Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Oct 2013
Analysis of aortic valve commissural fusion after support with continuous-flow left ventricular assist device.
Continuous-flow left ventricular assist devices (cf-LVADs) may induce commissural fusion of the aortic valve leaflets. Factors associated with this occurrence of commissural fusion are unknown. The aim of this study was to examine histological characteristics of cf-LVAD-induced commissural fusion in relation to clinical variables. ⋯ Aortic valve commissural fusion after support with cf-LVADs is a non-inflammatory process leading to changes in valve layer structure that can be observed in >50% of cf-LVAD patients. This is the first study showing that patients receiving full cf-LVAD support without opening of the valve have a significantly higher risk of developing commissural fusion than patients on partial support.
-
Interact Cardiovasc Thorac Surg · Oct 2013
Case ReportsMediastinal infectious complication after endobronchial ultrasound-guided transbronchial needle aspiration.
We report here a mediastinal infectious complication after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) that was successfully treated using intravenous antibiotic therapy. EBUS-TBNA was performed for a 59-year old man with mediastinal adenopathy 8 years after left pneumonectomy for squamous cell carcinoma of the lung. ⋯ The procedure itself was uneventful, but the patient developed a nightly fever after the biopsy. Finally, he was readmitted, and intravenous antibiotic therapy was required for 4 weeks to treat a mediastinal infection after EBUS-TBNA before chemotherapy for small-cell lung cancer.
-
Interact Cardiovasc Thorac Surg · Oct 2013
ReviewIs levosimendan effective in paediatric heart failure and post-cardiac surgeries?
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'do children with heart failure post-cardiac surgery undergoing treatment with levosimendan have an acceptable haemodynamic improvement?' The use of levosimendan as a vasoactive drug is an accepted intervention for patients with altered haemodynamics post-cardiac surgeries. However, the role of levosimendan and its efficacy have been debated. ⋯ Furthermore, it is best used as a rescue drug on a named-patient basis. A small sample size was indeed a limitation in all the above studies. Larger, well-designed trials are required to further evaluate the efficacy and feasibility of levosimendan in paediatric heart failure and post-cardiac surgeries.
-
Interact Cardiovasc Thorac Surg · Oct 2013
Multicenter StudyFeasibility and safety of minimized cardiopulmonary bypass in major aortic surgery.
Conventional cardiopulmonary bypass causes haemodilution and is a trigger of systemic inflammatory reactions, coagulopathy and organ failure. Miniaturized cardiopulmonary bypass has been proposed as a way to reduce these deleterious effects of conventional cardiopulmonary bypass and to promote a more physiological state. The use of miniaturized cardiopulmonary bypass has been reported in low-risk patients undergoing valve and coronary artery bypass graft (CABG) surgery. However, little is known about its application in major aortic surgery. ⋯ Our experience suggests that miniaturized cardiopulmonary bypass is safe and feasible for use in major aortic cardiac surgery. A randomized trial is needed to evaluate miniaturized cardiopulmonary bypass formally.