Non-surgical bleeding in cardiac surgery.

Bleeding is an occurrence stemming from complex interactions encountered in cardiac surgery and is often attributed to the perioperative administration of anti-thrombotic products if inadequate surgical haemostasis is excluded. Very occasionally, bleeding does not fit the norm and the aetiology is not a lack of surgical prolene or an iatrogenic-induced coagulopathy. Patients who present for cardiac surgery should be questioned carefully for a history of bleeding; however, patients at risk are not always identified. This case presents a series of haemorrhagic events incorrectly labelled as surgical complications resulting from an uncommon but not insignificant undiagnosed condition. The existing literature outlining protocols to safely manage patients with haemophilia during the perioperative cardiac surgical period is discussed in this report. This case explicitly demonstrates the importance of preoperative identification to avoid the morbidity that can result from cardiac surgery in an undiagnosed haemophilic patient.

A novel approach: how an intracoronary shunt proved to be lifesaving.

Outcomes and complications following internal massage in cardiac surgery are unknown due to the lack of cumulative effort to capture those events and subsequently developing a registry. Therefore, under the circumstances there are no algorithms defined in the literature. This case report outlines the importance of sound decision-making under pressure in order to achieve a favourable outcome. A potential solution is outlined to a very complex and rare problem: anastomotic disruption during internal cardiac massage in an intensive care unit setting, demonstrating the use of an intracoronary shunt for initial stabilization prior to a definitive procedure.

A meta-analysis assessing the benefits of concomitant pleural tent procedure after upper lobectomy.

A meta-analysis comparing outcomes of upper lobectomies with or without pleural tenting was performed. Five trials comprising 396 patients were selected. There was significantly reduced duration of hospital stay, chest drain use, and air leak in the pleural tenting group compared with the group without the pleural tent. There was also a significant reduction in number of patients with prolonged air leak more than 7 days in pleural tenting group. No other difference was noted in other outcomes such as total drainage, operative time, or hospital costs. In patients at high-risk of air leak, we advocate concomitant use of the pleural tent after upper lobectomies.

A meta-analysis comparing muscle-sparing and posterolateral thoracotomy.

We compared outcomes of posterolateral thoracotomy vs muscle-sparing thoracotomy after open thoracic operations. Twelve trials were included, comprising 571 patients in the muscle-sparing thoracotomy group and 512 patients in the posterolateral thoracotomy group. There was significantly improved shoulder internal rotation (weighted mean difference, -1.28; 95% confidence interval, -2.45 to -0.11; p = 0.03) and pain scores on day 7 (weighted mean difference, -0.76; 95% confidence interval, -1.26 to -0.27; p = 0.002) but higher seroma rates (odds ratio, 8.26; 95% confidence interval, 2.16 to 31.56; p = 0.002) in the muscle-sparing thoracotomy group compared with the posterolateral thoracotomy group. We advocate using muscle-sparing thoracotomy, especially on patients dependant on quicker recovery of shoulder function.