Journal of cardiac surgery
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Renal cell carcinoma (RCC) is a commonly encountered malignancy in urology. Extensive RCC may frequently invade the renal vein and the inferior vena cava (IVC). ⋯ Current techniques for resection of supradiaphragmatic RCC tumor thrombus in the IVC incorporate cardiopulmonary bypass (CBP) with deep hypothermic circulatory arrest, especially in cases where the thrombus reaches the right atrium. We report a safe technique using a transabdominal approach to such lesions that allows exposure to the level of the intrapericardial IVC and right atrium permitting safe resection of the tumor thrombus without median sternotomy, CBP, or deep hypothermic circulatory arrest.
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Early tracheostomy may increase the risk of mediastinitis after median sternotomy. Patients who had postoperative tracheostomy after cardiac surgery in the period 2000-2005 were retrospectively analyzed (total: 5095 patients) to evaluate the incidence of mediastinitis and sternal wound infections. Fifty-seven cases (1.1% of all operated patients) had postoperative tracheostomy at an average 5.6 +/- 0.7 days postoperatively. ⋯ The bacterial strains isolated from subcutaneous infection were qualitatively and quantitatively different from those isolated from bronchial secretions. We conclude that in this study there is no demonstrable link between early tracheostomy after sternotomy and mediastinitis. Early tracheostomy should not be denied due to concerns of increasing the risk of mediastinitis.
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Case Reports
Endovascular stent: grafting in penetrating atherosclerotic ulcer of the thoracic aorta.
The aim of our study is the presentation of some interesting images of a case with symptomatic penetrating atherosclerotic ulcer (PAU) of the thoracic aorta and its endovascular treatment. Penetrating atherosclerotic ulcer is an ulcerating atherosclerotic lesion that penetrates the elastic lamina and is correlated with intramural hematoma (IMH) formation into the media layer of the aortic wall. ⋯ Surgical treatment may become necessary in cases involving the ascending aorta or in cases of intramural haematoma formation. In the era of minimally invasive surgery stent-grafting is indicated mainly in the elderly patients in presence of serious co-morbidities.
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Revascularization of the subclavian artery during complex arch surgeries may be challenging. Options include ligation of the subclavian artery with or without in situ revascularization. ⋯ Furthermore, an aberrant subclavian artery also obviates in situ revascularization through a sternal approach. We herein report our experience with the use of an extra-anatomical bypass to revascularize the subclavian artery in these circumstances.