European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · May 2015
Two-year follow-up for 45 patients with achalasia who underwent peroral endoscopic myotomy.
Achalasia is an oesophageal disorder characterized by abnormalities of peristalsis and impaired swallowing-induced relaxation. The therapeutic approach at present remains palliative. Peroral endoscopic myotomy (POEM) is thought to be less invasive and to maintain the function of the lower oesophageal sphincter postoperatively. However, the effects of POEM still need to be evaluated and understood. ⋯ Peroral endoscopic myotomy provides definite relief of symptoms in these patients with achalasia and offers them long-term therapeutic benefit. Considering the risks of surgery, we believe that POEM is a better choice than surgery for achalasia patients and carries lower risk. However, our study is a preliminary exploration; therefore, larger-scale studies are needed for further research on POEM.
-
Eur J Cardiothorac Surg · May 2015
Case ReportsHybrid stenting therapy for dysphagia aortica with Rokitansky's diverticulum concomitant with thoracic aortic aneurysm.
An 87-year old man with a past medical history of a descending aortic aneurysm for 20 years presented with progressive dysphagia and aspiration pneumonia. Computed tomography angiography demonstrated the impending rupture of the thoracic aortic aneurysm (TAA) and endoscopic examinations revealed the extrinsic compression of the middle oesophagus with Rokitansky's diverticulum proximal to the compression area. ⋯ The patient's symptoms immediately improved, and the postoperative period was uneventful. This report is the first to describe a hybrid stenting therapy for dysphagia aortica with Rokitansky's diverticulum concomitant with a TAA.
-
Eur J Cardiothorac Surg · May 2015
Incidence and outcome of re-entry injury in redo cardiac surgery: benefits of preoperative planning.
Repeat sternotomy for redo cardiac surgery may be associated with catastrophic injuries to mediastinal structures. The purpose of this study was to determine the frequency of these injuries, associated outcome and if a preoperative computerized tomography (CT) scan reduces the risk of re-entry injury. ⋯ The incidence of re-entry injury during repeat sternotomy is low; however, it is associated with a significant increase in the risk of in-hospital mortality. Preoperative planning using CT scan reduces the risk by identifying adherent structures, and, in selected patients, establishing CPB prior to sternotomy is a safe strategy in redo cardiac surgery.
-
Eur J Cardiothorac Surg · May 2015
Prevalence, clinical characteristics and outcomes of high-risk patients treated for severe aortic stenosis prior to and after transcatheter aortic valve implantation availability.
Transcatheter aortic valve implantation (TAVI) has emerged as an effective treatment for high-risk patients with severe aortic stenosis (AS). The aim of our study was to compare the prevalence, characteristics and outcomes of high-risk patients treated prior to and after the availability of TAVI in our high-volume surgical institution. ⋯ The availability of TAVI has increased the prevalence of high-risk patients treated for severe AS and changed the clinical features of this kind of patients who were rarely surgically treated before. The 1-year survival was similar between pre-TAVI and modern eras.