Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2012
Randomized Controlled Trial Comparative StudyTriclosan-coated sutures do not reduce leg wound infections after coronary artery bypass grafting.
Leg wound infection is a common complication after coronary artery bypass grafting (CABG). Suture contamination has been suggested as a mechanism of surgical site infections. Vicryl Plus(®) is a polyglacitin suture coated with the antiseptic chemical substance Triclosan, which has been shown to inhibit the growth of Staphylococcus aureus in vitro. The first aim of the present study was to compare Vicryl Plus with conventional Vicryl(®) sutures with regard to leg wound infections following CABG. The second aim was to examine patient- and operative characteristics, which are assumed to predict leg wound infections. ⋯ In the present study, we report for the first time that Vicryl Plus did not reduce the incidence of leg wound infections in patients undergoing CABG. Obesity and prolonged time of extracorporeal circulation were both associated with the increased risk of infections. Currently, the clinical role and indication for the use of Vicryl Plus have yet to be defined.
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Interact Cardiovasc Thorac Surg · Sep 2012
Review Case ReportsDoes a conservative fluid management strategy in the perioperative management of lung resection patients reduce the risk of acute lung injury?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether a conservative fluid management strategy in the perioperative management of lung resection patients is associated with a reduced incidence of postoperative acute lung injury (PALI) and/or acute respiratory distress syndrome (ARDS) in the recovery period. Sixty-seven papers were found using the reported search, of which 13 level III and 1 level IV evidence studies represented the best evidence to answer the question. ⋯ On this best evidence, we recommend intra- and postoperative maintenance fluid to be administered at 1-2 ml/kg/h and that a positive fluid balance of 1.5 l should not be exceeded in the perioperative period with caution being exercised with regard to the adequacy of oxygen delivery. If the fluid balance exceeds this threshold, a high index of suspicion for PALI/ARDS should be adopted and escalation of the level of care should be considered. If a patient develops signs of hypoperfusion after these thresholds are exceeded, inotropic/vasopressor support should be considered.
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Interact Cardiovasc Thorac Surg · Sep 2012
Comparative StudyThe French airbridge for circulatory support in the Carribean.
We report the assessment and the activities for the first year of our airborne circulatory support mobile unit (CSMU) in the French Caribbean. ⋯ CSMUs can be very efficient in providing support to patients in refractory shock, when remote from a cardiac surgery centre. The airborne transfer of patients on ECMO/ECLS can be achieved safely, even over long distances.
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Interact Cardiovasc Thorac Surg · Sep 2012
Comparative StudyLow preoperative cerebral oxygen saturation is associated with longer time to extubation during fast-track cardiac anaesthesia.
Fast-track cardiac anaesthesia programs aiming at early tracheal extubation have not only been linked to a decrease in intensive care unit and hospital length of stay but also to a decrease in morbidity and mortality as well as a containment of rising medical costs. General recommendations for the inclusion criteria concerning fast-track programs are not available. ⋯ Cerebral oxygen saturation assessment prior to cardiac surgery is significantly related to time to extubation and may thus be used to stratify candidates in fast-track programs.
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Interact Cardiovasc Thorac Surg · Sep 2012
Case ReportsSimultaneous complex single ventricle palliation and tracheoplasty for heterotaxy syndrome.
Although isomerism of the bronchial tree is an integral part of hetrotaxy syndrome, the association of congenital tracheal stenosis is rare in this group of disorders, and it has not yet been thoroughly described in the literature. This condition is potentially life-threatening and precludes single ventricle palliation. This report presents the case of a 5-month old infant with symptomatic congenital tracheal stenosis, functionally univentricular heart and extracardiac total anomalous pulmonary venous connection (TAPVC). The condition was successfully treated with bidirectional Glenn anastomosis, central pulmonary artery plasty, repair of TAPVC and slide tracheoplasty.