Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2017
Observational StudyAntegrade and retrograde perfusion in minimally invasive mitral valve surgery with transthoracic aortic clamping: a single-institution experience with 1632 patients over 12 years.
The aim of the present study was to evaluate the impact of a retrograde arterial perfusion (RAP) strategy versus an antegrade arterial perfusion (AAP) strategy in a consecutive, large cohort of patients who underwent minimally invasive mitral valve surgery with transthoracic aortic clamping through a right minithoracotomy. ⋯ Minimally invasive mitral valve procedures can be performed with low morbidity and mortality. The use of retrograde perfusion is associated with a higher incidence of neurological complications in older patients with atherosclerotic burden. Central aortic cannulation permits avoidance of complications associated with retrograde perfusion and extends the suitability of minimally invasive mitral procedures to those patients who have an absolute contraindication for femoral artery cannulation.
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Interact Cardiovasc Thorac Surg · Mar 2017
Case ReportsNovel application of a percutaneous left ventricular assist device as a bridge to transplant in a paediatric patient with severe heart failure due to viral myocarditis.
A 13-year obese female with suspected viral myocarditis presented with acute decompensated heart failure. Due to her body habitus, she was a poor candidate for immediate heart transplantation. A peripherally inserted left ventricular assist device (LVAD) was implanted via the right axillary artery. ⋯ Removal of the device was well tolerated and post-removal echocardiography revealed an improvement in the left ventricular ejection fraction (LVEF) from 21% at baseline to 38% after device removal. This case represents a successful application of a peripherally inserted LVAD as a bridge to transplant in a pediatric patient with severe heart failure due to suspected viral myocarditis. For select patients with this condition, a transaxillary LVAD should be considered as a therapeutic option as it is well tolerated and provides effective left ventricle unloading to promote myocardial recovery and maintain performance status.
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Interact Cardiovasc Thorac Surg · Mar 2017
High preoperative monocyte count/high-density lipoprotein ratio is associated with postoperative atrial fibrillation and mortality in coronary artery bypass grafting.
The monocyte to high-density lipoprotein ratio has recently emerged as an indicator of inflammation and oxidative stress. The aim of this study was to evaluate the association of the monocyte to high-density lipoprotein ratio with postoperative atrial fibrillation and mortality in coronary artery bypass grafting. ⋯ We have observed that high preoperative monocyte count/ high-density lipoprotein ratio was associated with postoperative atrial fibrillation and mortality after coronary artery bypass grafting operation.
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Interact Cardiovasc Thorac Surg · Mar 2017
Case ReportsUniportal middle lobectomy after a previous right upper lobectomy.
Video-assisted thoracoscopic surgery (VATS) using a 3.5 cm single incision (uniportal) may not only result in better pain control, earlier mobilization and shorter hospital stays, but can also provide safer and clear visualization to perform thoracoscopic dissection during complex surgeries. This is a case of a 55-year-old woman who underwent redo-thoracoscopy through uniportal approach for a middle-lobe lobectomy, after a previous right-upper lobectomy.
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Interact Cardiovasc Thorac Surg · Mar 2017
Review Meta AnalysisClassification and outcomes of extended arch repair for acute Type A aortic dissection: a systematic review and meta-analysis.
Distal extent of repair in patients undergoing surgery for acute Type A aortic dissection (ATAAD) is controversial. Emerging hybrid techniques involving open and endovascular surgery have been reported in small numbers by select individual centres. A systematic review and meta-analysis was performed to investigate the outcomes following extended arch repair for ATAAD. A classification system is proposed of the different techniques to facilitate discussion and further investigation. ⋯ Perioperative results of extended arch procedures are encouraging. Further follow-up is required to see if long-term complications are reduced with these emerging techniques. The proposed classification system will facilitate future comparison of short- and long-term results of different techniques of extended arch repair for ATAAD.