The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Aug 2011
Comparative StudyComparison of blood-sparing efficacy of ε-aminocaproic acid and tranexamic acid in newborns undergoing cardiac surgery.
ε-Aminocaproic acid (EACA) and tranexamic acid (TXA) are used for antifibrinolytic therapy in neonates undergoing cardiac surgery, although data directly comparing their blood-sparing efficacy are not yet available. We compared two consecutive cohorts of neonates for the effect of these two medications on perioperative blood loss and allogeneic transfusions. ⋯ ε-Aminocaproic acid and tranexamic acid are equally effective with respect to perioperative blood loss and transfusion requirements in newborns undergoing cardiac surgery.
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Thorac Cardiovasc Surg · Aug 2011
Case ReportsParadoxical embolization of brachiocephalic and pulmonary arteries in a case of persistent foramen ovale: a case report.
Paradoxical embolism is the result of systemic arterial embolism and pulmonary embolism. It indicates the presence of an intracardial defect in the area of the atrial or ventricular septum. The most frequent cause of an intracardiac defect associated with paradoxical embolism is a patent foramen ovale (PFO). In the case presented here, the symptoms, diagnostics and surgical therapy are discussed.
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Pneumothorax can be a major complication following chest drain removal. As paediatric patients have poor breath-holding compliance, the incidence in this group may be raised compared to the adult population. A small pilot study in our hospital found a pneumothorax rate post chest drain removal of 6/39 (15.4%), which was high. The aim of this study was to determine the incidence of pneumothorax post paediatric chest drain removal after updating the guidelines for removal, and staff education. ⋯ This study found an incidence of pneumothorax post paediatric chest drain removal of 4.2%, an improvement since the initial pilot study. A good removal technique reduces complication rates with trained staff following structured guidelines less likely to encounter problems. The application of an occlusive dressing rapidly following suture failure helps to decrease exposure times and thus lowers the incidence of pneumothorax.
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Thorac Cardiovasc Surg · Aug 2011
Congenital heart surgery: expected versus observed surgical performance according to the Aristotle complexity score.
The Aristotle score quantifies the complexity involved in congenital heart surgery. It defines surgical performance as complexity score times hospital survival. We studied how expected and observed surgical performance evolved over time. ⋯ The standardized ratio of surgical performance integrates three factors into a single value: procedure complexity, postoperative observed survival, and comparison with expected survival. It constitutes an excellent instrument for quality monitoring of congenital heart surgery programs over time. It allows an accurate comparison of surgical performance across institutions with different case mixes.