Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Apr 2015
ReviewIn minor and major thoracic procedures is uniport superior to multiport video-assisted thoracoscopic surgery?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: Are there differences in outcomes in uniport compared with multiport video-assisted thoracoscopic surgery? Altogether, 45 papers were found using the reported search, of which 8 papers represent the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type and level of evidence of publication, relevant outcomes and results of these papers are tabulated. ⋯ Four other studies, however, did not find any significant difference in duration of hospital stay. Pain scores are lower in uniportal VATS, most studies however do not demonstrate differences in other outcomes including analgesic use, duration of chest tube drainage, length of hospital stay or other thoracic complications. We conclude that, although uniport access may offer improved pain scores, the current evidence reveals no differences in most postoperative outcomes between uniport and multiport approaches to VATS in either minor or major thoracic procedures.
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Interact Cardiovasc Thorac Surg · Apr 2015
Observational StudyTrainees can learn minimally invasive aortic valve replacement without compromising safety.
Minimally invasive aortic valve replacement (Mini-AVR) is a technically advanced procedure. However, it results in equivalent operative mortality, less bleeding and reduced intensive care/hospital stay when compared with conventional AVR. Our aim was to assess the impact of trainee performance on short-term outcomes of patients undergoing elective and urgent Mini-AVR where a significant proportion were performed by trainees. ⋯ Mini-AVR can be performed with a low conversion rate and hospital stay and taught to trainees without compromising safety.
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Interact Cardiovasc Thorac Surg · Apr 2015
Preoperative renal function and surgical outcomes in patients with acute type A aortic dissection†.
There are few data concerning the impact of preoperative renal function, assessed using estimated glomerular filtration rate, on surgical outcomes following acute type A aortic dissection. We investigated the accuracy of estimated glomerular filtration rate (in ml/min/1.73 m(2)) in predicting in-hospital mortality and postoperative renal replacement therapy in such cases. ⋯ Preoperative estimated glomerular filtration rate can effectively predict the need for renal replacement therapy after surgery for acute type A aortic dissection. However, it is not an effective diagnostic tool to predict in-hospital mortality. The complexity of the characteristics of patients who undergo surgical procedures may make prediction of surgical outcomes difficult. Risk models to predict hospital mortality and morbidities are needed to assist clinicians in determining the optimal treatment.
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Interact Cardiovasc Thorac Surg · Apr 2015
Maximal blood flow acceleration analysis in the early diastolic phase for in situ internal thoracic artery bypass grafts: a new transit-time flow measurement predictor of graft failure following coronary artery bypass grafting.
Maximal graft flow acceleration (max df/dt) determined by transit-time flowmetry (TTFM) in the diastolic phase was assessed as a possible predictor of graft failure in coronary artery bypass patients. ⋯ The TTFM 5-polymial max df/dt value in the early diastolic phase may be a promising predictor of future graft failure.
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Interact Cardiovasc Thorac Surg · Apr 2015
Surgical modification for preventing a gothic arch after aortic arch repair without the use of foreign material.
Systemic hypertension is the main late complication after arch reconstruction in patients with arch obstruction. Gothic arch geometry is suspected to be one of its possible causes. Accordingly, we evaluated here if a modified arch repair technique using an autologous pulmonary patch is effective in preventing gothic arch development. ⋯ Our modified technique was proven to be not only highly effective in preventing gothic arch geometry, but also as equally safe in terms of early clinical outcomes as conventional arch reconstruction techniques.