European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · May 2012
Randomized Controlled Trial Comparative StudyIncidence of post-thoracotomy pain: a comparison between total intravenous anaesthesia and inhalation anaesthesia.
Thoracotomy is one of the most painful surgical incisions. Little is known, however, about the effect of type of anaesthesia on chronic post-thoracotomy pain syndrome (CPTS). We therefore compared the incidence of CPTS after total intravenous anaesthesia (TIVA) and inhalation anaesthesia. ⋯ TIVA with propofol and remifentanil may reduce the incidence of CPTS at 3 and 6 months.
-
Eur J Cardiothorac Surg · May 2012
Management of anastomotic leakage-induced tracheobronchial fistula following oesophagectomy: the role of endoscopic stent insertion.
Tracheobronchial fistulas are rare but life-threatening complications after oesophagectomy. Leakage of the oesophagointestinal anastomosis with inflammatory involvement of the tracheobronchial tree is the predominant reason for postoperative fistulization between the airways and the oesophagus or the gastric tube. Successful management is challenging and still controversially discussed. After promising results in the treatment of intrathoracic anastomotic leaks, we adopted endoscopic stent implantation as the primary treatment option in patients with anastomotic leak-induced tracheobronchial fistula. The aim of this study was to investigate the feasibility, the limits and the results of this procedure. ⋯ Treatment of anastomotic leak-induced tracheobronchial fistulas by means of oesophageal and tracheal stent implantation is feasible. If stent insertion is limited by gastric tube necrosis or bronchial gangrene, the prognosis is likely to be fatal.
-
Eur J Cardiothorac Surg · May 2012
Comparative StudyIn vitro comparison of three techniques for ventriculo-aortic junction annuloplasty.
In aortic valve repair, reduction and stabilization of the ventriculo-aortic junction (VAJ) is generally recommended. In this in vitro study, we compare three techniques of annuloplasty: the subcommissural annuloplasty (SCA), the internal ring (IR) and the external ring (ER) annuloplasty. ⋯ The three annuloplasty techniques examined demonstrated differential effects on aortic valve function and root morphology. The ER and IR have greater potential to reduce VAJ diameter in comparison to SCA. The IR induced a subvalvular remodelling of the VAJ, whereas the ER induced a paravalvular remodelling.
-
Eur J Cardiothorac Surg · May 2012
Characterization of non-technical skills in paediatric cardiac surgery: communication patterns.
The management of non-technical skills in complex surgical domains, such as paediatric cardiac surgery, is being recognized as a major factor for both performance and safety. Communication patterns are very relevant for safety and were analysed in this human-factor observational study. ⋯ Communication is very frequent in paediatric cardiac surgery and shows a complex pattern. There is room for improvement, namely by a more formal and standardized communication flow structure that can be achieved with the help of behavioural, technological and organizational initiatives.
-
Eur J Cardiothorac Surg · May 2012
Does fast-tracking increase the readmission rate after pulmonary resection? A case-matched study.
The most recent evolution of patient management after thoracic surgery implies the concept of fast-tracking. Since 2008, our unit has implemented a programme based on clinical protocols and standardized pathways of care aimed to reduce the postoperative stay after major lung resection. The objective of this study was to verify the safety of this policy by monitoring the patient readmission rate. ⋯ In our experience, the implementation of a fast-tracking program after pulmonary lobectomy was very effective and safe. It led to a postoperative reduction of hospital stay without an increase in the readmission rate.