Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2011
ReviewIs video-assisted thoracoscopic surgery the best treatment for paediatric pleural empyema?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether video-assisted thoracic surgery (VATS) is the best treatment for paediatric pleural empyema. Altogether 274 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. ⋯ Ninety-five children (52%) received antibiotics alone, and 87 (45%) underwent drainage procedures (21 chest tube alone, 57 VATS/thoracotomy, and eight chest tube followed by VATS/thoracotomy); only four received fibrinolytics. Mean (standard deviation) length of stay was significantly shorter in the antibiotics alone group, 7.0 (3.5) days vs. 11 (4.0) days. The strongest predictors of undergoing pleural drainage were admission to the intensive care unit and large effusion size (>1/2 thorax filled).
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Interact Cardiovasc Thorac Surg · Jul 2011
Randomized Controlled TrialResults of coronary artery bypass grafting alone and combined with surgical ventricular reconstruction for ischemic heart failure.
In this study, we included 236 patients with ischemic heart failure and ejection fraction (EF) <35% who underwent surgical treatment. Patients were randomized in two groups. There were 116 patients who underwent coronary artery bypass grafting (CABG) with surgical ventricular reconstruction (SVR) and 120 patients who underwent CABG alone. ⋯ However, after isolated CABG EF did not increase significantly (32±7 preoperatively and 34±11 postoperatively). One- and three-year rates were 95% and 78% after SVR with CABG and 83% and 78% after CABG alone. Despite the more aggressive surgical strategy, left ventricular reconstruction did not increase operative mortality and early results were significantly effective compared with coronary artery bypass grafting alone.
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Interact Cardiovasc Thorac Surg · Jul 2011
Case ReportsCardiogenic shock due to pheochromocytoma rescued by extracorporeal membrane oxygenation.
This is the case of a 49-year-old female presenting in sustained cardiogenic shock due to an adrenal pheochromocytoma. She was rescued by venoarterial extracorporeal membrane oxygenation. ⋯ Successful open adrenalectomy was performed under protective extracorporeal life support and full anticoagulation early after cardiogenic shock. The patient could be weaned off mechanical support rapidly and made a full cardiopulmonary recovery.
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Interact Cardiovasc Thorac Surg · Jul 2011
Acute exacerbation of idiopathic interstitial pneumonias after surgical resection of lung cancer.
Idiopathic interstitial pneumonias (IIPs) are diffuse lung diseases of unknown cause. Morbidity and mortality are high in patients with IIPs who have undergone lung resection. Postoperative acute exacerbation (PAE) of IIPs is one of the fatal complications after lung resection. ⋯ PAE of IIPs causes high mortality. It is very difficult to predict the occurrence of PAE of IIPs. More efforts are required to develop strategies to prevent PAE of IIPs.
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Interact Cardiovasc Thorac Surg · Jul 2011
Mid-term results of tricuspid annuloplasty using the MC3 ring for secondary tricuspid valve regurgitation.
We investigated mid-term outcomes after ring annuloplasty with the MC3 ring and aimed to identify factors associated with recurrent tricuspid regurgitation (TR). From October 2006 to October 2010, 136 patients (male:female 80:56, with a mean age 64.7±11.8 years) underwent tricuspid valve (TV) annuloplasty for functional TR. The indications for TV annuloplasty were (1) severe TR, or (2) mild or moderate TR with pulmonary hypertension (systolic pulmonary artery pressure >50 mmHg) or tricuspid annular (TA) dilatation, in patients undergoing mitral valve (MV) surgery. ⋯ Multivariate analysis revealed that residual TR was significantly associated with preoperative severe TR, left ventricular end-diastolic dimension >70 mm, right ventricular dimension >40 mm, dilated cardiomyopathy (DCM) and left ventriculoplasty. This MC3 ring corrects TR effectively, and provided good results. We must point out, however, that additional or alternative surgical options should still be considered for high-risk of repair failure, such as those with DCM or high pulmonary hypertension.