Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2012
Insertion of paravertebral block catheters intraoperatively to reduce incidence of block failure.
Paravertebral block catheters are a recognized method of regional pain control after a thoractomy. We describe a technique of insertion with the belief that it provides a superior positioning of the paravertebral (extra-pleural) catheter resulting in a better distribution of the local anaesthetic and better pain control.
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Interact Cardiovasc Thorac Surg · May 2012
Case ReportsDiscrete subaortic stenosis 37 years after repair of a ventricular septal defect.
Discrete subaortic stenosis (DSS) is uncommon in adults after surgical correction of congenital heart defects. There are only a few published reports on the occurrence of DSS in adults. ⋯ Thirty-seven years later, she presented with congestive heart failure associated with severe subaortic membranous stenosis and atrial fibrillation (AF) that required surgical repair. We report successful surgical treatment of this adult patient with DSS and AF 37 years after repair of a VSD.
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Interact Cardiovasc Thorac Surg · May 2012
Comparative StudyPrediction of postoperative atrial fibrillation in a large coronary artery bypass grafting cohort.
The objective of this study was to identify and evaluate predictors of postoperative atrial fibrillation (POAF) in a large coronary artery bypass grafting (CABG) cohort. This was a single centre study of 7115 consecutive patients with preoperative sinus rhythm who underwent isolated CABG between January 1996 and December 2009. Independent risk factors for POAF were identified with multiple logistic regression. ⋯ The final prediction model was moderate (area under curve, 0.62; 95% confidence interval, 0.61-0.64). Patients with POAF had more postoperative complications, including a higher incidence of stroke and increased length of hospital stay. In conclusion, several risk factors for POAF were identified, but the moderate value of the prediction model confirms the difficulty of identifying patients at high risk of developing POAF after CABG.
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Interact Cardiovasc Thorac Surg · May 2012
Very low survival rates after non-traumatic lower limb amputation in a consecutive series: what to do?
The aim of this retrospective study was to evaluate factors potentially influencing short- and long-term mortality in patients who had a non-traumatic lower limb amputation in a university hospital. A consecutive series of 93 amputations (16% toe/foot, 33% trans-tibial, 9% through knee and 42% trans-femoral) were studied. Their mean age was 75.8 years; 21 (23%) were admitted from a nursing home and 87 (92%) were amputated due to a vascular disease and/or diabetes. ⋯ Further, the risk of not surviving increased with 7% per each additional year the patient got older. Of concern, almost one-third of patients died within 1 month. This may be unavoidable, but a multidisciplinary, optimized, multimodal pre- and postoperative programme should be instituted, trying to improve the outcome.
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Interact Cardiovasc Thorac Surg · May 2012
ReviewIs routine stress ulcer prophylaxis of benefit for patients undergoing cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. We address whether routine pharmacological stress ulcer prophylaxis is of benefit for patients undergoing cardiac surgery. One hundred and fifty-six papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. ⋯ Two prospective cohort studies that examined the use of PPI in conjunction with clopidogrel in patients with coronary artery disease concluded that there was no association with an increase in major adverse cardiovascular events with the use of PPIs. We conclude that the current evidence is marginally in favour of the use of prophylactic PPIs. However, this is associated with an increased risk of hospital-acquired pneumonia.