European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Sep 2006
Mechanical versus bioprosthetic valve replacement in middle-aged patients.
The current trend towards decreasing the age for selection of a tissue over a mechanical prosthesis has led to a dilemma for patients aged 50-65 years. This cohort study examines the long-term outcomes of mechanical versus bioprosthetic valves in middle-aged patients. ⋯ In middle-aged patients, MAPE may occur more often in patients with bioprosthetic valves, but definitive conclusions necessitate the accumulation of additional follow-up. At present, these data do not support lowering the usual cutoff for implantation of a tissue valve below the age of 65.
-
Eur J Cardiothorac Surg · Sep 2006
Complete stable remission after extended transsternal thymectomy in myasthenia gravis.
This study sought to determine the efficacy and prognostic factors of extended transsternal thymectomy as a treatment for myasthenia gravis (MG). ⋯ Extended transsternal thymectomy is a good treatment tool to achieve CSR in MG. Thymomatous MG and non-thymomatous MG were significantly different in patient characteristics and prognosis. Prognostic factors were steroid therapy and age of onset in non-thymomatous MG, and steroid therapy in thymomatous MG.
-
Eur J Cardiothorac Surg · Sep 2006
The spread of metastatic lymph nodes to the mediastinum from left upper lobe cancer: results of superior mediastinal nodal dissection through a median sternotomy.
This study endeavored to clarify the location, frequency, and prognostic value of metastatic lymph nodes in the mediastinum among patients with left upper lung cancer who underwent complete dissection of the superior mediastinal lymph node through a median sternotomy. ⋯ The aortic lymph node is the most common site of metastasis from left upper lobe cancer. Multivariate analysis demonstrated that aortic nodal involvement was a significant predictive factor for ESMD metastasis. Based upon the rates of metastasis and the post-operative prognosis in our study patients, dissection of aortic nodes and left tracheobronchial nodes may be important for patients with left upper lobe cancer. Whether ESMD dissection has a beneficial effect on prognosis remains controversial.
-
Eur J Cardiothorac Surg · Sep 2006
Hypothermic circulatory arrest with moderate, deep or profound hypothermic selective antegrade cerebral perfusion: which temperature provides best brain protection?
Selective antegrade cerebral perfusion (SACP) seems to be associated with a better outcome compared to hypothermic circulatory arrest (HCA) alone. This study was undertaken to evaluate the influence of different SACP temperatures on the neurological integrity. ⋯ In this model, SACP is superior to HCA alone. Regarding the optimal temperature for SACP, it seems that 20 degrees C provides adequate brain protection in comparison to the potential detrimental effects of moderate (30 degrees C) and profound (10 degrees C) temperatures.
-
Eur J Cardiothorac Surg · Sep 2006
Video-assisted thoracic surgery utilizing local anesthesia and sedation.
Video-assisted thoracic surgery (VATS) is usually performed with general anesthesia and double-lumen endotracheal intubation, but minor procedures have been carried out with patients spontaneously breathing and with epidural or regional analgesia. We have broadened our indications for VATS utilizing purely local anesthesia and sedation. ⋯ VATS utilizing local anesthesia and sedation is well tolerated, safe, and valuable for an increasing number of indications.