Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2011
Case ReportsExtra-anatomic lateral bypass combined with embolization of the femoral stump for management of groin infection and bleeding due to metastatic carcinoma of the penis.
We report a possible treatment strategy for a patient with squamous cell carcinoma of the penis in hemorrhagic shock, due to erosion of the right femoral artery by metastatic inguinal lymph nodes. Because of coexistent groin infection and the inability to perform radical excision, the patient was treated with a lateral extra-anatomic iliac femoral prosthetic bypass; to prevent further bleeding, the femoral stump was embolized percutaneously. The patient was discharged home and did not experience any vascular complications during the follow-up, until death due to pulmonary metastasis.
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Interact Cardiovasc Thorac Surg · May 2011
Comparative StudyExtracorporeal membrane oxygenation for acute respiratory distress syndrome: is the configuration mode an important predictor for the outcome?
Extracorporeal membrane oxygenation (ECMO) is increasingly applied as rescue-therapy for patients with severe acute respiratory distress syndrome (ARDS). Here, we evaluate the effect of different configuration strategies (venovenous vs. venoarterial vs. veno-venoarterial) on the outcome. From 2006 to 2008, 30 patients received ECMO for severe ARDS. ⋯ Although univariate analysis could not rule out a significant predictor for the outcome, there was a trend visible to decreased mortality in the vva-group when compared to vv- and va-groups (27% vs. 63% vs. 75%; P = 0.057). ECMO provides a survival benefit in patients when considering a predicted mortality rate of 80% in ARDS. The configuration mode appears to impact the outcome as the veno-venoarterial appears to further improve the survival in this subset of patients.
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Interact Cardiovasc Thorac Surg · May 2011
Case ReportsRobotic total endoscopic coronary artery bypass hybrid revascularization procedure in a patient with a preoperative tracheostoma.
Preoperative tracheostoma presents a significant risk of sternal wound complications, mediastinitis, stoma necrosis and tracheal injury in patients requiring cardiac surgery. Several approaches have been described to limit these risks. ⋯ Single left internal mammary artery grafting to the left coronary artery system was carried out successfully as the first stage of a hybrid revascularization and followed by percutaneous coronary intervention to the circumflex coronary artery. We regard this technique as the most minimally-invasive method of surgical coronary revascularization with a significant potential to reduce the risk of mediastinitis in patients with a tracheostoma.
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Interact Cardiovasc Thorac Surg · May 2011
Validation of pN2 sub-classifications in patients with pathological stage IIIA N2 non-small cell lung cancer.
Optimal surgical treatment for patients with stage IIIA N2 non-small cell lung cancer (NSCLC) remains a matter of debate, because of the outcomes. The outcomes may be affected from variations in patterns of lymph node metastasis. As the patterns of lymph node sub-classifications, multiple station metastases of mediastinal lymph nodes (MN2), highest metastasis of the mediastinal lymph nodes (HM), distribution of metastatic nodes (skip N2 or non-skip N2), and clinical (c-) N factor have been cited. ⋯ Based on log-rank testing, c-T factor (P = 0.022), p-T factor (P = 0.0002), c-N factor (P = 0.009), HM (P = 0.019) and skip N2 (P = 0.030) were identified as significantly prognostic. Using these variables, p-T factor, c-N factor and skip N2 showed significance and independence on Cox multivariate analysis. The sub-classification of lymph node metastasis in patients with p-stage IIIA N2 NSCLC has clinical implications for the prognosis.