Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Aug 2009
Clinical significance of anastomotic leak in ascending aortic replacement for acute aortic dissection.
'Anastomotic leak' after ascending aortic replacement for acute aortic dissection, which is determined as direct forward blood flow into the false lumen at the distal anastomosis, prevents the false lumen from being thrombosed. The aim of this study is to determine whether the leak influences on residual aortic growth. Between October 1999 and May 2006, 100 patients presenting for acute type A aortic dissection underwent surgery at our institution. ⋯ Initial maximum diameter just after ascending aortic replacement was greater in patients with anastomotic leak than without anastomotic leak in aortic arch and descending aorta (P=0.013, P=0.06). Anastomotic leak after ascending aortic replacement for acute type A aortic dissection contributed to remnant aortic growth. More sophisticated method for reapproximation of dissected aorta should be dictated.
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Interact Cardiovasc Thorac Surg · Aug 2009
Efficacy of emergent percutaneous cardiopulmonary support in cardiac or respiratory failure: fight or flight?
We retrospectively evaluated early outcome and conducted this study to determine the predictive factors for percutaneous cardiopulmonary support (PCPS) weaning and hospital discharge. From January 2004 to December 2006, 92 patients diagnosed as cardiac or respiratory failure underwent PCPS using the Capiox emergent bypass system (Terumo, Tokyo, Japan). The mean+/-S. ⋯ PCPS provides an acceptable survival rate and outcome in patients with cardiac or respiratory failure. Prompt application and selection of patients with a specific disease (myocarditis) provides good results. It is also effective in elderly patients, providing hospital survival similar to that for younger patients.
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Interact Cardiovasc Thorac Surg · Aug 2009
Comparative StudyPreliminary experience for the evaluation of the intraoperative graft patency with real color charge-coupled device camera system: an advanced device for simultaneous capturing of color and near-infrared images during coronary artery bypass graft.
We developed a new color charge-coupled device (CCD) camera for the intraoperative indocyanine green (ICG) angiography. This device consists of a combination of custom-made optical filters and an ultra-high sensitive CCD image sensor, which can detect simultaneously color and near-infrared (NIR) rays from 380 to 1200 nm. We showed a comparison between our system and other devices for the preliminary experience. ⋯ When the CCD camera suspected a graft failure, CCD camera and angiography showed a comparable graft failure. The unique device that visualized ICG-enhanced structures against a background of natural myocardial color improved the visibility of abnormality in flow and perfusion. Our findings show that this device may become a standard intraoperative graft and perfusion assessment tool in coronary artery bypass graft (CABG).
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Interact Cardiovasc Thorac Surg · Aug 2009
Case ReportsTriple heart valve surgery through a right antero-lateral minithoracotomy.
Triple valve surgery remains a complex intervention, with prolonged cardiopulmonary bypass (CPB) and cross-clamp times. A median sternotomy is the standard approach in the surgical treatment of multiple valve disease. In this report, we attempt to describe our approach for the correction of the triple heart valve disease through a right antero-lateral minithoracotomy, because avoiding sternotomy can bring less wound infections, faster recovery and a shorter hospital stay. The right minithoracotomy in the 3rd intercostal space was applied in two patients and a feasibility of either repair or replacement with a good field exposure to access the aortic, mitral and tricuspid valves without any particular difficulties was verified.
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Interact Cardiovasc Thorac Surg · Aug 2009
Surgical treatment for non-small cell lung cancer in octogenarians--the usefulness of video-assisted thoracic surgery.
The purpose of this study was to investigate whether surgical treatment for non-small cell lung cancer (NSCLC) confers a survival benefit in octogenarians, and whether video-assisted thoracic surgery (VATS) is effective in terms of postoperative morbidity, mortality, and quality of life (QOL). Among 1684 patients with primary NSCLC who underwent pathologically complete resection, 95 were octogenarians. Operation was performed by the VATS approach (VATS group, n=58) or the standard thoracotomy (ST group, n=37). ⋯ There was no significant difference in overall 5-year survival rates between the ST group and the VATS group (P=0.144). The VATS approach for pulmonary resection is recommended for octogenarians with NSCLC. Surgical resection is the optimal treatment for stage IA NSCLC, and therefore, advanced age is not a contraindication for curative resection.