Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2014
ReviewIs perioperative corticosteroid administration associated with a reduced incidence of postoperative atrial fibrillation in adult cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Is perioperative corticosteroid administration associated with a reduced incidence of postoperative atrial fibrillation (POAF) in adult cardiac surgery? A total of 70 papers were identified using the search as described below. Of these, eight were identified to provide best evidence to answer the clinical question. ⋯ Although the optimal dose, dosing interval and duration of therapy are unclear, meta-analysis suggests that a single dose can be as effective as multiple doses. No statistically significant complications associated with the use of corticosteroids were reported in any of the studies. We conclude that a single prophylactic moderate dose of corticosteroid (50-210 mg of dexamethasone equivalent or 200-1000 mg/day hydrocortisone) can significantly reduce the risk of POAF with no significant increase in morbidity or mortality.
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Interact Cardiovasc Thorac Surg · Feb 2014
Case ReportsRight massive haemothorax as the presentation of blunt cardiac rupture: the pitfall of coexisting pericardial laceration.
A 74-year old female was transferred to our institution because of blunt chest trauma. Chest X-ray and computed tomography (CT) revealed right haemothorax and little pericardial effusion. ⋯ There were three 1-cm lacerations actively bleeding from the right atrium and inferior vena cava junction, which were repaired successfully. Furthermore, we identified a 10 cm laceration in the right-side pleuropericardium and a communication existing between the pericardial space and the right pleural space.
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Interact Cardiovasc Thorac Surg · Feb 2014
ReviewIs cryoanalgesia effective for post-thoracotomy pain?
A best evidence topic was written according to a structured protocol. The question addressed was whether cryoanalgesia improves post-thoracotomy pain and recovery. Twelve articles were identified that provided the best evidence to answer the question. ⋯ Thoracotomy closure and site of area of chest drain insertion may have a role in postoperative pain; but only one article explained method of closure, and two articles mentioned placement of chest drain through blocked dermatomes. No causal inferences can be made by the above results as they are not directly comparable due to confounding variables between studies. Currently, the evidence does not support the use of cryoanalgesia alone as an effective method for relieving post-thoracotomy pain.
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Interact Cardiovasc Thorac Surg · Feb 2014
Randomized Controlled Trial Comparative StudyAssessment of concomitant paroxysmal atrial fibrillation ablation in mitral valve surgery patients based on continuous monitoring: does a different lesion set matter?
The efficacy of concomitant ablation techniques in patients with paroxysmal atrial fibrillation (AF) undergoing mitral valve surgery remains under debate. The aim of this prospective, randomized, single-centre study was to compare pulmonary vein isolation (PVI) only versus a left atrial maze (LAM) procedure in patients with paroxysmal AF during mitral valve surgery. ⋯ According to continuous ECG monitoring data, freedom from AF was significantly higher after the concomitant LAM procedure than after PVI in patients with paroxysmal AF who underwent mitral valve surgery.
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Interact Cardiovasc Thorac Surg · Feb 2014
ReviewShould the radial artery be used as a bypass graft following radial access coronary angiography.
The radial artery (RA) is often selected as the next conduit of choice following the internal thoracic artery for coronary artery bypass grafting operations (CABG). Radial access coronary angiography (RA-CA) has grown in popularity among cardiologists and has been advocated as the access route of choice for coronary angiography and intervention by many groups. However, sheath insertion and instrumentation may lead to structural and functional damage to the RA, which may preclude its use as a bypass conduit. ⋯ Only one paper directly assesses patency rates of RA's used as bypass grafts following RA-CA finding a significant adverse effect on graft patency (77% patency in RA-CA, compared with 98% in the control group). We recommend avoiding the RA as a bypass conduit if it has previously been used for RA-CA. In situations where conduit options are limited, if possible, the RA should be avoided for at least 3 months following RA-CA and it may be beneficial to assess the RA's patency and flow characteristics with Doppler ultrasound preoperatively.