Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2011
ReviewExtrapleural pneumonectomy or supportive care: treatment of malignant pleural mesothelioma?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether extrapleural pneumonectomy (EPP) is superior to supportive care in the treatment of patients with malignant pleural mesothelioma (MPM). Overall, 110 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. ⋯ The 30-day mortality rate was 7.8% and complications included prolonged air leak (9.8%) and empyema (4%). Median hospital stay was seven days. Overall, EPP shows no benefit in terms of survival or symptom improvement which is compounded by its high operative mortality and recurrence rate.
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Interact Cardiovasc Thorac Surg · Jun 2011
Should we operate on microscopic N2 non-small cell lung cancer?
Traditionally non-small cell lung cancer (NSCLC) stage N2 is considered as a contraindication for curative resection. We investigated the outcome of patients with microscopic N2 disease, who underwent potentially curative resections. The independent effects of lobectomy vs. pneumonectomy, histology subtype, body mass index (BMI), sex, and PET-scanning were investigated. ⋯ A low N2 survival risk score was associated with increased survival, P=0.001. Resecting microscopic N2 disease in NSCLC may be appropriate in some patients. An N2 survival scoring system may help select patients for surgery, and help evaluate adjuvant and neoadjuvant publications with regard to microscopic N2 disease.
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Interact Cardiovasc Thorac Surg · Jun 2011
Randomized Controlled Trial Comparative StudyComparative study of the non-dependent continuous positive pressure ventilation and high-frequency positive-pressure ventilation during one-lung ventilation for video-assisted thoracoscopic surgery.
The application of volume controlled high-frequency positive-pressure ventilation (HFPPV) to the non-dependent lung (NL) may have comparable effects to continuous positive-airway pressure (CPAP) on the surgical conditions during one-lung ventilation (OLV) for video-assisted thoracoscopic surgery (VATS). After local Ethics Committee approval and informed consent, we randomly allocated 30 patients scheduled for elective VATS after the first 15 min of OLV to ventilate the NL with CPAP of 2 cm H(2)O (NL-CPAP(2)) and HFPPV using tidal volume 2 ml/kg, inspiratory to expiratory ratio <0.3 and respiratory rate 60/min (NL-HFPPV) for 30 min, each in a randomized crossover order. ⋯ The operative field was much better during the application of NL-CPAP(2) than during NL-HFPPV (P<0.001). We concluded that the application of CPAP to the NL during OLV offers good quality of operative field and improved arterial oxygenation for VATS.
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Interact Cardiovasc Thorac Surg · Jun 2011
ReviewDoes use of intraoperative cell-salvage delay recovery in patients undergoing elective abdominal aortic surgery?
A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether the use of intraoperative cell-salvage (ICS) leads to negative outcomes in patients undergoing elective abdominal aortic surgery? Altogether 305 papers were found using the reported search, of which 10 were judged to represent 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 were tabulated. ⋯ Indeed two trials actually show a significantly shorter hospital stay after ICS use, one a shorter ITU stay and another suggests lower rates of chest sepsis. Based on these papers, we concluded that the use of ICS does not cause increased morbidity or mortality when compared to standard practise of transfusion of allogenic blood, and may actually improve some clinical outcomes. As abdominal aortic surgery inevitably causes significant intraoperative blood loss, in the range of 661-3755 ml as described in the papers detailed in this review, ICS is a useful and safe strategy to minimise use of allogenic blood.
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Interact Cardiovasc Thorac Surg · Jun 2011
ReviewIn adult patients undergoing redo surgery for left atrioventricular valve regurgitation after atrioventricular septal defect correction, is replacement superior to repair?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In adult patients undergoing redo surgery for left atrioventricular valve regurgitation after atrioventricular septal defect correction, is replacement superior to repair?' Altogether more than 109 papers were found using the reported search, of which eight 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. ⋯ We feel that for older patients or for those in whom long-term anticoagulation is a concern, biological prosthesis can be an option, also due to the growing and expanding experience of percutaneous/transapical valve-in-valve replacement in mitral position. Since in these patients the number of previous sternotomies is usually one or more and re-entry injuries can be a major source of perioperative mortality and morbidity, we believe that mini-thoracotomy approach can avoid potential damage; furthermore, arterial cannulation can be either central or peripheral according to the degree of visceral adhesions or surgeon's choice. Venous drainage should be provided by a percutaneous vacuum-assisted femoral double stage venous drainage, which is useful especially when concomitant tricuspid valve surgery is planned.