Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2013
Randomized Controlled Trial Multicenter StudyPrevention of sternal wound complications after sternotomy: results of a large prospective randomized multicentre trial.
A prospective randomized multicentre trial was performed to analyse the efficacy of a vest (Posthorax support vest®) to prevent sternal wound infection after cardiac surgery, and to identify risk factors. ⋯ Consistent use of the Posthorax® vest prevented deep sternal wounds. The anticipated risk factors for wound complications did not prove to be relevant, whereas intra- and postoperative complications appear to be very significant.
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Interact Cardiovasc Thorac Surg · Sep 2013
Prolonged intensive care treatment of octogenarians after cardiac surgery: a reasonable economic burden?
In accordance with the rising prevalence of octogenarians undergoing cardiac surgery, these patients utilize an increasing portion of intensive care unit (ICU) capacities, provoking economic and ethical concerns. In this study, we evaluated the outcomes and costs generated by the prolonged postoperative ICU treatment of octogenarians. ⋯ Presented data propose that advanced age is correlated with a higher mortality, but not with prolonged ICU treatment or higher costs after cardiac surgery. Considering the encouraging functional status and QOL of the survivors, the financial burden caused by octogenarians is justified.
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Interact Cardiovasc Thorac Surg · Sep 2013
Impact of intraoperative hyperglycaemia on renal dysfunction after off-pump coronary artery bypass.
Acute kidney injury (AKI) is one of the most frequently occurring complications after off-pump coronary artery bypass graft (OPCAB). Hyperglycaemia is a major, potentially modifiable risk factor of adverse outcome after cardiac surgery known to aggravate organ damage. The aim of this study was to address the association between intraoperative glucose concentration and postoperative AKI in patients who underwent OPCAB. ⋯ Intraoperative glucose concentration >150 mg/dl and increased variability of glucose were independently associated with AKI after OPCAB. Tight intraoperative glycaemic control (<110 mg/dl) does not seem to provide additional benefit in terms of AKI.
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Interact Cardiovasc Thorac Surg · Sep 2013
Case ReportsMinimally invasive access for off-pump HeartWare left ventricular assist device explantation.
The implantation of a left ventricular assist device as a bridge to transplantation is a well-established treatment of end-stage heart failure in selected patients. Device-related infection is a well-known complication that may require the removal of the device. We describe a minimally invasive explantation approach with complete removal of all components of a HeartWare left ventricular assist device in a patient with persistent infection related to the device.
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Interact Cardiovasc Thorac Surg · Sep 2013
Comparative StudyComparison of survival among neoadjuvant chemoradiation responders, non-responders and patients receiving primary resection for locally advanced oesophageal squamous cell carcinoma: does neoadjuvant chemoradiation benefit all?
While neoadjuvant chemoradiation followed by surgery has been shown to improve the survival of patients with locally advanced oesophageal cancer, it is not known whether neoadjuvant chemoradiation has a beneficial or harmful effect on the non-responders. We aimed to compare the outcomes among neoadjuvant chemoradiation responders, non-responders and patients receiving primary oesophagectomies for resectable locally advanced oesophageal squamous cell carcinoma. ⋯ Neoadjuvant chemoradiation non-responders demonstrated no benefit and an even worse outcome compared with those receiving primary resection for locally advanced oesophageal squamous cell carcinoma. However, no significant clinical parameters could be implemented in the clinics to predict the response to neoadjuvant chemoradiation before treatment.