Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2016
Is volumetric 3-dimensional computed tomography useful to predict histological tumour invasiveness? Analysis of 211 lesions of cT1N0M0 lung adenocarcinoma.
The purpose of this study was to use Hounsfield unit (HU) thresholds of computed tomography (CT) images to predict pathological lymph node metastasis and tumour invasiveness of cT1N0M0 lung adenocarcinoma on 3D evaluations. ⋯ Preoperative 3D CT using threshold values of -800 and -300 HU was useful for predicting pathological lymph node metastases and tumour invasiveness of cT1N0M0 lung adenocarcinoma.
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Interact Cardiovasc Thorac Surg · May 2016
Routine operation theatre extubation after cardiac surgery in the elderly.
The aim was to analyse in-hospital outcomes of patients over 70 years of age undergoing routine immediate operation theatre (OT) extubation after on-pump or off-pump cardiac surgery. ⋯ OT extubation in the elderly can be safely performed in nearly 50% of patients, without apparently worsening their outcomes. A key point of this success was the use of a short-acting volatile agent to maintain anaesthesia throughout the procedure. Low- or moderate-risk cardiac surgery assessed with a preoperative EuroSCORE II <2.11 will help to better predict successful OT extubation in the elderly.
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Interact Cardiovasc Thorac Surg · May 2016
Preoperative planning of left-sided valve surgery with 3D computed tomography reconstruction models: sternotomy or a minimally invasive approach?
With the emergence of a new concept aimed at individualization of patient care, the focus will shift from whether a minimally invasive procedure is better than conventional treatment, to the question of which patients will benefit most from which technique? The superiority of minimally invasive valve surgery (MIVS) has not yet been proved. We believe that through better patient selection advantages of this technique can become more pronounced. In our current study, we evaluate the feasibility of 3D computed tomography (CT) imaging reconstruction in the preoperative planning of patients referred for MIVS. ⋯ Preoperative planning of minimally invasive left-sided valve surgery with 3D CT reconstruction models is a useful and feasible method to determine operative strategy and exclude patients ineligible for a minimally invasive approach, thus potentially preventing complications.
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Interact Cardiovasc Thorac Surg · May 2016
Prospective validation of a predictive scoring system for deep sternal wound infection after routine bilateral internal thoracic artery grafting.
The Gatti score is a weighted scoring system based on risk factors for deep sternal wound infection (DSWI) that has been specifically created to predict DSWI risk after routine bilateral internal thoracic artery (BITA) grafting. It has not undergone an external validation. The aim of the present study was to perform this validation. ⋯ On the basis of the results of the present prospective study, the Gatti score has proved to be effective in predicting DSWI following BITA grafting despite some differences between the original and the present series of patients. More studies have to be performed in order to strengthen the evidence of this first external validation.
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Interact Cardiovasc Thorac Surg · May 2016
Unexpected results after sternal reconstruction with plates, cables and cannulated screws.
During the last decade, various plate fixation systems have been developed for the treatment of complicated sternal dehiscence after open-heart surgery. One of them is the Modular Sternal Cable System© (MSCS), which promises optimal distribution of forces along the whole sternum by using plates, cannulated screws and cables. However, in comparison with other systems, there is a lack of outcome data. ⋯ A high incidence of postoperative wound infections was observed after implantation of the MSCS. It may be speculated that hardware design (e.g. the absence of a locking system, large screws) compromises osseous microcirculation, favouring the development of infection. This should be kept in mind for further development of sternal reconstruction systems.