The Annals of thoracic surgery
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Comparative Study
Anterolateral thoracotomy as an alternative to repeat median sternotomy for replacement of the mitral valve.
Median sternotomy is the most common approach for repeat cardiac surgery despite the potential complications of cardiac injury. Right anterolateral thoracotomy has been recommended as an alternative for patients undergoing mitral valve replacement, but data supporting one approach over the other do not exist. ⋯ Significant differences between the two groups, favoring right anterolateral thoracotomy, were apparent when comparisons were made for length of perfusion (means, 94.8 min, thoracotomy group; 121.4 min, sternotomy group; p = .03), incidence of reexploration (0%, thoracotomy group; 13%, sternotomy group; p = .001), and blood transfusion (means, 5.3 units, thoracotomy group; 11.4 units, sternotomy group; p = .003). Right anterolateral thoracotomy is an effective alternative to repeat median sternotomy for replacement of the mitral valve in patients who have had a previous median sternotomy.
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Three patients with postpneumonectomy bronchopleural fistula were treated with endoscopic gluing of the fistula. The technique and the results of this method are described.
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Laryngotracheal trauma can be an immediately life-threatening injury. Failure to recognize such injuries and promptly secure an airway may have fatal consequences. Failure to recognize acute injuries or to observe the principles of management can lead to laryngotracheal stenosis. ⋯ Concomitant esophageal injury was repaired in 4 patients. Eight patients required intralaryngeal procedures prior to repair of the laryngotracheal stenosis. All patients except 1 have a good airway, and 16 of the 17 have a good voice.
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The consequences of controlled ventilation with positive end-expiratory pressure (PEEP) were studied, after cardiac surgical procedures, in two groups of patients supposed to have different lung and chest wall mechanical properties. The first group included 6 patients who had undergone coronary artery graft surgical procedures (CGS). The second group included 5 patients who had undergone a mitral valve replacement (MVR). ⋯ The decrease in cardiac output induced by PEEP was similar in the two groups. The results suggest that the opposing influences of lung and chest wall compliance on airway pressure transmission could at least partly explain the hemodynamic effects of PEEP in patients in whom the mechanical properties of the lung and thorax are impaired. PEEP ventilation should be used cautiously in patients suspected of having thoracic rigidity.