Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2010
Comparative StudyAortic root distensibility and cross-sectional areas in stented and subcoronary stentless bioprostheses in pigs.
A flexible aortic root is essential for natural leaflet stress distribution. It is suggested that stentless bioprosthetic valves retain the flexibility of native valves. We investigated aortic root distensibility and cross-sectional area (CSA) in stentless (Solo, n=4; Toronto SPV, n=7), stented (Mitroflow, n=8) and in native valves (n=8) in pigs. ⋯ In conclusion, the Solo valve had a larger CSA at the annulus than both the Mitroflow and the Toronto SPV. However, the stentless valves had a smaller CSA at the sino-tubular junction than the Mitroflow. We, furthermore, found that implantation of stentless heart valves preserves aortic root distensibility at the annular level in pigs.
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Interact Cardiovasc Thorac Surg · Jun 2010
Comparative StudyShort-term outcome following cardiac surgery--a comparison between consultant and trainees' performance.
Comparison of the outcome of cardiac operations performed by surgical trainees with those performed by consultant surgeons has been an interesting topic in recent years. We set out to examine the outcome of a high volume-training firm. Cardiac operations performed by surgical trainees and a consultant between January 2006 and March 2009 were studied. ⋯ Mortality for CABG in consultant and surgical trainees groups was six (1.7%) and six (4.2%), respectively (P=NS). There was no significant difference in morbidity outcome measures comparing the two groups. The non-significant higher overall mortality in operations performed by trainees in a fully supervised setting, may reflect the influence of experience and confidence, which are difficult to measure.
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Interact Cardiovasc Thorac Surg · Jun 2010
Risk and protective factors for major complications after pneumonectomy for lung cancer.
Pneumonectomy carries a high-risk for postoperative complications. The aim of the study was to identify factors that may predispose to the development of major postoperative complications after pneumonectomy for lung cancer. All consecutive patients from January 2000 to December 2005 were retrospectively studied. ⋯ Preoperative haemoglobin > or =10 g/dl (OR, 0.19; 95% CI, 0.01-0.91) and low tidal volume administrated during surgery (< or =7.35 ml/kg; OR, 0.36; 95% CI, 0.10-0.92) were identified as protective factors. Pneumonectomy remains a high-risk surgery. Postoperative complications may be influenced by the comorbidities but also the management of fluid infusion and mechanical ventilation during the surgical procedure.
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Interact Cardiovasc Thorac Surg · Jun 2010
Video-assisted thoracic surgery for pulmonary aspergilloma.
The purpose of this retrospective study was to review our experience with video-assisted thoracic surgery (VATS) for pulmonary aspergilloma. The patients (n=20) were aged 62+/-12 years, and eight (40%) were aged 70 years or more. The disease types were simple aspergilloma (SA) in six patients and complex aspergilloma (CA) in 14. ⋯ The 5-year survival rate was 89%. In suitable cases, VATS for pulmonary aspergilloma may not be inferior to open surgery with regard to safety and efficacy. In particular, SA is considered to be a good indication for VATS.
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Interact Cardiovasc Thorac Surg · Jun 2010
ReviewDo patients undergoing lung biopsy need a postoperative chest drain at all?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed whether insertion of an intercostal chest drain prolongs the length of stay of patients undergoing lung biopsy. Altogether 210 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. ⋯ Four studies advocate early chest tube removal, allowing discharge of 95% within 24 h in one study, reduced hospital stay from 3.9+/-2.1 days to 2+/-1 days (P=0.001) in another, and a median stay of 1.2 days (range 0-7 days) in a third. Removal of chest drain within 1 h of the operation was possible in 92% of patients (one study), significantly reducing pain (P=0.03, P=0.005; two studies) and postoperative complications (P=0.01; one study) compared with conventional treatment. Five studies in which patients were managed without chest drain following intraoperative air leak checks, reduced hospital stay vs. conventional management (two studies; 2 vs. 3, P<0.001, 1 vs. 3, P<0.01) but results in no difference in complication rates (three studies: pneumothoraces requiring chest drain; 2 vs. 2, P=non-significant; 0 vs. 0; 0 vs. 0) or pain score (two studies; 0.77 vs. 0.76, P=0.894; 5 vs. 5, P=0.81).