The Annals of thoracic surgery
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Comparative Study
Robotic-Assisted Versus Thoracoscopic Lobectomy Outcomes From High-Volume Thoracic Surgeons.
Reports of surgical outcomes comparing proficient surgeons who perform either robotic-assisted or video-assisted thoracoscopic lobectomy are lacking. We evaluate the comparative effectiveness of robotic-assisted and video-assisted thoracoscopic lobectomies by surgeons who performed 20 or more annual surgical procedures in a national database. ⋯ When surgical outcomes are limited to surgeons who perform 20 or more annual procedures, the robotic-assisted approach is associated with a lower conversion-to-open rate and lower 30-day complication rate when than video-assisted thoracoscopic surgeons, with a mean operative time difference of 25 minutes.
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Hemiarch Reconstruction Versus Clamped Aortic Anastomosis for Concomitant Ascending Aortic Aneurysm.
Deep hypothermic circulatory arrest (DHCA) is often avoided in patients with concomitant ascending aortic pathology when treating another cardiac disease to avoid increased risk of morbidity and mortality. We hypothesized that the use of DHCA with retrograde cerebral perfusion (RCP) does not add incremental risk to ascending aortic replacement alone in the setting of concomitant cardiac surgery. ⋯ Propensity score matching yielded 116 pairs of non-hemiarch patients versus 116 hemiarch patients. Within the propensity score-matched cohort, there were no differences in postoperative stroke (1.7% versus 3.4%; p = 0.41), new postoperative dialysis (6.0% versus 5.2%; p = 0.78), postoperative renal insufficiency (27.6% versus 19.8%; p = 0.16), 30-day mortality (2.6% versus 3.4%; p = 0.701), or 1-year mortality (4.3% versus 4.3%; p = 1.00) CONCLUSIONS: Hemiarch replacement using DHCA with RCP does not increase the risk of operative complications compared with a normothermic, clamped-distal aortic anastomosis, and therefore its use should not be limited when planning complex multiprocedural reconstructions during elective ascending thoracic aortic replacement with concomitant cardiac surgery.
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A patient with double inlet left ventricle with transposition of great arteries and severe coarctation of the aorta received aortoplasty and pulmonary artery banding, followed by bidirectional Glenn shunt and extracardiac total cavopulmonary connection (TCPC). Severe subaortic stenosis and increased atrioventricular valve regurgitation were noted 4 years after TCPC. ⋯ The TCPC was taken down with both caval veins reconnected to the right atrium; the neopulmonary artery was reconstructed. Biventricular conversion from TCPC was achieved.
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Randomized Controlled Trial Comparative Study
Patient-Controlled Paravertebral Block for Video-Assisted Thoracic Surgery: A Randomized Trial.
Paravertebral block (PVB) has been proven to be an efficient way to control postoperative pain in patients who have undergone a thoracotomy. This study explored whether the use of a patient-controlled PVB can provide benefits over intravenous patient-controlled analgesia (PCA) for 3-port single-intercostal video-assisted thoracic surgery. ⋯ PVB, which resulted in lower cumulative dezocine doses and produced fewer side effects than PCA, can provide effective pain relief for patients undergoing video-assisted thoracic surgery.