Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2017
Comparison of radial and bilateral internal thoracic artery grafting in patients with peripheral vascular disease†.
The composite T-graft with radial artery (RA) attached end-to-side to the left internal thoracic artery (ITA) provides arterial myocardial revascularization without the increased risk of deep sternal wound infection associated with harvesting 2 ITAs. However, many surgeons are reluctant to use RA in patients with peripheral vascular disease (PVD) due to concerns regarding the quality of the conduit in this subset of patients. The purpose of this study is to compare early- and long-term outcomes of arterial grafting with bilateral ITAs (BITA) to that of single ITA and RA in patients with PVD. ⋯ In patients with PVD, complete arterial revascularization with left ITA and RA can be justified with regards to survival.
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Interact Cardiovasc Thorac Surg · Jun 2017
Observational StudyPostoperative pulmonary complications and rehabilitation requirements following lobectomy: a propensity score matched study of patients undergoing video-assisted thoracoscopic surgery versus thoracotomy†.
: Video-assisted thoracoscopic surgical (VATS) lobectomy is increasingly used for curative intent lung cancer surgery compared to open thoracotomy due to its minimally invasive approach and associated benefits. However, the effects of the VATS approach on postoperative pulmonary complications (PPC), rehabilitation and physiotherapy requirements are unclear; our study aimed to use propensity score matching to investigate this. ⋯ This study demonstrates that patients undergoing VATS lobectomy developed less PPC and had improved associated outcomes compared to thoracotomy. Patients were more mobile earlier, and required half the physiotherapy resources having fewer pulmonary and mobility issues.
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Interact Cardiovasc Thorac Surg · Jun 2017
Mid-term results of zone 0 thoracic endovascular aneurysm repair after ascending aorta wrapping and supra-aortic debranching in high-risk patients.
Surgical repair of aneurysmal disease involving the ascending aorta, aortic arch and eventually the descending aorta is generally associated with significant morbidity and mortality. A less invasive approach with the ascending wrapping technique (WT), supra-aortic vessel debranching (SADB) and thoracic endovascular aneurysm repair (TEVAR) in zone 0 was developed to reduce the associated risk in these patients. ⋯ The use of the ascending WT, SADB and TEVAR in selected patients with complex thoracic aorta disease is safe and shows promising mid-term results at 3 years. The combination of these techniques could represent an alternative to the standard open surgical repair, especially in older patients or in patients unfit for cardiopulmonary bypass.
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Interact Cardiovasc Thorac Surg · Jun 2017
Liposomal bupivacaine versus bupivacaine/epinephrine after video-assisted thoracoscopic wedge resection†.
The purpose of this research is to compare liposomal bupivacaine and bupivacaine/epinephrine for intercostal blocks related to analgesic use and length of stay following video-assisted thoracoscopic wedge resection. ⋯ Thoracic surgery patients who have blocks performed with liposomal bupivacaine require fewer analgesics postoperatively. This may decrease complications related to poor pain control and decrease side effects related to narcotic use in our patient population.
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Interact Cardiovasc Thorac Surg · May 2017
Hyperkalemic arrest and the aortic no-touch technique in minimally invasive atrial septal defect closure in adults.
To avoid aortic cross-clamping and cardioplegic ischaemia, we propose the induction of hyperkalemic arrest and using aortic no-touch technique in minimally invasive atrial septal defect (ASD) closure. Twenty-eight patients were included in this study. After establishment of cardiopulmonary bypass, potassium was administered to induce hyperkalemic arrest. ⋯ At the end of the operation, serum potassium was normalized to 4.1 ± 0.5 mEq/l. The mean arrest time was 11 ± 4.4 min without complications. Hyperkalemic arrest in combination with aortic no-touch technique is safe and efficacious in minimally invasive ASD closure.