Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2020
ReviewDo perioperative protocols of enhanced recovery after cardiac surgery improve postoperative outcome?
A best evidence topic was constructed according to a structured protocol. The question addressed was whether the application of an enhanced recovery protocol or pathway improves patient outcomes after cardiac surgery. A total of 3091 papers were found using the reported search. ⋯ Significant differences from conventional care were reported for time to extubation or intubation time in 4 studies (3 FT, 1 ERAS), duration of intensive care unit stay in 6 studies (4 FT, 2 ERAS), length of hospital stay (LOS) in 8 studies (5 FT, 3 ERAS), cost in 5 studies (4 FT, 1 ERAS), pain scores in 2 studies (2 ERAS) and opioid use in 3 studies (3 ERAS). We conclude that FT or ERAS improve postoperative outcomes including length of stay and pain control, without increasing morbidity, mortality or readmission. However, there is a need for prospective studies and standardized protocols.
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Interact Cardiovasc Thorac Surg · Apr 2020
Novel percutaneous dual-lumen cannula-based right ventricular assist device provides effective support for refractory right ventricular failure after left ventricular assist device implantation.
Right heart failure after left ventricular assist device (LVAD) implantation is associated with significant morbidity and mortality. A new generation of percutaneous right ventricular assist devices (RVADs) may mitigate the need for invasive surgical RVAD implantation. The purpose of this study was to evaluate the safety and efficacy of the Protek Duo (TandemLife, Pittsburgh, PA, USA) RVAD in patients who developed severe acute right heart failure in the intensive care unit after LVAD implantation. ⋯ The use of the Protek Duo as a percutaneous RVAD is a safe and feasible treatment for patients who develop acute right heart failure after LVAD implantation.
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Interact Cardiovasc Thorac Surg · Apr 2020
Testing the clinical validity of the Bemelman Rib Fracture Management Guideline.
Whilst surgical stabilization of rib fractures (SSRF) results in better outcomes, selection algorithms are lacking. We aimed to validate the Rib Fracture Management Guideline proposed by Bemelman. From a cohort of 792 patients with multiple rib fractures, 2 sequential cohorts were selected: 48 patients who underwent SSRF and 48 patients who managed conservatively. ⋯ The positive and negative predictive values for surgical fixation were 0.87 (0.76-0.92) and 0.98 (0.85-0.99), respectively. The Bemelman guideline was thus a good predictor of SSRF in retrospective cohort but should be used in conjunction with clinical judgement. Further validation is indicated in a prospective study.
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Interact Cardiovasc Thorac Surg · Mar 2020
Sex-specific outcome after minimally invasive direct coronary artery bypass for single-vessel disease.
Female gender is reported as an independent risk factor for a poor outcome after coronary artery bypass grafting. We analysed the influence of gender on surgical outcome in patients with single-vessel disease undergoing minimally invasive direct coronary artery bypass (MIDCAB). ⋯ Female patients showed no adverse outcomes after MIDCAB, although risk factors were gender-specific. Overall, MIDCAB demonstrated excellent short- and long-term results as a treatment for single-vessel disease in both genders.