Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2011
Comparative StudyContinuous cardiac output monitoring with an uncalibrated pulse contour method in patients supported with mechanical pulsatile assist device.
We evaluated the accuracy of an uncalibrated pulse contour method called Pressure Recording Analytical Method (PRAM) compared with continuous thermodilution for cardiac output (CO) monitoring in patients implanted with a pulsatile left ventricular assist device (LVAD). Twelve adult patients implanted with the HeartMate I-XVE device were studied. CO was simultaneously evaluated by PRAM and by continuous thermodilution. ⋯ A good correlation was found between LVAD-CO and either ThD-CCO (r=0.88) or PRAM-CO (r=0.86), but an overestimation of 10% was observed for both PRAM-CO (mean bias -0.44 l/min) and ThD-CCO (mean bias -0.40 l/min). Our results demonstrated good agreements between PRAM-CO, ThD-CCO and LVAD-CO. PRAM derives CO from a peripheral artery without calibration and may be a complementary tool in the hemodynamic assessment of patients supported with a VAD.
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Interact Cardiovasc Thorac Surg · Jul 2011
Number of recurrent lesions is a prognostic factor in recurrent thymoma.
In advanced stage thymomas, recurrence is not uncommon but prognostic factors in recurrent thymoma have not been determined and standardized treatment for recurrence has not yet been established. A retrospective analysis was conducted on 24 thymoma patients who underwent treatment for recurrence in our institution to determine the prognostic factors for overall survival. Recurrence of thymoma appeared 11.6-109.6 months after the primary operation (34.6±25.7 months). ⋯ Patients with one or two recurrent lesions detected on CT examinations showed better prognosis. Prognosis in thymoma patients with recurrence was reviewed in the present study. Patients with a small number of recurrent lesions showed better prognosis irrespective of the treatment.
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Interact Cardiovasc Thorac Surg · Jun 2011
ReviewExtrapleural pneumonectomy or supportive care: treatment of malignant pleural mesothelioma?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether extrapleural pneumonectomy (EPP) is superior to supportive care in the treatment of patients with malignant pleural mesothelioma (MPM). Overall, 110 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. ⋯ The 30-day mortality rate was 7.8% and complications included prolonged air leak (9.8%) and empyema (4%). Median hospital stay was seven days. Overall, EPP shows no benefit in terms of survival or symptom improvement which is compounded by its high operative mortality and recurrence rate.
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Interact Cardiovasc Thorac Surg · Jun 2011
Should we operate on microscopic N2 non-small cell lung cancer?
Traditionally non-small cell lung cancer (NSCLC) stage N2 is considered as a contraindication for curative resection. We investigated the outcome of patients with microscopic N2 disease, who underwent potentially curative resections. The independent effects of lobectomy vs. pneumonectomy, histology subtype, body mass index (BMI), sex, and PET-scanning were investigated. ⋯ A low N2 survival risk score was associated with increased survival, P=0.001. Resecting microscopic N2 disease in NSCLC may be appropriate in some patients. An N2 survival scoring system may help select patients for surgery, and help evaluate adjuvant and neoadjuvant publications with regard to microscopic N2 disease.
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Interact Cardiovasc Thorac Surg · Jun 2011
Randomized Controlled Trial Comparative StudyComparative study of the non-dependent continuous positive pressure ventilation and high-frequency positive-pressure ventilation during one-lung ventilation for video-assisted thoracoscopic surgery.
The application of volume controlled high-frequency positive-pressure ventilation (HFPPV) to the non-dependent lung (NL) may have comparable effects to continuous positive-airway pressure (CPAP) on the surgical conditions during one-lung ventilation (OLV) for video-assisted thoracoscopic surgery (VATS). After local Ethics Committee approval and informed consent, we randomly allocated 30 patients scheduled for elective VATS after the first 15 min of OLV to ventilate the NL with CPAP of 2 cm H(2)O (NL-CPAP(2)) and HFPPV using tidal volume 2 ml/kg, inspiratory to expiratory ratio <0.3 and respiratory rate 60/min (NL-HFPPV) for 30 min, each in a randomized crossover order. ⋯ The operative field was much better during the application of NL-CPAP(2) than during NL-HFPPV (P<0.001). We concluded that the application of CPAP to the NL during OLV offers good quality of operative field and improved arterial oxygenation for VATS.