagnosis of aortic intra-mural haematoma, leading to emergency surgery. The peroperative findings revealed a normal aortic wall with the presence of an unusual pericardial recess at the right side of the aorta.
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Interact Cardiovasc Thorac Surg · Sep 2010
Case ReportsThe association of non-invasive cerebral and mixed venous oxygen saturation during cardiopulmonary resuscitation.
Mixed venous oxygen saturation (SvO(2)) is an accepted surrogate parameter for the ratio between oxygen delivery and demand and may thus be used to determine the adequacy of the function of the cardiopulmonary system. Cerebral oxygen saturation monitoring by near infrared spectroscopy is a non-invasive method for the determination of the cerebral oxygen delivery to demand ratio that is applicable outside the operating room or the intensive care unit and does not require calibration. The present case highlights the agreement of non-invasive cerebral and SvO(2) in an 87-year-old female cardiac surgery patient with severe aortic stenosis scheduled for transapical aortic valve replacement during prolonged cardiopulmonary resuscitation.
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Interact Cardiovasc Thorac Surg · Sep 2010
Comparative StudyReal life cardio-thoracic surgery training in Europe: facing the facts.
The objective of this study was to determine the current status of training in cardio-thoracic surgery in Europe and the residents' perception of the effects of the full implementation of the European Working Time Directive (EWTD) on training. We conducted a web-based survey of trainees registered with the European Association of Cardio-Thoracic Surgery and 79 respondents form the basis for this analysis. A majority of trainees (69.6%) are aware of the implications of the EWTD and 58.7% believe it will have an impact on their training. ⋯ Striking differences exist among European countries with regards to standards of training. These findings are alarming. Training in cardio-thoracic surgery across the European Union requires urgent attention to unify and improve the standards of training and compensate the potential negative impact of the EWTD.