European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Sep 2013
Review Meta AnalysisIs video-assisted thoracic surgery lobectomy better than thoracotomy for early-stage non-small-cell lung cancer? A systematic review and meta-analysis.
The study aimed to compare the reported oncological outcomes based on satisfactory lymph node dissection (LND) or lymph node sampling (LNS), systemic and loco-regional recurrence rate and long-term survival rate of patients with early-stage non-small-cell lung cancer (NSCLC) who underwent video-assisted thoracic surgery (VATS) lobectomy or thoracotomy lobectomy. A systematic review was conducted using PubMed, EMBASE and OVID-EBMR databases ranging from 1990 to 2011. The studies compared VATS and thoracotomy for patients with NSCLC, with results including LND or LNS where recurrence as well as survival rates were identified. ⋯ Systemic (RR: 0.61; 95% CI: 0.48 to 0.78; P < 0.01) and loco-regional (RR: 0.66; 95% CI: 0.46 to 0.95; P = 0.03) recurrence rates were significantly lower in the VATS group. Moreover, a significantly higher survival rate (RR: 1.09; 95% CI: 1.03 to 1.15; P < 0.01) was also demonstrated by a Forest plot in the VATS group. These results suggest that VATS lobectomy might be an eligible alternative in place of thoracotomy in patients with early-stage NSCLC by reducing recurrence and improving survival rates.
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Eur J Cardiothorac Surg · Sep 2013
Acute lung injury after mechanical circulatory support implantation in patients on extracorporeal life support: an unrecognized problem.
We observed early acute lung injury (ALI) after a switch from veno-arterial extracorporeal life support (VA-ECLS) to long-term mechanical circulatory support (MCS). The aim of our study was to analyse the frequency, impact on mortality and characteristics of patients presenting ALI after MCS implantation in the bridge-to-bridge (BTB) strategy. ⋯ Implantation of a long-term MCS device in patients on ECLS can result in severe ALI, which is associated with ominous outcomes. Various preimplant risk factors for ALI have been identified and might allow devising strategies to prevent this complication.
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Eur J Cardiothorac Surg · Sep 2013
Prognostic impact and initial recurrence site of lymphovascular and visceral pleural invasion in surgically resected stage I non-small-cell lung carcinoma.
This study aimed to analyse and validate the prognostic impact and effect of the initial recurrence site of lymphovascular and visceral pleural invasion (VPI) on survival outcomes for Stage I non-small-cell lung carcinoma (NSCLC). ⋯ We propose that LVI and/or VPI may be a candidate marker to determine adjuvant therapy or a more careful follow-up for these patients.
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Eur J Cardiothorac Surg · Sep 2013
Severe intraprocedural complications after transcatheter aortic valve implantation: calling for a heart team approach.
Transcatheter aortic valve implantation (TAVI) has emerged rapidly. Despite unanimous recommendations and potentially fatal intraoperative complications, the heart-team approach is not comprehensively adopted by all centres. We sought to characterize severe intraprocedural complications during TAVI requiring immediate surgical or interventional bailout manoeuvres and evaluate outcomes. ⋯ An interdisciplinary approach to TAVI facilitated bailout procedures accomplishing acceptable outcomes, despite severe intraprocedural complications. These bailout manoeuvres in potentially fatal complications were only accomplished through an interdisciplinary heart-team effort, creating a surgical and interventional safety net, which should be established in all centres performing TAVI procedures.