To determine current practice regarding the use of epicardial pacing wires by cardiothoracic surgeons in the U.K. Aims/ObjectivesTo determine current practice regarding the use of epicardial pacing wires by cardiothoracic surgeons in the U.K. MethodAn internet-based survey was distributed via email to all U.K. cardiac and cardiothoracic surgeons.The questionnaire consisted of 18 questions regarding use and management of epicardial pacing wires.
OBJECTIVESMinimally invasive surgical approaches for aortic valve replacement (AVR) are growing in popularity in an attempt to decrease morbidity from conventional surgery. We have adopted a technique that divides only the manubrium and spares the body of the sternum. We sought to determine whether patients benefit from this less-invasive approach.
Objectives Symptoms associated with lung cancer and thoracic surgery might increase fall risk. We aimed to investigate: 1) balance, gait and functional status in people post-thoracic surgery compared to healthy controls; 2) perceptions of balance, gait and functional status. Methods Recruitment targeted older adults (≥50 years) who had undergone thoracic surgery for a diagnosis of lung cancer in the previous 3 months, and healthy age-matched controls. Dynamic and static balance, gait velocity, knee-extension strength and physical activity levels were assessed using the BESTest, Kistler force plate, GAITRite system, Biodex System 3 and CHAMPS questionnaire, respectively. Two-part semi-structured interviews were conducted post-surgery. Results Individuals post-surgery ( n = 15) had worse dynamic balance and gait, and lower levels of moderate/vigorous physical activity (MVPA) (all p<0.05) versus healthy controls ( n = 15). Strength did not differ between groups ( p > 0.05). No associations between BESTest and strength or physical activity existed post-surgery ( p > 0.05). Three themes were identified: 1) Symptoms affect daily activities; 2) Functional assessments alter perceptions of balance ability and 3) Open to supervised rehabilitation. Conclusion Balance, gait and MVPA are impaired post-thoracic surgery, yet balance was not viewed to be important in enabling activities of daily living. However, supervised rehabilitation was considered acceptable.
Objective: Although VATS lobectomy has been demonstrated to be safe and effective, the technique is not widely practiced. This may, in part, reflect difficulty in acquiring appropriate skills. We have evaluated the effect of experience and training on surgical outcomes during the development and establishment of a VATS lobectomy programme. Methods: Data were collected prospectively on 276 consecutive VATS lobectomies under the care of a single consultant as either the primary surgeon or supervising four trainees. The series was divided into cohorts of 46 patients. These comprised one trainee cohort and five sequential consultant cohorts. Statistical analysis utilised standard tests of significance. Results: Increasing experience with the VATS lobectomy programme was associated with a significant reduction in operating time but intraoperative blood loss and postoperative stay were not influenced by increasing consultant surgical experience. Training was associated with a mean increase of 22 min operative time (p = 0.0005) but no increase in intraoperative blood loss, morbidity, mortality or postoperative stay. The 46 trainee operative times were similar to the first 46 consultant cases. Conclusions: VATS lobectomy can be safely taught to trainee thoracic surgeons. However, in view of the limited number of centres undertaking VATS lobectomy, training should be coordinated at a national level to concentrate experience and improve uptake of this technique.
Stereotactic ablative radiotherapy (SABR) is a well-established treatment for medically inoperable peripheral stage I nonsmall cell lung cancer (NSCLC). Previous nonrandomised evidence supports SABR as an alternative to surgery, but high-quality randomised controlled trial (RCT) evidence is lacking. The SABRTooth study aimed to establish whether a UK phase III RCT was feasible.
<i>Background:</i> Cardiac surgery is widely believed to be an excessively high-risk intervention for very elderly patients with coronary artery or valvular disease. However, as life expectancy and the prospect of sustained quality of life into older age increase, this assumption should be challenged so that surgery is not denied to patients who may derive significant symptomatic benefit with acceptable levels of operative risk. <i>Objective:</i> To evaluate outcomes from cardiac surgery in nonagenarian patients. <i>Design:</i> Analysis of prospectively collected single-centre data and review of outcomes reported in the literature. <i>Results:</i> Twenty-three patients (13 males) aged 90 years or more underwent open cardiac surgery between 1998 and 2007. Four patients died within 30 days of surgery (surgical mortality 17.4%) and all-cause in-hospital morbidity was 74%. Actuarial survival at 1 and 5 years was estimated at 72 and 54%, respectively. Comparison of patients’ survival against age-matched life tables for the English population found a standardised mortality ratio of 0.57 (95% CI: 0.24–0.99; one-sample log-rank test χ<sup>2</sup> = 3.93; p < 0.05) representing a significant survival benefit associated with surgery. The majority of patients reported symptomatic improvement reflected by significant decreases in angina and dyspnoea scores. Six single-centre series of nonagenarians and 3 reviews from national databases in the US and UK were identified in the literature. Pooled surgical mortality was 12.7% (95% CI: 8.7–17.3%) with no significant heterogeneity (χ<sup>2</sup> = 4.12; p = 0.77; I<sup>2</sup> = 0). <i>Conclusion:</i> Cardiac surgery in the elderly carries higher operative risk than in younger patients. However, in selected nonagenarians, surgery can be performed with acceptable morbidity and early mortality, and patients gain significant symptomatic relief and survival benefit.
The effect of BMI on cost of intensive care unit (ICU) stay and ward stay in cardiac surgery is currently unknown. To assess these data on BMI, ICU stay and EuroSCORE were prospectively collected for 6100 patients undergoing cardiac surgery between 2000 and 2004. Patients were categorised according to BMI and comparisons were conducted, using non-parametric tests (Kruskal-Wallis and Mann-Whitney U-tests). One day in ICU was costed at pound1,300 and one ward-day pound300/day by this hospital's finance department. Despite similar median (due to a distribution skewed to a short ICU stay), a significant difference is observed between all 6 groups (Kruskal-Wallis; P<0.001) for ICU stay and ward stay. Underweight and morbidly obese patients had longer ICU stays compared with the ideal weight patients (P=0.010 and P=0.004, respectively); while overweight and obese patients had shorter ICU stays (P<0.001 and P=0.007, respectively). Underweight patients had a longer ward stay than ideal weight patients (P=0.005) but there was no difference between ideal and morbidly obese patients (P=0.789). These results demonstrate that BMI has a significant impact on ICU and ward stay with 'ideal weight' not always being ideal for patients undergoing cardiac surgery. This cost appears to be independent of EuroSCORE.
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