Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2011
ReviewDoes use of intraoperative cell-salvage delay recovery in patients undergoing elective abdominal aortic surgery?
A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether the use of intraoperative cell-salvage (ICS) leads to negative outcomes in patients undergoing elective abdominal aortic surgery? Altogether 305 papers were found using the reported search, of which 10 were judged to represent 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 were tabulated. ⋯ Indeed two trials actually show a significantly shorter hospital stay after ICS use, one a shorter ITU stay and another suggests lower rates of chest sepsis. Based on these papers, we concluded that the use of ICS does not cause increased morbidity or mortality when compared to standard practise of transfusion of allogenic blood, and may actually improve some clinical outcomes. As abdominal aortic surgery inevitably causes significant intraoperative blood loss, in the range of 661-3755 ml as described in the papers detailed in this review, ICS is a useful and safe strategy to minimise use of allogenic blood.
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Interact Cardiovasc Thorac Surg · Jun 2011
ReviewIn adult patients undergoing redo surgery for left atrioventricular valve regurgitation after atrioventricular septal defect correction, is replacement superior to repair?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In adult patients undergoing redo surgery for left atrioventricular valve regurgitation after atrioventricular septal defect correction, is replacement superior to repair?' Altogether more than 109 papers were found using the reported search, of which eight 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. ⋯ We feel that for older patients or for those in whom long-term anticoagulation is a concern, biological prosthesis can be an option, also due to the growing and expanding experience of percutaneous/transapical valve-in-valve replacement in mitral position. Since in these patients the number of previous sternotomies is usually one or more and re-entry injuries can be a major source of perioperative mortality and morbidity, we believe that mini-thoracotomy approach can avoid potential damage; furthermore, arterial cannulation can be either central or peripheral according to the degree of visceral adhesions or surgeon's choice. Venous drainage should be provided by a percutaneous vacuum-assisted femoral double stage venous drainage, which is useful especially when concomitant tricuspid valve surgery is planned.
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Interact Cardiovasc Thorac Surg · Jun 2011
Preoperative computed tomography is associated with lower risk of perioperative stroke in reoperative cardiac surgery.
Preoperative computed tomography (CT) use appears to be increasing among patients undergoing cardiac reoperations. We hypothesized that preoperative CT imaging reduces adverse outcomes and operative mortality for these patients. From July 2002 to February 2009, 373 patients underwent cardiac reoperations. ⋯ Importantly, perioperative stroke occurred only within the NCT group (5.6% vs. 0.0%, P=0.003), and emergent operative status [odds ratio (OR): 6.45, confidence interval (CI): 1.15-36.10, P=0.03] as an independent multivariate predictor of perioperative stroke. Thus, preoperative CT imaging is associated with lower rates of perioperative stroke in patients undergoing cardiac reoperations by optimizing cannulation and aortic clamping strategies. Routine use of preoperative CT should be considered for patients undergoing cardiac operations following prior sternotomy.
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Interact Cardiovasc Thorac Surg · Jun 2011
Case ReportsFirst experience with the ultra compact mobile extracorporeal membrane oxygenation system Cardiohelp in interhospital transport.
In patients with severe cardiopulmonary failure extracorporeal assist devices are to support patients during resuscitation, for transportation, until organ recovery, and as bridge to further therapeutic modalities. We report on our first experience with the new Cardiohelp system for interhospital transfer of cardiopulmonarily compromised patients. The Cardiohelp system was used for transportation and in-house treatment in six male patients with a mean age of 41±17 years. ⋯ A 100% survival was achieved. The portable Cardiohelp system allows location-independent stabilization of cardiopulmonary compromised patients with consecutive interhospital transfer and in-house treatment. The integrated sensors, which register arterial and venous line pressure, blood temperature, hemoglobin as well as SvO(2), greatly alleviate its management and considerably increase safety.
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Interact Cardiovasc Thorac Surg · Jun 2011
Rescue extracorporeal membrane oxygenation in children with refractory cardiac arrest.
We describe our experience with extracorporeal cardiopulmonary resuscitation (CPR) using extracorporeal membrane oxygenation (ECMO) in children with refractory cardiac arrest, and determine predictors for mortality. ECMO support was instituted on 42 children, median age 0.7 years (1 day-17.8 years), median weight 7.05 (range 2.7-80) kg who suffered refractory cardiac arrest (1992-2008). Patients were postcardiotomy (n=27), or had uncorrected congenital heart diseases (n=3), cardiomyopathy (n=3), myocarditis (n=2), respiratory failure (n=3), or had trauma (n=4). ⋯ Age, weight, sex, anatomic diagnosis, etiology (surgical vs. medical) were not significant predictors of poor outcome. Prolonged CPR and high-dose inotropes are significant predictors of mortality. Rescue ECMO support in children with refractory cardiac arrest can achieve acceptable survival and neurological outcomes.