European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Dec 2011
Multicenter StudyOff-label use of recombinant activated factor VII in intractable haemorrhage after cardiovascular surgery: an observational study of practices in 23 French cardiac centres (2005-7).
The study aimed to describe French off-label use of rFVIIa for intractable bleeding in major cardiovascular surgery. ⋯ rFVIIa rescue therapy was followed by control of bleeding in a substantial number of the patients with seemingly acceptable safety; however, thrombotic risk remains a matter of concern. Our observational study suggests that the dose to be tested prospectively is at least 80 μg.kg(-1).
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Eur J Cardiothorac Surg · Dec 2011
Support time-dependent outcome analysis for veno-venous extracorporeal membrane oxygenation.
The majority of patients suffering from pulmonary failure refractory to mechanical ventilation require extracorporeal membrane oxygenation (ECMO) support between 1 and 2 weeks. This study was designed to evaluate differences in outcome depending on ECMO duration. ⋯ VV ECMO in patients suffering from severe lung failure is effective in improving gas exchange with an overall survival of higher than 50%. Prolonged need of ECMO support does not have an impact on survival.
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Eur J Cardiothorac Surg · Dec 2011
Acquired Von Willebrand syndrome is an early-onset problem in ventricular assist device patients.
Acquired Von Willebrand syndrome (AVWS) can contribute to bleeding complications in patients with ventricular assist devices (VADs). AVWS results from shear stress, which causes unfolding of the high-molecular-weight (HMW) multimers of Von Willebrand factor (VWF) with subsequent cleavage. Loss of the HMW multimers of VWF is the leading finding in AVWS. In consequence, binding of VWF to collagen and to platelets is impaired. The onset of AVWS after VAD implantation is not yet determined. We examined VAD patients for presence of an AVWS in the early, intermediate, and late phase after VAD implantation. ⋯ The AVWS is present already in the early postoperative phase after VAD implantation. Therefore, reduced shear stress has to be an important feature of newly developed assist devices in the future.
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Eur J Cardiothorac Surg · Dec 2011
Risk factors for chronic thoracic pain after cardiac surgery via sternotomy.
This study examines the influence of patient demographics and peri- and postoperative (<7 days) characteristics on the incidence of chronic thoracic pain 1 year after cardiac surgery. The impact of chronic thoracic pain on daily life is also documented. ⋯ We have identified a number of factors correlated with persistent thoracic pain following cardiac surgery with sternotomy. Awareness of these predictors may be useful for further research concerning both the prevention and treatment of chronic thoracic pain, thereby potentially ameliorating the postoperative quality of life of a significant proportion of patients. Meanwhile, chronic thoracic pain should be discussed preoperatively with patients at risk so that they are truly informed about possible consequences of the surgery.
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Eur J Cardiothorac Surg · Dec 2011
Clinical feasibility and surgical benefits of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer.
This study was performed to assess the clinical feasibility and surgical outcomes of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer. ⋯ Video-assisted mediastinoscopic lymphadenectomy is a clinically feasible procedure with acceptable complication rate and provides more accurate staging of mediastinal node in lung cancer patients. It may be also an excellent supplementary technique used for complete mediastinal node dissection at minimal invasive surgery for cancer resection, especially with left-sided video-assisted thoracoscopic lobectomy.