Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2010
Comparative StudyElectrothermal bipolar vessel sealing device LigaSureV for pulmonary artery ligation--burst pressure and clinical experiences in complete video-assisted thoracoscopic major lung resection for lung cancer.
Intraoperative bleeding is one of the main severe complications in complete video-assisted thoracoscopic surgery (c-VATS). We investigated whether one sealing device, the LigaSureV (LSV) vessel sealing system (Valleylab, Tyco Healthcare, Boulder, CO, USA) was experimentally and clinically safe and effective for c-VATS. The burst pressures (BP) of each pulmonary artery (PA) in resected lungs were measured and were compared between a thin PA group (<5 mm) and a thick PA group (> or =5 mm). ⋯ However, average BP was physiologically high enough to inhibit a burst even for thick PA sealed in a wet state. There was single case of delayed bleeding sealed PA resulted from seal contact with a sucton device. These studies demonstrated the safety and efficacy of the LSV to sealed PA in c-VATS.
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Interact Cardiovasc Thorac Surg · Sep 2010
ReviewIn patients with severe active aortic valve endocarditis, is a stentless valve as good as the homograft?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients with severe active aortic valve endocarditis, is a stentless valve as good as a homograft?' The scientific literature was reviewed by searching Medline, using the OVID interface, from 1950 to March 2010. One hundred and eight papers were found. ⋯ He finds the reinfection rate to be lower for the homograft and stentless groups than for the patients treated with standard prostheses, respectively, 5.8%, 3.7% and 33%. The stentless valve offers a reinfection rate and postoperative echocardiographic data comparable to those achieved with homografts. Further follow-up is required to determine the stentless valve durability and long-term freedom from valve-related complications.
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Interact Cardiovasc Thorac Surg · Sep 2010
ReviewIn patients coming to theatre with an intra aortic balloon pump, is it better to turn it off or keep it on while on bypass?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients coming to theatre with an intra aortic balloon pump (IABP), is it better to turn it off or keep it on while on bypass?' Altogether 46 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. Nine of them were randomised controlled trials (RCTs). ⋯ Although several randomised control trials in this field have conveyed considerable benefit in terms of biochemical markers measured, none of them have resulted in better clinical outcomes in terms of reduction in major morbidity or mortality. This may be largely due to the small sample size in most of these studies. Seven out of 11 papers were published by same group of authors.
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Interact Cardiovasc Thorac Surg · Sep 2010
Case ReportsTransapical aortic valve prosthetic endocarditis.
An 83-year-old patient underwent a transapical aortic valve implantation at our institution. Four months later, she was readmitted to our institution because of fever and heart failure. ⋯ Because of the high surgical risk, surgery was refused and the patient died shortly after the diagnosis. We briefly discuss the implications of this finding in the prevention of infective endocarditis after transcatheter aortic valve implantation.
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Interact Cardiovasc Thorac Surg · Sep 2010
Case ReportsChallenging pacemaker implantation in a patient with acquired dextrocardia after pneumonectomy, skoliosis and complete heart block.
Pacemaker implantation after pneumonectomy is rare and there have been no previously reported cases of acquired dextrocardia after implantation. The authors report the case of a pacemaker implantation in a patient with complete heart block, impaired left ventricular function, sclerosis of heart valves and radiation induced vasculopathy resulting in ostial stenosis of the right coronary artery 30 years after radiochemotherapy in childhood. Acquired dextrocardia after right pneumonectomy for mucoepidermoid carcinoma made implantation a challenge due to and poor fluoroscopic visualization of the heart and increased radio-opacity of the right chest when compared to congenital dextrocardia.