Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2011
Multicenter Study Comparative StudyDoes the technique of distal anastomosis influence clinical outcomes in acute type A aortic dissection?
The purpose of this study was to evaluate clinical outcomes of two different surgical techniques for the repair of acute type A dissection: open distal anastomosis under deep hypothermic circulatory arrest (DHCA) compared with distal aortic clamping on hypothermic cardiopulmonary bypass (ACPB). Between January 2000 and July 2008, 82 patients underwent DHCA and 42 had ACPB. Major morbidity, operative mortality and five-year actuarial survival were compared between groups. ⋯ No significant differences in operative mortality, major morbidity and actuarial five-year survival were observed between DHCA and ACPB. There are some practical technical advantages if the distal anastomosis is performed in an open manner. More studies are required to determine the fate of the false lumen between the two techniques.
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Interact Cardiovasc Thorac Surg · Mar 2011
ReviewIs lung volume reduction surgery effective in the treatment of advanced emphysema?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether lung volume reduction surgery (LVRS) might be superior to medical treatment in the management of patients with severe emphysema. Overall 497 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. ⋯ Five studies compared LVRS to MTA using data independent from the NETT trial. They found greater six-minute walking distances (433 vs. 300 m, P<0.002), improved total lung capacity (18.8 vs. 7.9% predicted, P<0.02) and quality of life scores (47 vs. 23.2, P<0.05) with LVRS compared to MTA. Even though LVRS has a much greater cost per person over five years ($137,000 vs. $100,200, P<0.001), its improved lung function, greater exercise capacity and better quality of life scores make it a preferable treatment option to MTA, with particular indications for patients with upper-lobe-predominant disease and low exercise capacity.
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Interact Cardiovasc Thorac Surg · Mar 2011
Candidemia after cardiac surgery in the intensive care unit: an observational study.
Candidemia is a well-recognized complication of hospital stay, especially in critically ill patients. There is not a general consensus that predictors for candidemia in cardiosurgical intensive care unit (cICU) are different from a general ICU and it has been reported that cardiopulmonary bypass time is a specific risk factor in the cICU. We performed a prospective study to evaluate the main predictors for candidemia in patients admitted to the cICU. ⋯ Only 26 patients (1.3%) had candidemia after an ICU-LOS of 20 days (inter-quartile range, IQR 8-49 days). Total parenteral nutrition [odds ratio (OR)=9.56; confidence interval (CI)=1.741-52.534], severe sepsis (OR=4.20; CI=1.292-13.667), simplified acute physiology score II (OR=1.16; CI=1.052-1.278) and ICU-LOS >20 days (OR=6.38; CI=1.971-20.660) were independent predictors of candidemia. Patients undergoing cardiac surgery developed candidemia late after cICU admission and the independent predictors were similar to the general ICU.
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Interact Cardiovasc Thorac Surg · Mar 2011
Comparative StudyBeating heart versus conventional mitral valve surgery.
The present study aimed to compare the results of beating heart technique and conventional mitral valve surgery (MVS). ⋯ This study concluded that beating heart MVS can be performed successfully, particularly for patients at higher risk which will lead to increased morbidity and mortality in postoperative period.