Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2020
Adult cardiovascular surgery and the coronavirus disease 2019 (COVID-19) pandemic: the Italian experience.
The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected all health care professionals. The outbreak required a thorough reorganization of the Italian regional local health care system to preserve resources such as ventilators, beds in intensive care units and surgical and anaesthesiological staff. Levels of priority were created, together with a rigorous triage procedure for patients with COVID-19, which led to postponement of all elective procedures. ⋯ Systemic inflammation, cytokine storm and hypercoagulability associated with COVID-19 increased the risk of heart failure and cardiac death. In this regard, the early use of extracorporeal membrane oxygenation could be life-saving in patients with severe forms of acute respiratory distress syndrome or refractory heart failure. The goal of this paper was to report the Italian experience during the COVID-19 pandemic in the setting of cardiovascular surgery.
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Interact Cardiovasc Thorac Surg · Aug 2020
Meta AnalysisIntravenous iron therapy for patients with preoperative iron deficiency or anaemia undergoing cardiac surgery reduces blood transfusions: a systematic review and meta-analysis.
The benefits of preoperative intravenous (IV) iron treatment in cardiac surgery patients with preoperative anaemia or iron deficiency have not been well-established. We performed a systematic review and meta-analysis to determine the effects of treating preoperative anaemia or iron deficiency with IV iron in adult cardiac surgery patients. ⋯ International prospective register of systematic reviews ID Number CRD42019122844.
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Interact Cardiovasc Thorac Surg · Jul 2020
ReviewDoes lobar or size-reduced lung transplantation offer satisfactory early and late outcomes?
A best evidence topic was constructed according to a structured protocol. The question addressed was whether size-reduced or lobar lung transplantation (LLTx) offers the same benefit as classic lung transplantation (LTx). Of the 147 papers found using the reported search, 9 were selected to provide the best evidence. ⋯ Two of the studies reported a higher incidence of postoperative complications, such as the need for cardiopulmonary bypass, reperfusion oedema or primary graft dysfunction, and longer intubation or intensive care unit stay times. Although the largest study showed a significantly worse 1-year survival in LLTx, a sub-analysis considering patients successfully discharged showed similar outcomes at 1, 3 and 5 years when compared with classic LTx patients. We conclude that LLTx is a valid therapeutic option for recipients with significant donor size mismatch, offering similar outcomes as classical LTx in the medium term and long term.
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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 · Feb 2020
ReviewDoes concurrent use of intra-aortic balloon pumps improve survival in patients with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does concurrent use of intra-aortic balloon pump (IABP) improve survival in patients with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO)?'. Altogether 472 papers were found using the reported search, of which 3 level 2 systematic reviews represented the best evidence to answer the clinical question. ⋯ We conclude that there was no significant improvement in survival with the concurrent use of IABP and VA-ECMO for a cardiogenic shock as compared to the use of VA-ECMO alone. However, the concurrent use of IABP with VA-ECMO improved weaning success from VA-ECMO. The incidence of vascular and non-vascular complications was similar with or without IABP usage.