European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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We wanted to evaluate the role of surgical and conservative therapy in the treatment of post-intubation tracheal rupture. ⋯ Early surgical repair is the preferred treatment for most patients with post-intubation tracheal ruptures. Conservative treatment may be a viable alternative for patients with small rents, in the absence of gross air leak, or for those judged unsuitable for surgery. The role of tracheostomy is limited by its potential for late sequelae.
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To assess the impact of the bidirectional cavopulmonary shunt, total cavopulmonary connection, and baffle fenestration on outcome of the Fontan operation in our unit. ⋯ The bidirectional cavopulmonary shunt is a suboptimal stimulus for pulmonary artery enlargement, but may reduce the risk of Fontan operation in selected children. Fenestrated lateral tunnel operations have reduced the duration of postoperative pleural effusions.
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Eur J Cardiothorac Surg · Jul 1997
Minimally invasive thoracoscopically assisted coronary artery bypass surgery.
Minimally invasive techniques have been widely used in other surgical fields including video-assisted thoracic surgery (VATS) in thoracic surgery. These concepts are now being applied to cardiac surgery. The opportunities to make cardiac surgery less invasive include elimination of the median sternotomy incision, elimination of cardiopulmonary bypass and no manipulation of the aorta. ⋯ The ability to perform an endoscopic anastomosis still remains the rate limiting step for totally endoscopic coronary artery bypass surgery. The present MIDCAB (minimally invasive direct coronary artery bypass grafting) procedure is a significant advance in cardiac surgery, but still has limitations that make performance of an exact anastomosis still somewhat difficult and applicable only to single-vessel disease. Present efforts are directed toward extending the MIDCAB procedure by various immobilization and circulatory support devices and combining the MIDCAB procedure with catheter techniques for treating more advanced disease.
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Eur J Cardiothorac Surg · Jun 1997
Randomized Controlled Trial Clinical TrialEvaluation of preoperative intra-aortic balloon pump support in high risk coronary patients.
The intra-aortic balloon pump (IABP) is an established additional support to pharmacological treatment of the failing heart after myocardial infarction, unstable angina and cardiac surgery. The effect of preoperative IABP in high risk patients was evaluated. ⋯ The use of preoperative IABP in high risk patients lowers hospital mortality and shortens the stay in ICU, due to improved cardiac performance, compared to a controls. The procedure was cost-beneficial. One day preoperative IABP treatment improves cardiac performance more than 1-2 h preoperative IABP treatment, but does not significantly affect the outcome in terms of hospital mortality or postoperative morbidity.
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Eur J Cardiothorac Surg · Jun 1997
Case ReportsSuccessful surgery for perforation of the thoracic aorta caused by the tip of an intra-aortic balloon pump.
We describe a case of perforation of the thoracic aorta caused by the tip of an intra-aortic balloon pump. The perforation was confirmed by computed tomography (CT) scan and immediate surgical repair was successful. Vascular injury due to the insertion of an intra-aortic balloon pump is quite common but is predominantly confined to limb ischemia or injury to the femoral or iliac artery. Iatrogenic aortic perforation leading to significant bleeding is much less common and usually fatal.