Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Oct 2014
Case ReportsExtracorporeal membrane oxygenation as a support for emergency bronchial reconstruction in a traumatic patient with severe hypoxaemia.
Extracorporeal membrane oxygenation (ECMO) is an extracorporeal life support technique to provide cardiac and/or respiratory assistance to patients. ECMO has been demonstrated to be beneficial for the life support of selected traumatic individuals. However, the application of arteriovenous ECMO as an intraoperative support strategy in emergency operations has rarely been described. ⋯ His right main bronchus was sewn completely closed during the first operation in a local hospital, and he developed refractory hypoxaemia and haemodynamic instability. Although general anaesthesia was not applicable, arteriovenous ECMO was applied as a support to perform the second operation to reconstruct successfully his right main bronchus. As a result, he recovered from this injury.
-
Interact Cardiovasc Thorac Surg · Oct 2014
Case ReportsOutflow graft thrombectomy during HeartMate II left ventricular assist device exchange.
We report the pump exchange secondary to a detached bend relief sheath of a HeartMate II (Thoratec Corporation, Pleasanton, CA, USA) left ventricular assist device, consistent with previous Food and Drug Administration warnings. This report highlights a thrombectomy technique and reuse of the outflow graft during subcostal pump exchange in a patient with relative contraindications to repeat sternotomy.
-
Interact Cardiovasc Thorac Surg · Oct 2014
Endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymphadenopathy: effect of the learning curve.
This study aimed to evaluate the learning curve and efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the examination of mediastinal or hilar lymph nodes suspected of having cancer or of benign disease such as sarcoidosis. A success-adjusted cumulative sum model was used to evaluate the learning curve for diagnostic rates and operation time. A total of 99 patients (77 men and 22 women) who underwent EBUS-TBNA from April 2011 to March 2012 in a single centre were analysed retrospectively. ⋯ The sensitivity, specificity, and positive and negative predictive values and diagnostic accuracy for EBUS-TBNA were 80, 100, 100, 87.1 and 91.5%, respectively. According to the learning curve analysis, the ability to perform EBUS required performing approximately 37 procedures for the trials. In conclusion, more successful results are obtained after a certain learning curve, as is the case for every other invasive procedure.
-
Interact Cardiovasc Thorac Surg · Oct 2014
Case Reports'Fast-implantable' aortic valve implantation and concomitant mitral procedures.
Concomitant aortic and mitral valve replacement or concomitant aortic valve replacement and mitral repair can be a challenge for the cardiac surgeon: in particular, because of their structure and design, two bioprosthetic heart valves or an aortic valve prosthesis and a rigid mitral ring can interfere at the level of the mitroaortic junction. Therefore, when a mitral bioprosthesis or a rigid mitral ring is already in place and a surgical aortic valve replacement becomes necessary, or when older high-risk patients require concomitant mitral and aortic procedures, the new 'fast-implantable' aortic valve system (Intuity valve, Edwards Lifesciences, Irvine, CA, USA) can represent a smart alternative to standard aortic bioprosthesis. Unfortunately, this is still controversial (risk of interference). ⋯ Interestingly, we learned that there is no interference (or not significant interference) among the standard valve and the stent valve. Consequently, we can assume that a fast-implantable valve can also be safely placed next to a biological mitral valve or next to a rigid mitral ring without risks of distortion, malpositioning, high gradient or paravalvular leak. This paper describes two cases: a concomitant Intuity aortic valve and bioprosthetic mitral valve implantation and a concomitant Intuity aortic valve and mitral ring implantation.