The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Review Meta AnalysisUnilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery: a meta-analysis of 5100 patients.
Our objective was to determine whether the use of unilateral (u-ACP) or bilateral antegrade cerebral perfusion (b-ACP) results in different mortality and neurologic outcomes after complex aortic surgery. ⋯ This meta-analysis shows that b-ACP and u-ACP have similar postoperative mortality and both PND and TND rates after circulatory arrest for complex aortic surgery.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Randomized Controlled Trial Comparative StudyAnalgesia in patients undergoing thoracotomy: epidural versus paravertebral technique. A randomized, double-blind, prospective study.
Pain control after thoracotomy prevents postsurgical complications and improves respiratory function. The gold standard for post-thoracotomy analgesia is the epidural catheter. The aim of this study was to compare it with a new technique that involves placement of a catheter in the paravertebral space at the end of surgery under a surgeon's direct vision. ⋯ According to our data, drugs administered through a paravertebral catheter are very effective. Moreover, it does not present contraindications to its positioning or collateral effects. More studies are necessary to confirm data we collected.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Multicenter StudyInvasive mechanical ventilation in patients with fibrosing interstitial pneumonia.
The prognosis of patients with idiopathic pulmonary fibrosis or fibrosing idiopathic nonspecific interstitial pneumonia undergoing invasive mechanical ventilation (MV) for acute respiratory failure is known to be poor. The issue of life support in these patients needs to be reconsidered in light of changes during the past decade in ventilator settings and in the management of acute exacerbation. We therefore aimed to reassess the prognosis of such patients. ⋯ We confirm that use of invasive MV for acute respiratory failure in patients with idiopathic pulmonary fibrosis or fibrosing idiopathic nonspecific interstitial pneumonia is associated with a high mortality; however, a subset of patients may be discharged alive from the intensive care unit and hospital, providing an opportunity to consider lung transplant in case of eligibility. Our results suggest that invasive MV should not be systematically denied to these patients but discussed on a case-by-case basis.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyOptimal treatment strategy for type A acute aortic dissection with intramural hematoma.
The management strategy for type A acute aortic dissection (AAD) with intramural hematoma (IMH) remains controversial. The aim of this study was to compare the outcomes of emergency surgery and medical treatment for patients with acute type A IMH. ⋯ Emergency surgery for patients with type A IMH showed favorable mortality rates because most of the patients were in hemodynamically stable condition preoperatively. On the other hand, several patients died suddenly during medical care. Emergency surgical treatment may provide a better outcome than medical treatment at the time of onset, even for patients with type A IMH.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
ReviewSimulation in cardiothoracic surgical training: where do we stand?
Simulation may reduce the risks associated with the complex operations of cardiothoracic surgery and help create a more efficient, thorough, and uniform curriculum for cardiothoracic surgery fellowship. Here, we review the current status of simulation in cardiothoracic surgical training and provide an overview of all simulation models applicable to cardiothoracic surgery that have been published to date. ⋯ Surgical simulation is becoming an increasingly important educational tool in training cardiothoracic surgeons. Our next steps forward will be to develop an objective, standardized way to assess surgical simulation training compared with the current apprenticeship model.