European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · May 2011
The impact of preoperative body mass index on respiratory complications after pneumonectomy for non-small-cell lung cancer. Results from a series of 154 consecutive standard pneumonectomies.
Although it may seem intuitive that obesity is an additional risk factor for surgical patients, few studies have correlated this condition with lung cancer resection. The only data currently available suggest that obesity does not increase the rate of complications after anatomic resection for non-small-cell lung cancer (NSCLC). ⋯ The risk of respiratory complications in patients with BMI higher than 25 kg m⁻² undergoing pneumonectomy for lung cancer is 5.3 times higher than that of patients with BMI < 25 kg m⁻². Thoracic surgeons and anaesthesiologists should be aware of this information before planning elective pneumonectomy in overweight and especially in obese patients.
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Eur J Cardiothorac Surg · May 2011
Tricuspid valve repair in the presence of a permanent ventricular pacemaker lead.
Few studies have focussed on the outcomes of tricuspid valve (TV) repair in patients with a right ventricular permanent pacemaker lead (PPL) and tricuspid regurgitation (TR). ⋯ Patients with a pre-existing PPL, who require TV surgery for significant TR, however without evidence of PPL-induced TR, can undergo TV repair without removal of the PPL. In patients with evidence of PPL-related TR, we suggest PPL removal followed by insertion of an epicardal or transcoronary sinus lead.
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Eur J Cardiothorac Surg · May 2011
Value of the average basal daily walked distance measured using a pedometer to predict maximum oxygen consumption per minute in patients undergoing lung resection.
Maximum oxygen consumption per min (VO(₂max)) is currently considered the most accurate test for the preoperative risk assessment in patients scheduled for pulmonary resection. Due to its high-technology requirements and cost, VO(₂max) is performed less frequently than is desired. The objective of this investigation is to determine if the measurement of the basal daily ambulatory activity of the patients, with a pedometer, can be used to predict VO(₂max) values. ⋯ These preliminary data show that a combination of the measured daily ambulatory activity using a pedometer, especially the mean daily walked distance in km, and the DLCO% of the patient could predict the VO(₂max) value. Larger data series are needed for conclusive results.
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Eur J Cardiothorac Surg · May 2011
High-dose tranexamic acid is related to increased risk of generalized seizures after aortic valve replacement.
To investigate the incidence of postoperative generalized seizures in patients undergoing aortic valve replacement (AVR) under extracorporeal circulation, who received either high-dose tranexamic acid (TXA) or epsilon aminocaproic acid (EACA) as an antifibrinolytic agent. ⋯ Our results indicate that high-dose TXA is associated with an increased incidence of postoperative generalized seizures in patients undergoing AVR compared with EACA, especially when suffering from renal impairment. A possible association between recombinant activated factor VIIa and the occurrence of postoperative seizures needs further investigation.
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Eur J Cardiothorac Surg · May 2011
Failure of noninvasive ventilation after lung surgery: a comprehensive analysis of incidence and possible risk factors.
Noninvasive ventilation has been successfully used after thoracic surgery. However, noninvasive ventilation fails in about 20% of patients. The aim of the study was to analyze episodes of noninvasive ventilation failure and to assess possible risk factors, while taking into account the performance of fiberoptic bronchoscopy for secretion management. ⋯ Noninvasive ventilation failure is associated with higher mortality, but is merely a marker of progression of a more severe disease. This may at least indicate the need for caution in some patients. Interestingly, increased use of fiberoptic bronchoscopies during noninvasive ventilation appliance was identified as a risk factor of failure.