Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2015
The relevance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging in diagnosing prosthetic graft infections post cardiac and proximal thoracic aortic surgery.
Diagnosis of prosthetic graft infection after cardiac and proximal aortic surgery is a challenge. Besides technical considerations, redo surgery is associated with substantial morbidity and mortality. Therefore, an accurate diagnosis is mandatory. We report on our experience with hybrid 18-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET)/computed tomography (CT) imaging, which is increasingly used to diagnose infections in the detection of graft infection after cardiac surgery. ⋯ PET provides functional data, confirms a CT diagnosis and may even increase diagnostic sensitivity in comparison with CT alone in selected cases. Specificity can be compromised by postoperative changes or chronic inflammatory reactions induced by the graft. CT and/or echocardiography should remain the first diagnostic step in case of a suspected infection because of their broad and fast availability. If confirmation is needed or diagnosis is not achievable using conventional methods, PET might be chosen as the next modality to gain additional information in experienced centres.
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Interact Cardiovasc Thorac Surg · Oct 2015
Case ReportsTransapical off-pump Neochord implantation on bileaflet prolapse to treat severe mitral regurgitation.
A 74-year old lady was admitted for the presence of a symptomatic severe mitral regurgitation (MR) due to bileaflet prolapse. The patient refused any surgical conventional procedure because of severe arthrosis and osteoporosis documented by previous fractures requiring knee and hip replacements, and was sent directly to us for transapical off-pump mitral valve repair with Neochord implantation (TOP-MINI procedure). ⋯ After 11 months of follow-up, the patient presented with recurrence of symptomatic moderate MR due to rupture of one of two neochordae implanted on the anterior leaflet and new onset of atrial fibrillation. The patient underwent uneventful mitral valve replacement.
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Interact Cardiovasc Thorac Surg · Oct 2015
Randomized Controlled Trial Multicenter StudyCan posterior pericardiotomy reduce the incidence of postoperative atrial fibrillation after coronary artery bypass grafting?†.
Atrial fibrillation (AF) is a common complication that increases the morbidity after open heart surgery. The pathophysiology is uncertain, and its prevention remains suboptimal. The aim of this study was to assess the efficiency of posterior pericardiotomy in decreasing the incidence of pericardial effusion and postoperative AF. ⋯ Posterior pericardiotomy is a simple, safe and effective method for reducing the incidence of postoperative pericardial effusion and related atrial fibrillation by improving pericardial drainage after coronary artery bypass grafting.
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Interact Cardiovasc Thorac Surg · Oct 2015
Meta Analysis Comparative StudyRobotic thoracic surgery versus video-assisted thoracic surgery for lung cancer: a meta-analysis.
There are two different minimally invasive approaches, robotic thoracic surgery (RTS) and video-assisted thoracic surgery (VATS), which are performed for lung cancer resection. This meta-analysis aimed to compare the perioperative outcomes of RTS with those of VATS for patients with lung cancer. ⋯ This meta-analysis showed that RTS resulted in similar outcomes compared with VATS cases. RTS appears to be an appropriate alternative to VATS, which is associated with improved outcomes compared with open thoracotomy. RTS should be studied further in selected centres and compared with VATS in a randomized fashion to better define its potential advantages and disadvantages.