Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2014
ReviewEfficacy and safety of negative pressure wound therapy for Szilagyi grade III peripheral vascular graft infection.
A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether it is safe and effective to use negative pressure wound therapy (NPWT) for Szilagyi grade III (i.e. the arterial implant proper involved in the infection) peripheral vascular graft infection. Altogether, 69 papers were found using the reported search. ⋯ The major complication of NPWT was bleeding and the incidence rate was reported to be <10%. We conclude that the amount of evidence for recommending NPWT alone as the first-line treatment for Szilagyi grade III peripheral vascular graft infection is small with only one small-sized randomized controlled trial demonstrating that NPWT alone is superior to alginate dressing change in shortening the time to complete wound healing by 2 months. Limited evidence (case series with >1 year of follow-up) showed that NPWT with a continuous negative pressure of 125 mmHg, or combined NPWT and sartorius myoplasty, may shorten the time to complete wound healing by 2 months, have a >70% success rate, and have a <10% NPWT-related complication rate.
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Interact Cardiovasc Thorac Surg · Dec 2014
Randomized Controlled Trial Comparative Study Observational StudyInterposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery.
The management of cardiac arrest after cardiac surgery differs from the management of cardiac arrest under other circumstances. In other studies, interposed abdominal compression-cardiopulmonary resuscitation (IAC-CPR) resulted in a better outcome compared with conventional CPR. The aim of the present study was to determine the feasibility, safety and efficacy of IAC-CPR compared with conventional CPR in patients with cardiac arrest after cardiac surgery. ⋯ IAC-CPR is feasible and safe and may be advantageous in cases of cardiac arrest after cardiac surgery.
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Interact Cardiovasc Thorac Surg · Dec 2014
Multicenter Study Comparative StudyImproved clinical outcomes and survival following repair of acute type A aortic dissection in the current era.
The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute type A aortic dissection during 2000-2005 and 2006-2010. ⋯ Surgical era significantly impacts early outcomes and actuarial survival following repair of acute type A aortic dissection.
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Interact Cardiovasc Thorac Surg · Dec 2014
Randomized Controlled Trial Comparative StudyLong-term follow-up of a randomized, controlled clinical trial of three therapeutic strategies for multivessel stable coronary artery disease in women.
Coronary artery disease is the leading cause of death in women. The proposed treatments for women are similar to those for men. However, in women with multivessel stable coronary artery disease and normal left ventricular function, the best treatment is unknown. ⋯ Percutaneous coronary intervention and coronary artery bypass graft surgery compared with medical treatment had better results after 10 years of follow-up.
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Interact Cardiovasc Thorac Surg · Dec 2014
ReviewDoes the placement of an Amplatzer septal occluder device confer benefit in patients with a post-infarction ventricular septal defect?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is the placement of an Amplatzer septal occluder device across a post-infarction ventricular septal defect a suitable alternative for patients not eligible for surgical repair?' Altogether, 31 papers were found using the reported search, of which 17 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. ⋯ Patients presenting in cardiogenic shock experienced an increased risk of death and if the timing of myocardial infarction to VSD closure could be delayed by 3 weeks, there was a statistically significant reduction in operative mortality. Percutaneous closure of a post-infarction VSD may avoid the requirement for surgical closure. However, in some cases, it provides time to allow the VSD to mature and the patient to stabilize and be optimized acting as a bridge to surgery to offer the best possible outcome for the patient.