Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2014
ReviewIs it possible to predict the risk of ischaemic bowel after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is it possible to predict the risk of ischaemic bowel after cardiac surgery?' Altogether 80 papers were found as a result of the reported search, of which 7 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. ⋯ Thus, careful intraoperative management to minimize cardiopulmonary bypass and cross-clamp time and optimal care of patients' postoperative haemodynamic status, particularly in elderly patients with severe atherosclerotic disease, are useful in preventing this rare but lethal postoperative complication. Besides that, a heightened clinical suspicion in patients with these risk factors may lead to prompt diagnosis of bowel ischaemia, allowing intervention to prevent mortality. The variability of the study design and risk factors studied in each paper impose limitation to summarize the predicting risk factors.
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Interact Cardiovasc Thorac Surg · Sep 2014
ReviewDo patients with haematological malignancy who need cardiopulmonary bypass have a short-term higher mortality or a higher chance of disease progression?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether patients with haematological malignancy (HM) who need cardiopulmonary bypass (CPB) have a higher short-term mortality or a higher chance of disease progression secondary to CPB. Altogether, 107 papers were found using the reported search terms, but ultimately only eight were relevant to our subject. ⋯ No paper reported an acute change in blood disorders. Long-term mortality rates were not mentioned in some papers, but when it was stated, the HM patients' long-term mortality seemed not increased by using CPB surgery, with more than 80% survival at 3 years and 20-25% progression of the disease at 3 years. Although these study limitations are linked to the low-evidence levels in some of the papers used, haematological malignancies should not be considered a contraindication for cardiac CPB surgery.
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Interact Cardiovasc Thorac Surg · Sep 2014
Randomized Controlled Trial Comparative StudyComparative evaluation of high-flow nasal cannula and conventional oxygen therapy in paediatric cardiac surgical patients: a randomized controlled trial.
The aim of this study was to compare high-flow nasal cannula (HFNC) and conventional O2 therapy (OT) in paediatric cardiac surgical patients; the primary objective of the study was to evaluate whether HFNC was able to improve PaCO2 elimination in the first 48 h after extubation postoperatively. ⋯ HFNC had no impact on PaCO2 values. The use of HFNC appeared to be safe and improved PaO2 in paediatric cardiac surgical patients.
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Interact Cardiovasc Thorac Surg · Sep 2014
ReviewWho might benefit from early aspirin after coronary artery surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether early administration of aspirin might optimize vein graft patency. More than 250 papers were found using the reported search, of which 4 new papers in addition to the previous 7 represented the best evidence to answer the clinical question. ⋯ It is essential to define/quantify the postoperative blood loss that precludes administration of early aspirin. This will enhance prompt administration in some cases and guide judgement, especially in patients with high-risk factors for vein graft thrombosis. Administration at 6 h is the optimal time to give aspirin as long as bleeding has settled.
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Interact Cardiovasc Thorac Surg · Sep 2014
Randomized Controlled Trial Comparative StudySub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trial.
The aim of this trial was to compare functional capacity, pulmonary shunt fraction and clinical outcomes between patients undergoing pleurotomy with a pleural drain inserted in the sub-xyphoid position and patients with a pleural drain placed in the intercostal position after off-pump coronary artery bypass surgery. ⋯ Sub-xyphoid pleural drain determined better functional capacity and exercise tolerance with a smaller pulmonary shunt fraction and improved clinical outcomes compared with intercostal pleural drainage after off-pump coronary artery bypass surgery.