European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Dec 2004
Long-term outcome of lung transplantation for cystic fibrosis--Danish results.
Over the last decades improvements in medical therapies have delayed the progression of lung disease in cystic fibrosis (CF). However, lung disease is still the most common cause of premature death, and lung transplantation today is the only treatment for end-stage lung disease in patients with CF. We present a retrospective review of the outcome of CF patients transplanted in Denmark since start of the national lung transplantation programme in 1992. ⋯ Lung transplantation is a well-established life-extending treatment for patients with CF and end-stage lung disease. The operative mortality is low and CF patients have a significant early survival benefit after lung transplantation. Satisfying long-term results can be achieved in this young and severely ill group of patients.
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Eur J Cardiothorac Surg · Dec 2004
Resection of chest wall invasion in patients with non-small cell lung cancer.
The treatment of patients with non-small cell lung cancer invading the parietal pleura or chest wall is still debated. It is unsolved whether the depth of chest wall involvement or the type of resection (extrapleural or en bloc) affects long-term survival. ⋯ Survival of patients with lung cancer invading the chest wall or parietal pleura after resection is highly dependent on the completeness of resection and the extent of nodal involvement, but not so much on the depth of chest wall invasion or type of resection.
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Tradition and experience of cardiopulmonary bypass in the hand of cardiac surgeons Led to several spin-offs of this extracorporeal technique. Acute organ support is realized for situations of failing cardiac output, circulatory arrest respectively, of pulmonary failure and of drowning. Extracorporeal circulation is a promising adjunct to aim in better surgical technique and treatment in neurosurgery, thoracic aortic surgery, complex Lung resection, tumor surgery and procedures where safe organ perfusion must be ascertained. ⋯ Replacement of Long lasting periods of chest compression for heart massage is a future perspective if circulation is maintained by transcutaneously adapted miniaturized heart-lung-machine. Long lasting traumatizing mechanical ventilation of a severely diseased lung maybe replaced by extracorporeal lung assistance to give better chances for the lung to recover. Thoughts for these new interdisciplinary duties of cardio surgical units were discussed in the committee for the Symposium for the Future of Cardiac Surgery.
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In highly developed nations, valve surgery will be increasing applied in older people, with more co-morbidities and a higher incidence of concomitant coronary artery disease. Valve surgeons will be facing increased competition from the catheter-based procedures, both for valve repair and replacement; these are already applied clinically, and their numbers will rise in near future. Early mortality in double valve procedures and in combined CABG and valve operations remains substantial, and there is ample room for improvement of surgical results. ⋯ Tissue-engineered valves are being developed, but are not ready for larger clinical trials. Cardiac surgery is undergoing a rapid transformation; radical changes both in scope and workload of cardiosurgical units in Europe can be expected in near future. Socio-economic factors and recent advances in medical technology contribute to these changes.
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Eur J Cardiothorac Surg · Dec 2004
Long-term follow-up of total arterial myocardial revascularization using exclusively pedicle bilateral internal thoracic artery and right gastroepiploic artery.
In order to reduce remote cardiac events associated with graft occlusions, arterial conduits are being increasingly utilized in coronary artery bypass grafting (CABG). While the internal thoracic artery (ITA) is the graft of choice for CABG, it is sometimes difficult or impossible to obtain a complete arterial revascularization only with ITAs in three-vessel diseases. We present our experience with total arterial myocardial revascularization with bilateral internal thoracic artery (BITA) and right gastroepiploic artery (rGEA). ⋯ This study indicates that the myocardial revascularization in young patients with three-vessel disease using exclusively pedicle BITA and rGEA provides excellent 9-year patient survival and improvement in terms of freedom from return of angina pectoris and freedom from any cardiac-related event. These results encourage the more extensive use of BITA and rGEA in selected patients with three-vessel coronary disease.