Does a combined procedure for cardiac surgery and thyroidectomy offer acceptable outcomes?

This best evidence topic on cardiothoracic surgery was written using a structured protocol. The question addressed was: 'in an adult patient requiring cardiac surgery, can a thyroidectomy for a large retrosternal goitre be performed with good outcomes as a combined procedure?' Of 150 papers identified through the literature search, 16 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, patient group studied, relevant outcomes and results were tabulated. This paper includes 3 Level 4 papers and 13 case reports. All papers reported postoperative outcomes and five papers reported intraoperative outcomes. Of a total cohort of 32 patients, 25 were euthyroid prior to combined surgery. Twenty-nine of 32 thyroid surgeries were performed immediately prior to cardiac surgery in the combined procedure sequence. Post-procedural complications including transient recurrent laryngeal palsy and tracheomalacia were reported in 8 patients. There was one intraoperative death. Where reported, all patients were euthyroid on follow-up. All identified papers reported good outcomes with combined thyroidectomy and cardiac surgery.

Corynebacterium diphtheriae endocarditis--surgery for some but not all!

Corynebacterium diphtheriae endocarditis was thought to be a rare disease. We reviewed our experience in four cases of this disease treated over a period of 10 years. Seventy cases reported in literature were reviewed. The outcome is good if cases are carefully selected for medical or surgical treatment. We conclude that infective endocarditis due to C. diphtheriae, is perhaps more common than expected. It may be recognized more frequently and on occasion may be an aggressive disease. Those patients with an abnormal valve (including prosthetic valves) should be subjected to surgery at the earliest available opportunity, whereas patients with normal valves may be carefully watched during the course of medical treatment as long as immediate surgery can occur if needed.

Left ventricular assist device implantation via left thoracotomy: alternative to repeat sternotomy.

Repeat sternotomy for left ventricular assist device insertion may result in injury to the right heart or patent coronary grafts, complicating intraoperative and postoperative management. In 4 critically ill patients, left thoracotomy was used as an alternative to repeat sternotomy. Anastomosis of the outflow conduit to the descending thoracic aorta provided satisfactory hemodynamic support.