Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2010
ReviewIn elderly patients with lung cancer is resection justified in terms of morbidity, mortality and residual quality of life?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: In [patients over 70 years of age with lung cancer] is [lung resection] when compared with [non-surgical treatment] justified in terms of [postoperative morbidity, mortality and quality of life]? Altogether more than 297 papers were found using the reported search, of which 12 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. ⋯ Residual QoL following lobectomy (evaluated by patient self-assessment) showed decreased social (P<0.001) and role (P<0.001) functioning but less pain at discharge (P<0.001) in those over 70 years. Global QoL, however, was not influenced by age (global QoL; <70 years 22.2+/-25.3 vs. >70 years 17.6+/-22.9). Pneumonectomy showed statistically significant decreases in physical functioning [six months postoperatively (MPO) P=0.045], role functioning (3 MPO P=0.035), social functioning (6 MPO P=0.006, 12 MPO P=0.001) and general pain (6 MPO P=0.037), but showed no age related differences (<70 years; 81.9+/-19.1, >70 years; 78.0+/-22.8).
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Interact Cardiovasc Thorac Surg · Jun 2010
Randomized Controlled TrialEffect of a neutrophil elastase inhibitor on acute lung injury after cardiopulmonary bypass.
Cardiopulmonary bypass (CPB) has been implicated as a cause of acute lung injury (ALI) in cardiac surgical patients. We used a bronchoscopic microsampling (BMS) probe to examine alveolar biochemical constituents and evaluated the effect of sivelestat sodium hydrate, a novel synthesized polymorphonuclear (PMN) neutrophil elastase inhibitor, on ALI induced by CPB. Twelve patients undergoing aortic valve replacement were treated with either sivelestat 0.2 mg/kg/h (sivelestat group, n=6) or 0.9% saline (control group, n=6) from the start of surgery. ⋯ Alveolar-arterial oxygen difference markedly increased, and a worsening of the PaO(2)/FiO(2) ratio indicated severe impairment after CPB. However, sivelestat attenuated the pattern of physiological deterioration of gas exchange. Sivelestat may attenuate neutrophil elastase or proinflammatory cytokines, and improve pulmonary dysfunction in patients undergoing CPB.
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Interact Cardiovasc Thorac Surg · Jun 2010
Comparative StudyExtracorporeal bubbles: a word of caution.
Gaseous microemboli (GME) are a cause of neurocognitive deficit postcardiac surgery with cardiopulmonary bypass. However, the measurement of microbubbles during cardiopulmonary bypass is not easy, because blood is an opaque fluid and contains microparticles. Recently, two new microbubble counters, the Gampt BC200 and the emboli detection and classification (EDAC) quantifier, were developed for use during cardiac surgery. The accuracy of both devices was validated against industrial standards. ⋯ Both the EDAC and Gampt can be used in a clinical setting for monitoring basal GME production. However, both devices have some major limitations when used for studying 'worst case' scenarios. One should take great caution when correlating measured data with neurocognitive outcome. Finally, results obtained by one device in a first study cannot be compared nor exchanged with results from the other device in a second study.
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Interact Cardiovasc Thorac Surg · Jun 2010
Simultaneous temporary CentriMag right ventricular assist device placement in HeartMate II left ventricular assist system recipients at high risk of right ventricular failure.
An approach is reported for right ventricle temporary mechanical support in long-term axial left ventricular assist device (LVAD) patients preoperatively judged at high risk of right ventricular (RV) failure. The timing for RV assist device (RVAD) weaning and the technique for its removal through a right mini-thoracotomy are described. This strategy provides a good outcome in LVAD recipients avoiding the risk of immediate postoperative RV failure.
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Interact Cardiovasc Thorac Surg · Jun 2010
Seal properties of TachoSil: in vitro hemodynamic measurements.
Fibrin glue products and collagen patches are frequently used as a sealing product, preventing surgical side bleedings. This is especially true in the field of cardiovascular surgery, where increasing numbers of patients are being operated with antiplatelet and anticoagulation therapy. The aim of this report was, in an in vitro hemodynamic setting, to examine the sealant properties of the TachoSil (Nycomed Pharma, Linz, Austria) patch. ⋯ However, at the larger defects the seal character was significantly reduced. These results suggest that the device may be a good alternative for hemostasis for small defects. The capacity to curtail or stop hemorrhage at the larger defects is unlikely.