European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jun 2011
Efficacy of anterior fissureless technique for right upper lobectomies: a case-matched analysis.
In pulmonary lobectomy, the dissection through the fissure to gain access to the pulmonary artery may increase the risk of postoperative air leak. For several anatomic reasons, this risk is especially high after right upper lobectomies (RULs). The objective of this investigation was to verify the efficacy of an anterior fissureless lobectomy (FL) technique in reducing the incidence and duration of air leak after RUL. ⋯ The use of an anterior fissureless technique during RUL reduced the duration of air leak and hospital costs without increasing the surgical time. Given its simplicity and efficacy, we regard it as a useful tool for implementing fast-tracking policies and cutting hospital costs.
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Operating in a day surgery unit has potential benefits, including lower risk of cancellation, reduced infection rates, cost effectiveness and increased patient satisfaction. We believe that we are the first unit in the UK to regularly perform thoracic surgery in a dedicated day surgery unit, and describe our experience to date. ⋯ Surgeons are continually trying to fast track increasingly complex procedures and, with good patient selection, thoracic surgery can be performed safely and effectively in day surgery units.
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Eur J Cardiothorac Surg · Jun 2011
Alternative approaches for trans-catheter self-expanding aortic bioprosthetic valves implantation: single-center experience.
Trans-catheter aortic valve implantation has emerged and rapidly gained credibility as a valuable alternative to treat patients with severe aortic stenosis and no surgical option; however, these patients are often affected also by severe iliac-femoral arteriopathy, rendering the transfemoral approach unemployable. From May 2008, 92 patients with severe, symptomatic aortic stenosis and no reasonable surgical option because of excessive risk underwent trans-catheter aortic valve implantation at our center. Eighty patients (34 male) with mean age 82 ± 8 years were eligible for CoreValve percutaneous femoral implantation. Twelve patients, mean age 81 ± 8 years, were excluded from percutaneous femoral CoreValve implantation because of iliac-femoral arteriopathy. ⋯ Trans-catheter aortic valve implantation with surgical subclavian or direct aortic approach seems safe and feasible, offering a new attractive option to treat selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, and has emerged as a valuable alternative route to trans-apical procedures.
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Eur J Cardiothorac Surg · Jun 2011
Omni-Stat (Chitosan) arrests bleeding in heparinised subjects in vivo: an experimental study in a model of major peripheral vascular injury.
To explore the effectiveness of Omni-Stat (Chitosan) in a model of major haemorrhage in the presence of clotting dysfunction. ⋯ The study supports the evidence that Omni-Stat (Chitosan) acts independently of classical clotting pathways and should be effective in patients with clotting dysfunctions, who suffer major haemorrhage. It also suggests the potential for a role in cardiac surgery.
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Eur J Cardiothorac Surg · May 2011
Predictors of postoperative decline in quality of life after major lung resections.
Severe impairment in quality of life (QoL) is one of the major patients' fears about lung surgery. Its prediction can be valuable information for both patients and physicians. The objective of this study was to identify predictors of clinically relevant decline of the physical and emotional components of QoL after lung resection. ⋯ A consistent proportion of patients undergoing lung resection exhibit an important postoperative worsening in their QoL. We were able to identify reliable risk factors and predictive equations estimating this decline. These findings may be used as selection criteria for efficacy trials on perioperative physical rehabilitation or psychological treatments, during preoperative counseling, in the surgical decision-making process and for selecting those patients who would benefit from physical and emotional supportive programs.