Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2012
Self-perceived video-assisted thoracic surgery lobectomy proficiency by recent graduates of North American thoracic residencies.
Minimally invasive surgical techniques offer several advantages over traditional open procedures, yet the pathway to minimally invasive proficiency can be difficult to navigate. As a part of an effort of the Joint Council of Thoracic Surgical Education to increase access to this skill set in the general thoracic community, recent graduates of thoracic residencies were surveyed to determine the self-reported achievement of video-assisted thoracic surgery (VATS) lobectomy proficiency and the merits of various educational opportunities. The objective of this study was to estimate the comfort level of recent graduates with the minimally invasive approach, as this demographic not only reflects the current status of training, but represents the future of the specialty. ⋯ The vast majority of the 25 dedicated general thoracic surgeons who graduate each year consider themselves proficient in VATS lobectomies, largely due to training in their thoracic residencies. On the other hand, the minority of surgeons performing general thoracic procedures as a part of a mixed practice consider themselves proficient in VATS lobectomies. Further study is warranted to enhance the VATS lobectomy experience of mixed practice surgeons particularly during their thoracic residencies.
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Interact Cardiovasc Thorac Surg · Jun 2012
Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension.
Delayed presentation of ventricular septal defect (VSD) is common in developing countries. Such patients often have severe pulmonary arterial hypertension (PAH), which increases post-operative morbidity and mortality. To address these problems, we used our technique of unidirectional valved patch (UVP) for closure of VSD. ⋯ Mean follow-up was 30 ± 14.7 months and all patients are well without cyanosis. Echocardiography showed no shunt across the patch and all have systemic saturation >95%. We conclude that UVP is a promising technique in patients with large VSD and severe PAH.
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Interact Cardiovasc Thorac Surg · Jun 2012
Bicuspidy does not affect reoperation risk following aortic valve reimplantation.
Aortic valve reimplantation has been shown to be a safe procedure. However, evidences of durability in bicuspid aortic valves (BAVs) are limited in the literature. Between 2002 and 2011, 132 patients (mean age 61 ± 12 years) underwent aortic valve reimplantation. ⋯ Patients with valve cusp repair showed a higher rate of aortic valve reoperation; however, only postoperative aortic regurgitation >2+/4+ was significant risk factor for redo procedure at multivariate analysis. Aortic valve reimplantation in BAV without cusp repair provides excellent mid-term results. Further observations and longer follow-up are necessary to determine if BAV sparing, even in the presence of cusps alterations, could allow satisfying durability.
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Interact Cardiovasc Thorac Surg · Jun 2012
Survival impact of node zone classification in resected pathological N2 non-small cell lung cancer.
We assessed the prognostic value of the 'Zone-classification' which has been proposed by the Japanese Association for Lung Cancer (JALC) for mediastinal nodal metastases in non-small cell lung cancer (NSCLC). Among 357 NSCLC patients who underwent curative surgery, 46 patients with pathological (p) N2 disease were divided into two groups as follows: 32 patients in whom the nearer zone was involved were classified as the pN2a-1 group, and 14 patients in whom the further mediastinal node station was involved were classified as the pN2a-2 group. ⋯ A multivariate analysis confirmed that pN2a-2 sub-classification (hazard ratio 2.77; P = 0.03) and undergoing pneumonectomy (hazard ratio 4.86; P < 0.01) were independent and significant factors in predicting a poor prognosis. In pN2 NSCLC patients, the involved mediastinal zone according to the primary tumour site was important in prediction of survival.
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Interact Cardiovasc Thorac Surg · Jun 2012
Thymectomy for thymoma and myasthenia gravis. A survey of current surgical practice in thymic disease amongst EACTS members.
Thymic disorders, both oncological and non-oncological, are rare. Multi-institutional, randomized studies are currently not available. The Thymic Working Group of the European Association for Cardio-Thoracic Surgery (EACTS) decided to perform a survey aiming to estimate the extent and type of current surgical practice in thymic diseases. ⋯ High-volume surgeons cooperate more frequently with a dedicated neurologist and anaesthesist (P = 0.04), determine more frequently neurological scores pre- and postoperatively (P = 0.02) and do not operate on thymic hyperplasia in stage I myasthenia gravis (MG) (P = 0.04). High-volume thymoma surgeons more often use a transpleural approach for stage I thymoma < 4 cm (P = 0.01), induction therapy (P = 0.05) and are more likely to have access to a tissue bank (P = 0.04). Both in thymoma and MG surgery, cooperative prospective studies seem to be feasible in dedicated thoracic surgical associations as EACTS.