European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 1997
Intraoperative radiofrequency microbipolar coagulation to replace incisions of maze III procedure for correcting atrial fibrillation in patients with rheumatic valvular disease.
Radiofrequency catheter ablation of atrial tachycardias and flutter is an established technique. The same modality in the microbipolar mode is effective in producing full thickness coagulation injury. Cox's maze procedure is highly successful in curing atrial fibrillation (AF) surgically. However, it consumes relatively long cross clamp time and cardiopulmonary bypass time. In this study, radiofrequency microbipolar coagulation was used as an adjunct to corrective valve surgery, as an intraoperative ablative modality to replace Cox's maze III incisions, thus remarkably shortening the procedure. The results of this procedure are compared historically with those of 26 patients who underwent corrective valve surgery alone. ⋯ Thus, our modification considerably shortened the time taken for creating the maze in comparison to the Cox's maze procedure and was effective in restoring normal sinus rhythm in 80% of the patients.
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Eur J Cardiothorac Surg · Sep 1997
Should the number of pulmonary metastases influence the surgical decision?
To assess, using a large homogeneous retrospective series, the prognostic value of the number of resected pulmonary metastases, and thus, to determine to what extent the number of resectable metastases should influence the surgical decision. ⋯ In patients with resectable pulmonary metastases from sarcoma or carcinoma, the number of metastases should have little influence on the surgical decision, except for delaying this decision in patients with several metastases until a significant interval, with or without treatment, has shown that metastatic disease remains resectable and confined to the lungs.
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Eur J Cardiothorac Surg · Sep 1997
Diagnostic and therapeutic video assisted thoracic surgery (VATS) following chest trauma.
Thoracic injury remains a major source of morbidity and mortality in urban trauma centers. With the advent and increasing expertise in video assisted thoracic surgery, this modality has become an attractive alternative in the management of patients with thoracic injury. This report will review our experience with video assisted thoracic surgery at a level I trauma center and attempt to further delineate the indications for and timing of thoracoscopy in thoracic trauma. ⋯ Video assisted thoracic surgery can be utilized as an effective and safe method for the initial diagnostic evaluation and surgical management of stable patients with penetrating thoracic trauma.
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Minimally invasive direct coronary artery bypass (MIDCAB) is a technique for coronary artery bypass grafting performed under direct vision without sternotomy or cardiopulmonary bypass. The approach has been used principally for primary single vessel grafting of the anterior or inferior coronary circulation. This initial experience presents a new lateral technique for patients with isolated circumflex coronary disease which can be used for both primary and reoperative revascularization with either saphenous vein or a free radial artery conduit. ⋯ Lateral MIDCAB grafting provides focused revascularization to the circumflex distribution in both primary and reoperative settings. This approach avoids the hazards of resternotomy, eliminates cardiopulmonary bypass, and hastens postoperative recovery. These early results suggest the technique is effective at relieving symptoms and minimizing perioperative morbidity. Further experience at multiple centers will serve to define the ultimate capabilities of this new approach.
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Eur J Cardiothorac Surg · Sep 1997
Left internal mammary elongation with inferior epigastric artery in minimally invasive coronary surgery.
Sometimes the left internal mammary artery (LIMA) is not long enough to reach a too lateral LAD when a left anterior small thoracotomy (LAST operation) is the surgical approach to graft the LAD. LIMA elongation with an inferior epigastric artery (IEA) can be an useful surgical option. ⋯ IEA elongation of LIMA is an alternative strategy to reach a lateral LAD in selected cases; a satisfying patency rate can be expected, when correct surgical indications are used.