Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2013
ReviewRadial artery for coronary artery bypass grafting: does proximal anastomosis to the aorta or left internal mammary artery achieve better patency?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'in coronary artery bypass grafting using radial artery grafts, does proximal anastomosis to the aorta or left internal mammary artery achieve better patency'. Altogether >183 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. ⋯ Additionally, different centres and investigators report very different patency results for grafts that have the same site of proximal anastomosis. One centre was able to achieve patency rates for off-LIMA grafts of 88% up to a mean of 7.7 years postoperatively while another centre reported a patency rate of only 78.6% at three years. Given this, and the plethora of other factors influencing graft patency, we conclude that the best evidence suggests that the site of proximal anastomosis has little or no effect on radial artery graft patency following CABG.
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Interact Cardiovasc Thorac Surg · Dec 2013
Case ReportsOff-pump transapical closure of a mitral periprosthetic leak: a new approach to a difficult problem.
A 60-year old male patient with multiple risk factors and two previous interventions over the mitral valve was admitted to the emergency unit with symptoms of cardiac failure. Initial examination revealed a competent mitral bioprosthesis with severe perivalvular mitral insufficiency. Based on previous experiences with transapical procedures, a transapical transcatheter closure of the perivalvular leak was performed. ⋯ No neurological deficits were detected, and the patient was transferred to the intensive care unit. The patient recovered well and was transferred to the ward after 1 day. Discharge was accomplished after 4 days.
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Interact Cardiovasc Thorac Surg · Dec 2013
Diagnostic work-up and surgery in participants of the Gdansk lung cancer screening programme: the incidence of surgery for non-malignant conditions.
Low-dose computed tomography (LDCT) screening improves lung cancer prognosis but also results in diagnostic work-up and surgical treatment in many individuals without cancer. Therefore, we analysed the procedures that screening participants underwent to better understand the extent of overdiagnosis. ⋯ Futile diagnostic work-ups and operations must be reduced before LDCT screening can be broadly used. Stage I adenocarcinoma dominated in the NSCLC patients who underwent surgery.
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Interact Cardiovasc Thorac Surg · Dec 2013
Randomized Controlled TrialPerioperative sildenafil therapy for pulmonary hypertension in infants undergoing congenital cardiac defect closure.
Pulmonary hypertension in paediatric patients with ventricular septal defect remains one of the most important determinants of perioperative morbidity and mortality. Sildenafil is an oral, well-tolerated pulmonary vasodilator with few drug interactions. We studied the effect of oral sildenafil, when given before and after surgical closure compared with starting it postoperatively, on the pulmonary artery pressure and patients' outcome. ⋯ The low cost, the oral availability and the good tolerability of sildenafil make it a suitable and simple alternative therapy for secondary pulmonary hypertension including persistent postoperative pulmonary hypertension associated with ventricular septal defect in resource limited places. However, starting sildenafil early before surgery does not add a great benefit in terms of improving postoperative pulmonary hypertension or patients' outcome.