The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Aug 2008
Randomized Controlled Trial Comparative StudyEpicardial versus transvenous left ventricular lead placement in patients receiving cardiac resynchronization therapy: results from a randomized prospective study.
The aim of this prospective study was to determine the differences in left ventricular (LV) lead positioning for cardiac resynchronization therapy (CRT): comparing a percutaneous transvenous approach via the coronary sinus versus epimyocardial placement via a left lateral mini-thoracotomy. ⋯ Both epicardial and transvenous LV-lead placement for CRT therapy are safe and effective. The transvenous approach is less invasive and should be considered the standard procedure for patients without renal insufficiency. However, in a case of difficult coronary venous anatomy with the inability to position the lead as desired, epicardial LV-lead placement remains an alternative option.
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Thorac Cardiovasc Surg · Aug 2008
Comparative StudyTherapeutic optimization of atrioventricular delay in cardiosurgical ICU patients by noninvasive cardiac output measurements versus pulse contour analysis.
Optimizing atrioventricular (AV) delay improves cardiac output and postoperative outcome. Impedance cardiography (ICG) is a non-invasive method for CO measurement. This study evaluates the ability of two ICG methods to determine the optimal AV delay (OAVD) and to compare ICG with invasive PICCO measurements. ⋯ Inappropriate selection of AVD can compromise the hemodynamic situation of cardiosurgical patients. As it is totally noninvasive, ICG is a reliable and effective tool for tailoring AVD. Both systems (CI and EV) offer valid OAV determination.
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Thorac Cardiovasc Surg · Aug 2008
Clinical experience of Nuss procedure for pectus excavatum in adult female patients.
Pectus excavatum (PE) repair by Nuss procedure is well established in pediatrics, but studies of adult female patients are rare. We analyzed the efficacy of the Nuss procedure in adult, female PE patients. ⋯ The Nuss procedure offers a high satisfaction rate and an acceptable complication rate for PE repair in adult female patients. A subsequent surgery for breast augmentation can be considered after the Nuss repair has stabilized.
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Thorac Cardiovasc Surg · Jun 2008
Staple line covering procedure after thoracoscopic bullectomy for the management of primary spontaneous pneumothorax.
Thoracoscopic bullectomy together with a pleural adhesive procedure is generally accepted as the standard for the definitive treatment of primary spontaneous pneumothorax (PSP). The purpose of this study was to evaluate whether the results of a thoracoscopic bullectomy followed by coverage of the staple line with cellulose mesh and fibrin glue could be comparable with those of adhesive procedures described in the literature. ⋯ Given the nature of a meticulous thoracoscopic bullectomy followed by coverage with cellulose mesh and fibrin glue, good surgical results can be expected without the need for a pleural adhesive procedure.