Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2011
Case ReportsTotal cricoidectomy and laryngotracheal reconstruction for subglottic stenosis with glottic involvement.
We present a case of subglottic stenosis involving the glottis with inflammatory destruction of the cricoid cartilage after prolonged endotracheal intubation. Total cricoidectomy and laryngotracheal anastomosis were performed with T-tube placement that was retained for five months postoperatively. ⋯ Good respiratory and phonatory results were obtained during normal daily activity, although a slightly hoarse voice was present, but no aspiration was observed. Total cricoidectomy and laryngotracheal reconstruction may be considered suitable for subglottic stenosis with glottic involvement, if accompanied by inflammatory destruction of the cricoid cartilage.
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Interact Cardiovasc Thorac Surg · Sep 2011
Left ventricle unloading by percutaneous pigtail during extracorporeal membrane oxygenation.
Arterial-venous extracorporeal membrane oxygenation (ECMO) is more and more used as first line mechanical support in acute cardiopulmonary failure. Important pitfall of this technique is the inappropriate unloading of left ventricle (LV) in case of myocardial insufficiency, leading to pulmonary stasis and inadequate myocardial recovery. ⋯ Echographic guidance is sufficient to pigtail positioning and follow-up monitoring avoiding catheterization laboratory transport. With this approach we were able to support three different patients, resolving LV distension and preventing lung congestion, without major complication.
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Interact Cardiovasc Thorac Surg · Sep 2011
Triclosan-coated sutures for the reduction of sternal wound infections? A retrospective observational analysis.
Sternal wound infections are an infrequent but serious complication of cardiac surgery, leading to a prolonged hospital stay, increased costs and greater morbidity. To prevent bacterial colonisation of the suture material, which disables local mechanisms of wound decontamination, sutures coated with triclosan were developed. The current study set out to evaluate the effectiveness of such sutures against the development of sternal wound infections after cardiac surgery. ⋯ Triclosan-coated sutures therefore showed no advantage in avoiding or reducing sternal wound infections. As the cost of these new materials is higher, the rationale for using these sutures remains to be determined.
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Interact Cardiovasc Thorac Surg · Aug 2011
Comparative StudyOne-year follow-up of patients undergoing elective cardiac surgery assessed with the Comprehensive Assessment of Frailty test and its simplified form.
Assessment of perioperative risk of elderly patients in cardiac surgery is demanding. Most of the commonly used cardiac surgery risk scores over-or underestimate individual risk. Therefore, we recently developed a 'frailty score', the comprehensive assessment of frailty (CAF) score that showed a good prediction of 30-day mortality. ⋯ A new, easily applicable score ('Frailty predicts death One yeaR after Elective Cardiac Surgery Test') was built out of the basic score and showed a promising ability to predict one-year mortality. CAF is a new additional tool to assess prognosis of elderly patients before cardiac surgical interventions. The 'CAF' score facilitates prediction of mid-term outcome of high-risk elderly patients.
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Interact Cardiovasc Thorac Surg · Aug 2011
ReviewIdiopathic thrombocytopenic purpura and coronary artery disease: comparison between coronary artery bypass grafting and percutaneous coronary intervention.
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a low platelet count and an increased risk of bleeding. At the same time, ITP patients present an increased risk of thrombosis and atherosclerosis related to the high presence of haemostatic factors and chronic steroid therapy. ⋯ In particular, no recommendations exist regarding the best management approach. We reviewed the literature making a comparison between coronary artery bypass grafting and percutaneous coronary intervention.