Abstract:
OBJECTIVES:Owing to the great absorption capability of the pleura for transudates, the protein content of draining pleural fluid may be considered as a more adequate determinant than its daily draining amount in the decision-making for earlier chest tube removal. In an a priori pilot study, we observed that the initially draining protein-rich exudate converts to a transudate quickly in most patients after lobectomies. Thus, chest tubes draining high-volume but low-protein fluids can safely be removed earlier in the absence of an air leak. This randomized study aims to investigate the validity and clinical applicability of this hypothesis as well as its influence on the timing for chest tube removal and earlier discharge after lobectomy. METHODS:Seventy-two consecutive patients undergoing straightforward lobectomy were randomized into two groups. Patients with conditions affecting postoperative drainage and with persisting air leaks beyond the third postoperative day were excluded. Drains were removed if the pleural fluid to blood protein ratio (PrRPl/B) was ≤0.5, regardless of its daily draining amount in the study arm (Group S; n = 38), and patients in the control arm (Group C; n = 34) had their tubes removed if daily drainage was ≤250 ml regardless of its protein content. Patients were discharged home immediately or the following morning after removal of the last drain. All cases were followed up regarding the development of symptomatic pleural effusions and hospital readmissions for a redrainage procedure. RESULTS:Demographic and clinical characteristics as well as the pattern of decrease in PrRPl/B were the same between groups. The mean PrRPl/B was 0.65 and 0.67 (95% CI = 0.60-0.69 and 0.62-0.72) on the first postoperative day, and it remarkably dropped down to 0.39 and 0.33 (95% CI = 0.33-0.45 and 0.27-0.39) on the second day in Groups S and C, respectively, and remained below 0.5 on the third day (repeated-measures of ANOVA design, post hoc 'within-group' comparison of the first postoperative day versus second and third days; P < 0.002). Eleven of 38 (29%) and 16 of 27 (59%) patients' chest tubes were, respectively, removed on the first and second postoperative days in Group S, but only two of 34 (6%) and ten of 32 (31%) patients, respectively, had their chest tubes removed in Group C (two-tailed Fisher's exact test, P = 0.02 and 0.005 for the first and the second postoperative days, respectively). On the third postoperative day, daily drainage remained ≥250 ml in 22 (65%) patients, among whom, 17 (77%) would have their chest tubes removed on the PrRPl/B value in Group C. However, drains could not be removed due to the high protein content of draining fluid despite the acceptable volume of daily drainage in only three (27%) of 11 cases in Group S (McNemar's paired proportions test, P = 0.009). The mean chest tube removal time (2.1 ± 0.9 vs 2.9 ± 1.0 days; P < 0.001) and the median hospital stay [3 days (IQR: 1-3) vs 4 days (IQR: 2-4), P < 0.003] were significantly shorter in Group S. None of the patients required a redrainage procedure due to a persistent and symptomatic pleural effusion. CONCLUSIONS:Regardless of the daily drainage, chest tubes can safely be removed earlier than anticipated in most patients after lobectomy if the protein content of the draining fluid is low.
