The Annals of thoracic surgery
-
Heparin is the main anticoagulant used during extracorporeal membrane oxygenation (ECMO) support. Nafamostat mesilate, a synthetic serine protease inhibitor, has seen increased use as a substitute for heparin in patients undergoing ECMO because of its short half-life. We aimed to compare these 2 anticoagulants with respect to bleeding and thromboembolic complications during ECMO support. ⋯ Nafamostat mesilate was found to increase the bleeding risk in patients receiving venoarterial ECMO. Regarding thromboembolic complications, there was no significant difference between heparin and nafamostat. Only old age increased the thromboembolic risk.
-
Pulsatile versus nonpulsatile cardiopulmonary bypass (CPB) perfusion remains debated. Beneficial effects on tissue perfusion, inflammation, and microvascular fluid exchange have been linked to pulsatile perfusion by some investigators and denied by others. This study evaluated fluid extravasation and tissue perfusion during nonpulsatile or pulsatile roller pump-induced CPB perfusion. ⋯ No important differences were found between pulsatile and nonpulsatile CPB perfusion for microvascular fluid balance and tissue perfusion.
-
Trocars used during video-assisted thoracic surgery (VATS) present some technical disadvantages due to their rigid structure. We propose the use of an extra-small wound retractor system, designed for general surgery, as alternative to rigid trocar for camera port during VATS. In our experience the wound retractor presents 5 objective advantages: reduces intercostal nerve compression and skin injuries, improves the camera maneuverability, does not displace during operation, and protects the camera by any small parietal bleeding.
-
The purpose of this analysis was to revise the model for perioperative risk for esophagectomy for cancer utilizing The Society of Thoracic Surgeons General Thoracic Surgery Database to provide enhanced risk stratification and quality improvement measures for contributing centers. ⋯ Thoracic surgeons participating in The Society of Thoracic Surgeons General Thoracic Surgery Database perform esophagectomy with low morbidity and mortality. McKeown esophagectomy is an independent predictor of combined postoperative morbidity or mortality. Revised predictors for perioperative outcome were identified to facilitate quality improvement processes and hospital comparisons.
-
The stentless Freedom Solo aortic bioprosthesis is implanted supraannularly using one running suture line in the sinuses of Valsalva. We report our 9-year experience with this bioprosthesis. ⋯ Aortic valve replacement with the Freedom Solo is safe and has a low rate of permanent pacemaker implantations and prosthesis-patient mismatch. Survival is comparable to that with other aortic bioprostheses, and structural valve deterioration and aortic valve reoperation are infrequent during midterm follow-up. Hemodynamic performance is excellent, with low valvular gradients that remain stable during follow-up.