Innovations : technology and techniques in cardiothoracic and vascular surgery
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Innovations (Phila) · Nov 2010
Thromboembolic events in patients on extracorporeal membrane oxygenation without anticoagulation.
: Heparinization is thought to be mandatory to avoid thromboembolic complications during venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, bleeding complications are common. We report our experience of VA-ECMO without systemic anticoagulation. ⋯ : VA-ECMO support without systemic anticoagulation may reduce bleeding complications and transfusion requirement, without increasing the risk of thromboembolism.
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: For elderly patients with symptomatic aortic valve stenosis, aortic valve replacement with tissue valves is still the treatment of choice. Stentless valves were introduced to clinical practice for better hemodynamic features as compared with stented tissue valves. However, the implantation is more complex and time demanding, especially in minimal invasive aortic valve replacement. We present our clinical data on 22 patients having received a sutureless ATS 3f Enable aortic bioprosthesis via partial upper sternotomy. ⋯ : Sutureless valve implantation via partial sternotomy is feasible and safe with the ATS 3f Enable bioprosthesis. Reduction of cardiopulmonary bypass and aortic crossclamp time seems possible with increasing experience. Hemodynamic data are very promising with low gradients at discharge and after 12 month. Sutureless valve implantation via minimal invasive access may be an alternative treatment option for elderly patients with high comorbidity.
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Innovations (Phila) · Mar 2009
Stentless versus stented bioprosthetic aortic valves: a systematic review and meta-analysis of controlled trials.
: This meta-analysis sought to determine whether stentless bioprosthetic valves improve clinical and resource outcomes compared with stented valves in patients undergoing aortic valve replacement. ⋯ : Evidence from randomized trials shows that subcoronary stentless aortic valves improve hemodynamic parameters of effective orifice area index, mean gradient, and peak gradient over the short and long term. These improvements have not led to proven impact on patient morbidity, mortality, and resource-related outcomes; however, few trials reported on clinical outcomes beyond 1 year and definitive conclusions are not possible until sufficient evidence addresses longer-term effects.
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Innovations (Phila) · May 2008
Preoperative hemoglobin a1c predicts sternal wound infection after coronary artery bypass surgery with bilateral versus single internal thoracic artery grafts.
: Bilateral internal thoracic artery (BITA) grafting during coronary artery bypass (CABG) improves long-term and event-free survival but may carry a higher risk of wound complications. It is unknown whether preoperative hemoglobin A1c (HbA1c), a measure of long-term glucose control, predicts deep sternal wound infection (DSWI) after BITA grafting. ⋯ : Elevated preoperative HbA1c and BITA grafting were significant predictors of DSWI after CABG. Elevated HbA1c level should be considered in the risk/benefit analysis when selecting patients for BITA grafting.
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Innovations (Phila) · Nov 2007
Video-assisted thoracic surgery in lung cancer resection: a meta-analysis and systematic review of controlled trials.
: This meta-analysis sought to determine whether video-assisted thoracic surgery (VATS) improves clinical and resource outcomes compared with thoracotomy (OPEN) in adults undergoing lobectomy for nonsmall cell lung cancer. ⋯ : This meta-analysis suggests that there may be some short term, and possibly even long-term, advantages to performing lung resections with VATS techniques rather than through conventional thoracotomy. Overall, VATS for lobectomy may reduce acute and chronic pain, perioperative morbidity, and improve delivery of adjuvant therapies, without a decrease in stage specific long-term survival. However, the results are largely dependent on non-RCTs, and future adequately powered randomized trials with long-term follow-up are encouraged.