journal_name
Interact Cardiovasc Thorac Surgjournal_title
Interactive cardiovascular and thoracic surgeryauthors
Olgac G,Cosgun T,Vayvada M,Ozdemir A,Kutlu CAdoi
10.1093/icvts/ivu207subject
Has Abstractpub_date
2014-10-01 00:00:00pages
650-5issue
4eissn
1569-9293issn
1569-9285pii
ivu207journal_volume
19pub_type
杂志文章,随机对照试验abstract::The aim of this study was to investigate the change of hepatic metabolic activity presented by the ketone body ratio (AKBR) during and after cardiopulmonary bypass (CPB) and to evaluate the prognostic value. AKBR were measured in 20 cases of coronary aortic bypass grafting using moderate hypothermic CPB (group M), ten...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1016/S1569-9293(02)00094-4
更新日期:2003-03-01 00:00:00
abstract::In order to determine anticoagulation strategies in OPCAB a questionnaire survey among 750 European cardio-thoracic surgeons was performed. Questions addressed volume of OPCAB procedures performed, intra- and perioperative heparinization and antiplatelet therapy, as well as perioperative management. A total of 325 (43...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,多中心研究
doi:10.1510/icvts.2007.169086
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVE:To conduct a meta-analysis of available comparative studies evaluating hybrid arch repair versus open surgical repair of aortic arch aneurysm. METHODS:A literature search was performed using PubMed, Embase and Web of Science to identify any studies comparing the results of hybrid arch repair with open surgic...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1093/icvts/ivw305
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVES:The HAART ring device has been introduced as a novel strategy to facilitate aortic valve repair. This rigid, elliptical device aims to restore normal leaflet configuration and to provide annular stabilization in the setting of aortic regurgitation. The goal of this preclinical study is to evaluate the in viv...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivy341
更新日期:2019-06-01 00:00:00
abstract::We herein report an emergency technique of composite Bentall operation using a fast release valve. The technique was successfully performed in 2 emergency cases after failed supracoronary ascending aortic replacement in acute Type A aortic dissection. The speed and ease of execution are the main advantages of the proc...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivx435
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVES:Preclinical studies have suggested acute stiffening of the aorta following experimental thoracic endovascular aortic repair (TEVAR), resulting in acute elevated pulse pressure, hypertension and possibly heart failure. The aim of this study was to evaluate cardiac remodelling following TEVAR. METHODS:From 20...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivz298
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVES:The aim of this multicentric study was to outline surgical indications and evaluate mid-term outcomes of porcine extracellular matrix (ECM) in surgery for congenital heart disease (CHD). METHODS:The use of ECM was categorized into four major groups: A, valve repair; B, septal reconstruction; C, arterial pla...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,多中心研究
doi:10.1093/icvts/ivv076
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVES:The use of staplers for thoracic surgery has been widely accepted and regarded as a safe procedure. However, adverse events (AEs) of stapling are occasionally experienced. The aim of this retrospective study was to analyse the AEs of stapling in pulmonary vascular surgery. METHODS:A retrospective multi-inst...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,多中心研究
doi:10.1093/icvts/ivt130
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVES:Few reports on the outcomes of patients treated for Stanford type A acute aortic intramural haematoma (TAAIMH) and retrograde thrombosed type A acute aortic dissection exist. This study aimed to evaluate their long-term results and predictors of adverse outcomes. METHODS:We retrospectively analysed 40 patie...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivz222
更新日期:2020-01-01 00:00:00
abstract::Pericardial tamponade is a life-threatening emergency. Chyle is a rare cause of pericardial effusion and can lead to cardiac tamponade. This case illustrates the presentation, work-up and operative video of a patient in pericardial tamponade secondary to chylopericardium. ...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2005.120899
更新日期:2006-06-01 00:00:00
abstract::To improve our understanding of myxomatous degeneration of the valvar tissue as seen in mitral valve prolapse, we have compared the biosynthetic phenotype of the connective tissue cells in myxomatous segments (n=4) resected during surgery with that of homologous segments of normal valves (n=4) harvested in age-matched...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1016/S1569-9293(03)00107-5
更新日期:2003-09-01 00:00:00
abstract::Treatment of breast cancer involves surgery, then perhaps radiation, hormonal or chemotherapy. Radiation-induced arterial injury is a well-known entity that represents a rare cause of arterial occlusion. We present the case of a 76-year old woman who complained of a severe intermittent claudication of the right upper ...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivr147
更新日期:2012-07-01 00:00:00
abstract::The use of temporary epicardial pacing wires during cardiac surgery is a routine procedure and has been associated with low morbidity. We describe a rare case of right paracardiac mass due to organized pericardial hematoma with right atrial compression around the epicardial pacing wires left in-situ, presenting three ...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2010.264853
