General thoracic and cardiovascular surgery
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Gen Thorac Cardiovasc Surg · Jun 2014
Optimal coronary artery bypass grafting strategy for acute coronary syndrome.
Conventional coronary artery bypass grafting (CABG) using cardiopulmonary bypass and cardiac arrest is associated with higher mortality and morbidity rates in acute coronary syndrome (ACS) patients undergoing surgery. Although off-pump CABG (OPCAB) is beneficial for high-risk patients, its efficacy for ACS is unknown, with on-pump beating CABG an adjunctive method. We investigated the effects of OPCAB and on-pump beating CABG for ACS. ⋯ OPCAB might have beneficial effects for ACS patients with UA, while IABP was found essential for completing OPCAB. In AMI patients, on-pump beating CABG might be reasonable for avoiding conversion from OPCAB and ischemic perfusion injury.
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Following the revision of the therapeutic guideline of ACC/AHA in (Circulation 114:450-527, 2006), the incidence of mitral valve repair in asymptomatic patients with moderate or severe mitral valve regurgitation has increased. For mitral valve repair, the quality and outcomes as well as lower invasive procedure are important to obtain the confidence of cardiologists and ensure request of early phase operation from cardiologists. With recent innovations of technologies and the development of revolutionary techniques, minimally invasive surgery of the mitral valve (MIS-MV) has become a widespread surgical option of mitral valve repair. It is vital, however, that careful preoperative assessment, and planning of the approach and perfusion strategy are put in place to perform MIS-MV safely.
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Gen Thorac Cardiovasc Surg · May 2014
Lung metastasectomy for postoperative colorectal cancer in patients with a history of hepatic metastasis.
Our objective was to evaluate the efficacy of pulmonary metastasectomy for postoperative colorectal cancer with hepatic metastasis, and to investigate the role of clinicopathological factors as predictors of outcome. ⋯ Pulmonary resection is not contraindicated in clinical practice. Significant factors indicating a good prognosis were female sex and the number of pulmonary metastases. Special attention should be paid to comparison of survival among studies.
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Gen Thorac Cardiovasc Surg · Mar 2014
Efficacy and safety of artificial pneumothorax under two-lung ventilation in thoracoscopic esophagectomy for esophageal cancer in the prone position.
Thoracoscopic esophagectomy for esophageal cancer performed using two-lung ventilation in the prone position has many advantages, such as convenient anesthesia induction and maintenance, and good oxygenation. We examined the safety of surgery and anesthetic management by following chronological changes in intraoperative respiration and hemodynamics. ⋯ No excessive increases in airway pressure or clear circulatory depressions were observed because of artificial pneumothorax under two-lung ventilation in thoracoscopic esophagectomy for esophageal cancer in the prone position. These results suggest that artificial pneumothorax under two-lung ventilation is beneficial for maintaining stable hemodynamics and oxygenation in thoracoscopic esophagectomy in prone position.