European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Feb 2014
Case ReportsTransplantation of lungs after ex vivo reconditioning in a patient on semi-elective long-term veno-arterial extracorporeal life support.
We present the case of a 41-year old patient suffering from end-stage pulmonary hypertension secondary to veno-occlusive disease who underwent implantation of a veno-arterial extracorporeal membrane oxygenator as a bridge to lung transplantation (LTx) due to significant deterioration of myocardial pump and liver function. After 33 days on support, lungs with extended donor criteria were offered. Owing to the deteriorating clinical condition of the patient, the lungs were assessed using our ex vivo lung perfusion system. After reconditioning of the graft, a bilateral LTx was performed.
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Eur J Cardiothorac Surg · Feb 2014
Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day.
In fast-track pulmonary resections, we removed chest tubes after video-assisted thoracic surgery (VATS) lobectomy with serous fluid production up to 500 ml/day. Subsequently, we evaluated the frequency of recurrent pleural effusions requiring reintervention. ⋯ Our findings suggest that chest tube removal after VATS lobectomy is safe despite volumes of serous fluid production up to 500 ml/day. The proportion of patients who developed pleural effusion necessitating reintervention was low (2.8%), and a complication of the reintervention was seen in only 1 patient.
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Eur J Cardiothorac Surg · Feb 2014
Predictors and consequences of postoperative atrial fibrillation following robotic totally endoscopic coronary bypass surgery.
Postoperative atrial fibrillation (AFib) is common in patients undergoing coronary artery bypass grafting. Little information is available concerning AFib following minimally invasive cardiac surgery. The aim of our study was to assess the incidence of AFib after totally endoscopic coronary artery bypass (TECAB) grafting and to investigate the factors influencing its occurrence. ⋯ We conclude that the incidence of postoperative AFib in TECAB is relatively low. Age and body weight are the most important predictors of postoperative AFib following TECAB. Short-term clinical outcome and intermediate-term survival are similar in patients with and without postoperative AFib.
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Eur J Cardiothorac Surg · Feb 2014
The efficacy and short-term results of hybrid thoracic endovascular repair into the ascending aorta for aortic arch pathologies.
Conventional total aortic arch repair is a high-risk procedure, particularly for high-risk patients. Although endovascular treatment of aortic arch aneurysm is a recently induced procedure, only a few cases are indicated and outcomes are questionable. Here, we report on the early and short-term results of our surgical procedure, i.e. hybrid arch repair with supra-aortic debranching and endografting into the ascending aorta. ⋯ We achieved satisfactory early and short-term results with hybrid arch repair into the ascending aorta. Our findings suggest that hybrid repair into the ascending aorta may be a viable option for high-risk patients with aortic arch pathologies.
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Eur J Cardiothorac Surg · Feb 2014
Total aortic arch replacement with the elephant trunk technique: single-centre 30-year results.
The combined disease of the aortic arch and the descending aorta (aneurysms and dissection) remains a surgical challenge. Various approaches have been used to treat this complex pathology. In the two-stage operation, at the first-stage operation, the aortic arch is replaced through a median sternotomy. Later, at the second-stage operation, the descending thoracic aorta is replaced through a lateral thoracotomy. The elephant trunk (ET) technique was introduced by H.G. Borst at our centre in March 1982, greatly simplifying the second-phase operation. We present our 30-year experience. ⋯ The ET technique has greatly facilitated the two-stage approach to the surgical treatment of combined diseases of the aortic arch and descending aorta. The initial learning curve, acute dissections, re-do and concomitant procedures partially explain the higher mortality rate. Despite the development of new hybrid techniques, there is still a role for the classical ET in selected patients, particularly in the context of proven long-term results and cost effectiveness.