更新日期:2011-07-01 00:00:00
abstract::The Ross procedure has gained increasing interest for therapy of aortic valve pathologies in young adults because of excellent long-term results. This case report describes the first published experiences of the Ross procedure performed through a minimally invasive access in two consecutive patients. The limited acces...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2009.203067
更新日期:2009-09-01 00:00:00
abstract::The rotary blood pump (the HeartWare® Ventricular Assist Device) from HeartWare® (Medtronic) is an established left ventricular assist device and usually implanted via sternotomy. To reduce the invasiveness of the implant procedure and to optimize the position of the inflow cannula, we propose an alternative implant t...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivy183
更新日期:2018-12-01 00:00:00
abstract::A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'Does the use of bilateral mammary artery grafts compared with the use of a single mammary artery graft offer a long-term survival benefit in patients undergoing coronary artery bypass surgery?' Altoget...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,评审
doi:10.1093/icvts/ivt423
更新日期:2014-01-01 00:00:00
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,随机对照试验
doi:10.1093/icvts/ivw213
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVES:Because of the high prevalence of psychological disorders among ventricular assist device patients, mental health support is consensually recommended. No study as yet has provided an overview of recommended and reported mental health interventions. This article presents the results of a scoping review on the...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章,评审
doi:10.1093/icvts/ivy125
更新日期:2018-12-01 00:00:00
abstract::Six patients with acute Type A aortic dissection were medically treated due to advanced age, patient refusal and comorbidity despite surgical indication. Computed tomography after onset revealed a thrombosed false lumen in 3 patients and a patent false lumen with flap in 3 patients. All patients were stable during adm...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivx404
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVES:The percutaneous coronary artery angioplasty is routinely being used worldwide for the management of short and discrete coronary artery stenosis. The purpose of this report is to address the potentially lethal complication among the variety of surgical problems in conjunction with this procedure. The case al...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2006.140194
更新日期:2007-02-01 00:00:00
abstract::Foregut duplication cysts are rare congenital anomalies of enteric origin that arise during early embryonic development. They are usually incidentally found on routine imaging studies. The diagnosis can usually be made by computed tomography (CT) and endoscopic ultrasound (EUS) appearance. On CT, cyst attenuation valu...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2009.217067
更新日期:2010-02-01 00:00:00
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 临床试验,杂志文章
doi:10.1093/icvts/ivw052
更新日期:2016-06-01 00:00:00
abstract::The Smart canula concept allows for collapsed cannula insertion, and self-expansion within a vein of the body. (A) Computational fluid dynamics, and (B) bovine experiments (76+/-3.8 kg) were performed for comparative analyses, prior to (C) the first clinical application. For an 18F access, a given flow of 4 l/min (A) ...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1016/s1569-9293(02)00006-3
更新日期:2002-09-01 00:00:00
abstract:OBJECTIVES:Minimally invasive cardiac valve surgery is safe, effective and increasingly popular. It is performed worldwide with the use of either external aortic clamping or endoaortic balloon occlusion. METHODS:We conducted a literature search using MEDLINE, EMBASE, Scopus and Web of Science. Primary outcomes include...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivy016
更新日期:2018-08-01 00:00:00
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivz246
更新日期:2020-02-01 00:00:00
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1016/S1569-9293(03)00118-X
更新日期:2003-12-01 00:00:00
abstract::We report a case of successful treatment of a mycotic aneurysm of the thoracic aorta. A 65-year-old man with a dissecting aneurysm presented with urinary tract infection. He had a history of severe liver cirrhosis. Two weeks after admission, he had a high-grade fever and enhanced computed tomography (CT) demonstrated ...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2010.249102
更新日期:2011-01-01 00:00:00
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivs030
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abstract::Cystic tumor of the atrioventricular nodal region is a rare cardiac primary tumor that can cause heart blockage and sudden death. Antemortem diagnosis and successful excision of the atrioventricular nodal region are extremely rare. A 41-year-old woman who presented with dyspnea and palpitations is reported. Electrocar...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2008.191866
更新日期:2009-05-01 00:00:00
abstract::We describe our experience with extracorporeal cardiopulmonary resuscitation (CPR) using extracorporeal membrane oxygenation (ECMO) in children with refractory cardiac arrest, and determine predictors for mortality. ECMO support was instituted on 42 children, median age 0.7 years (1 day-17.8 years), median weight 7.05...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2010.254193
更新日期:2011-06-01 00:00:00