European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Mar 2011
Case ReportsCoronary stenting for iatrogenic stenosis of the left main coronary artery post-aortic valve replacement: an alternative treatment?
Iatrogenic coronary ostial stenosis after aortic valve replacement is a rare, life-threatening complication, which may follow implantation of either a mechanical or a biological prosthesis. Historically, this condition has been treated by urgent coronary bypass surgery but is associated with high morbidity and mortality, due to the hazards of early repeat sternotomy. We report a case of iatrogenic coronary ostial stenosis successfully treated with stenting and discuss the advantages of percutaneous intervention over coronary bypass surgery.
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Eur J Cardiothorac Surg · Mar 2011
Bronchoscopic lung volume reduction as a bridge to lung transplantation in patients with chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is the leading indication for lung transplantation; however, these patients rarely gain priority on the waiting list until very late. The clinical status can be improved by surgical lung volume reduction; this procedure, although carries significant morbidity, has been repeatedly advocated as a bridge. Recently, bronchoscopic lung volume reduction (BLVR) has been proposed to improve functional parameters in patients with emphysema; however, it has never been reported as a bridge to lung transplantation so far. ⋯ BLVR allowed to improve the functional status and quality of life of these patients. In a selected group of COPD patients awaiting lung transplantation, the reported short- to medium-term objective improvement may play an important role to ameliorate the clinical status and reach the time of surgery.
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Eur J Cardiothorac Surg · Mar 2011
ReviewTraining and assessment of technical skills and competency in cardiac surgery.
The assessment of surgical competency has become a priority for both surgical educators and licensing boards. Surgical educators must incorporate rigorous, reliable, and valid means of assessment into residency programs. Objective evaluation of technical skills has been extensively explored in various surgical specialties, but its role in cardiac surgery has not been well studied and there is limited experience with integration into the educational curricula. ⋯ Most of the available models have not been well validated or integrated into educational curricula. The cardiac surgery simulation tools in development need validation and incorporation into structured, competency-based training curricula. The ongoing development of surgical simulators and educational curricula will enable a transition from the century-old graded responsibility training program to a competency-based program, where trainees must demonstrate technical competence to progress to the next level of training and gain certification and re-certification--ultimately ensuring better and faster technical skill acquisition as well as improved quality of care and patient safety.
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Eur J Cardiothorac Surg · Mar 2011
Use of donors who have suffered cardiopulmonary arrest and resuscitation in lung transplantation.
Shortage of donors is one of the major limitations in lung transplantation (LuTX) and an aggressive expansion of criteria for donor selection has been proposed. This study evaluates the outcome of recipients of pulmonary grafts coming from resuscitated donors when compared with recipients of non-resuscitated donors. ⋯ This study indicates that transplantation of lungs from resuscitated donors may not affect outcome after LuTX. Therefore, donor history of CA should not automatically preclude LuTX.