European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Apr 2011
ReviewClassification of acute type A dissection: focus on clinical presentation and extent.
Recent advances in the management of acute Stanford type A dissection have highlighted the clinical importance of clinical presentation and extent of dissection. The Penn classification of type A clinical presentations is based on ischemic profiles that not only determine mortality but also influence management options. The extent of type A dissection as summarized by the DeBakey classification significantly determines the role of endovascular intervention in this important disease. We propose an integration of these three classifications of acute type A dissection as a framework for future advances in diagnosis, intervention and prognosis.
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Eur J Cardiothorac Surg · Mar 2011
ReviewTraining and assessment of technical skills and competency in cardiac surgery.
The assessment of surgical competency has become a priority for both surgical educators and licensing boards. Surgical educators must incorporate rigorous, reliable, and valid means of assessment into residency programs. Objective evaluation of technical skills has been extensively explored in various surgical specialties, but its role in cardiac surgery has not been well studied and there is limited experience with integration into the educational curricula. ⋯ Most of the available models have not been well validated or integrated into educational curricula. The cardiac surgery simulation tools in development need validation and incorporation into structured, competency-based training curricula. The ongoing development of surgical simulators and educational curricula will enable a transition from the century-old graded responsibility training program to a competency-based program, where trainees must demonstrate technical competence to progress to the next level of training and gain certification and re-certification--ultimately ensuring better and faster technical skill acquisition as well as improved quality of care and patient safety.
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Eur J Cardiothorac Surg · Aug 2010
ReviewBronchoscopic balloon dilatation of tracheobronchial stenosis: long-term follow-up.
Bronchoscopic balloon dilatation (BBD) has become a valuable tool in the treatment of tracheobronchial stenosis (TBS). The objective of this study was to assess the short- and long-term effects of BBD. ⋯ BBD is a safe method that offers immediate symptomatic relief in both tracheal and bronchial stenosis. However, BBD is a temporary measure, as many patients will require definitive or additional treatment with laser or stent placement.
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Eur J Cardiothorac Surg · Jun 2010
Review Meta AnalysisLessons from aprotinin: is the routine use and inconsistent dosing of tranexamic acid prudent? Meta-analysis of randomised and large matched observational studies.
In view of the safety concerns that led to the withdrawal of aprotinin, should antifibrinolytics be used indiscriminately in cardiac surgery? This meta-analysis examines the efficacy and safety profile of tranexamic acid, and in comparison to aprotinin. We identified randomised trials and large observational studies investigating the use tranexamic acid from January 1995 to January 2009 using Pubmed/Cochrane search engine and included them in a two-tier meta-analysis. There were 25 randomised trials and four matched studies with a total of 5411 and 5977 patients, respectively, reporting tranexamic acid use in varying dosages. ⋯ Compared to aprotinin, tranexamic acid has less effective blood-conserving effect and mortality risk. Given the potential to increase neurological complications, the current trend towards indiscriminate use of tranexamic acid for all cardiac patients needs to be re-evaluated. Further studies are needed to clarify the neurological risk, appropriate indications and dosing of tranexamic acid.
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Eur J Cardiothorac Surg · May 2010
Review Meta Analysis Comparative StudyPercutaneous aspiration versus tube drainage for spontaneous pneumothorax: systematic review and meta-analysis.
Spontaneous pneumothorax is an extremely frequent pathology. Despite this, there is still no clear consensus on managing these patients. Therefore, we perform a systematic review and meta-analysis of the effectiveness of percutaneous aspiration compared with tube drainage for treating idiopathic spontaneous pneumothorax. ⋯ Relevant articles were identified by searching electronic databases (e.g., Medline, EMBASE, CENTRAL, mRCT and Pascal), as well as the references of the papers found in this manner, with a cut-off date of April 2009. Quality was assessed by two independent evaluators, using the CASPe appraisal tool. Effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission.