European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Aug 2009
ReviewThe present status of off-pump coronary artery bypass grafting.
Coronary revascularisation using cardiopulmonary bypass remains the gold standard treatment for coronary artery disease. Over the past decade, techniques of revascularisation on the beating heart without the use of cardiopulmonary bypass (off-pump surgery) have evolved with an attempt to reduce the potential deleterious effects of extracorporeal circulation. ⋯ The impact of this mode of revascularisation has probably been underestimated especially in an era where surgical revascularisation is being increasingly undertaken in older patients with significant comorbidities. In this contribution, the current evidence from randomised trials, meta-analyses and observational studies is critically reviewed.
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Eur J Cardiothorac Surg · Jul 2009
ReviewThe current role of hybrid procedures in the stage 1 palliation of patients with hypoplastic left heart syndrome.
Hypoplastic left heart syndrome is a relatively common cardiac malformation, accounting for 4-9% of children born with congenital heart disease. Since 1981 the mainstay of treatment has been the Norwood series of operations which have been variously modified, most recently using an RV-PA conduit (Sano shunt). With these surgical modifications and with increased experience in perioperative care survival for the surgical approach to completion of stage 2 palliation has improved to 70-80%. ⋯ Poor initial results caused many to discontinue this approach but some persevered, and with increasing experience survival to completion of stage 2 following hybrid palliation is now 50-80%. Although these results may superficially appear to be poorer than for surgery, it must be observed that increasingly the hybrid approach has been used by many groups as palliation for the highest risk cases (particularly small size and adverse cardiac factors). This review therefore considers what is the optimal management of children with hypoplastic left heart syndrome currently, and, specifically, what is the role for the hybrid approach in palliation of patients with hypoplastic left heart syndrome?
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Eur J Cardiothorac Surg · Jul 2009
ReviewChronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention.
Chronic pain complaints after thoracic surgery represent a significant clinical problem in 25-60% of patients. Results from thoracic and other surgical procedures suggest multiple pathogenic mechanisms that include pre-, intra-, and postoperative factors. This review attempts to analyse the methodology and systematics of the studies on the post-thoracotomy pain syndrome (PTPS) after lung cancer surgery in adults, in order to clarify the relative role of possible pathogenic factors and to define future strategies for prevention. ⋯ The available data have major inconsistencies in collection of pre-, intra- and postoperative data that may influence PTPS, thereby hindering precise conclusions as well as preventive and treatment strategies. However, intercostal nerve injury seems to be the most important pathogenic factor. Since there is a general agreement on the clinical relevance of PTPS, a proposal for design of future trials is presented.
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Eur J Cardiothorac Surg · Jun 2009
Review Meta AnalysisTracheal rupture after endotracheal intubation: a literature systematic review.
We aim to perform a systematic review and meta-analysis of the cases of postintubation tracheal rupture (PiTR) published in the literature, with the aim of determining the risk factors that contribute to tracheal rupture during endotracheal intubation. A further objective has been to determine the ideal treatment for this condition (surgical repair or conservative management). A MEDLINE review of cases of tracheal rupture after intubation published in the English language and a review of the references in the articles found. ⋯ Conservative treatment is associated with a better outcome. However, the group of patients who would benefit from surgical treatment has not been fully defined. Further studies are required to evaluate the best treatment options.
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Coronary heart disease (CHD) is the leading cause of death worldwide. Coronary artery bypass graft (CABG) surgery remains the procedure of choice for coronary artery revascularisation in a large number of patients with severe CHD. ⋯ Myocardial injury sustained during cardiac surgery, most of which can be attributed to acute myocardial ischaemia-reperfusion injury, is associated with worse short-term and long-term clinical outcomes. Clearly, new treatment strategies are required to protect the heart during cardiac surgery in terms of reducing myocardial injury and preserving left ventricular systolic function, such that clinical outcomes can be improved. 'Conditioning' the heart to harness its endogenous cardioprotective capabilities using either brief ischaemia or pharmacological agents, provides a potentially novel approach to myocardial protection during cardiac surgery, and is the subject of this review article.