Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2010
Comparative StudyImpact of number and site of lymph node invasion on survival of adenocarcinoma of esophagogastric junction.
Lymph node involvement in adenocarcinoma of the esophagogastric junction (EGJ) is similar to that of gastric cancer. The impact on survival of the number and site of lymph nodes involved in a subgroup of patients undergone surgery for adenocarcinoma of EGJ is reported. Sixty-four patients undergone transthoracic esophagectomy with two-field lymphadenectomy for adenocarcinoma of the EGJ were retrospectively assessed. ⋯ Overall survival was different depending on the infiltration of distal or proximal site nodes, 23% vs. 58% (P<0.05); in N0 patients it was related to the number of lymph nodes removed (83% >15 vs. 57% <15, P<0.05). Classification of lymph node involvement in adenocarcinoma of the EGJ by gastric cancer criteria is adequate for prognostic purposes. The involvement of distal nodes in all cases and the removal of <15 nodes in N0 group resulted as independent negative predictive factors.
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Interact Cardiovasc Thorac Surg · May 2010
Case ReportsSafety of coronary artery bypass grafting in patients with bilateral total carotid occlusions.
The presence of bilateral carotid artery occlusions in patients that require coronary artery bypass surgery is rare. Here, we report the successful coronary revascularization of two patients with cardiopulmonary bypass under moderate hypothermia. ⋯ The vertebral blood flows of both patients were also found to be highly increased. Following successful surgery, the postoperative courses were uneventful and patients were discharged from the hospital on the seventh postoperative day.
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Interact Cardiovasc Thorac Surg · May 2010
Sutureless pericardial repair of total anomalous pulmonary venous connection in patients with right atrial isomerism.
Surgical repair of total anomalous pulmonary venous connection (TAPVC) in patients with right atrial isomerism is associated with a significant risk of recurrent pulmonary venous obstruction (PVO). We evaluate the effect of sutureless repair to reduce the risk of recurrent PVO. Since November 2007, five patients, including three neonates, with right atrial isomerism underwent sutureless repair of TAPVC. ⋯ Two patients underwent a bidirectional Glenn shunt after the sutureless repair. The pulmonary venous confluence was confirmed to be left open at the time of the Glenn surgery. The sutureless technique may be useful not only for postrepair PVO but also for non-operated TAPVC in neonates with right atrial isomerism.
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Interact Cardiovasc Thorac Surg · Apr 2010
Multicenter Study Comparative StudySurgical ventricular reconstruction with different myocardial protection strategies. A propensity matched analysis.
The aim of this study is to compare outcomes of patients undergoing surgical ventricular reconstruction (SVR) with normothermic cardiopulmonary bypass (CPB) and beating heart or hypothermic CPB and cardioplegic arrest. Between 2001 and 2008, 588 patients underwent SVR. A propensity score matching was performed and 91 matched pairs were created: group 1 (G1) operated with normothermic CPB and beating-heart technique, and group 2 (G2) operated with hypothermic CPB and cardioplegic arrest. ⋯ Left ventricular volume reduction, ejection fraction and New York Heart Association (NYHA) class improvement were significant in the overall population; no significant differences were found between groups. The following independent risk factors for cardiac death were identified: mitral valve regurgitation, surgery <3 months from myocardial infarction, NYHA class III-IV. This study showed that outcomes following SVR are not affected by myocardial protection strategies neither in cardiac function and clinical status nor in survival.