Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jul 2000
The thoratec ventricular assist device: a paracorporeal pump for treating acute and chronic heart failure.
The Thoratec Ventricular Assist Device (VAD) System (Thoratec Laboratories, Pleasanton, CA) is a paracorporeal pump that can provide univentricular or biventricular assistance for patients with heart failure. The system consists of a prosthetic ventricle that has a blood-pumping chamber of Thoralon (Thoratec Laboratories) polyurethane, cannulas for univentricular or biventricular support, and either a hospital-based pneumatic drive console or a portable battery-powered drive unit. For biventricular assistance, 2 pumps are used. ⋯ Patient mobility is being improved by the use of a portable driver. The Thoratec VAD is suitable for a wide range of applications, and efforts are underway to facilitate patient mobility and allow hospital discharge. An intracorporeal version of the VAD, which is currently under development, will help achieve these goals.
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Semin. Thorac. Cardiovasc. Surg. · Jul 2000
ReviewMinimally invasive approaches to antireflux surgery.
Gastroesophageal reflux disease is one of the most common disorders affecting western civilization. Historically, surgical antireflux therapy was reserved for patients who had failed medical therapy, typically in the presence of refractory ulcers or difficult-to-manage strictures. More recently, with improvements in acid control, these acid-pepsin-related complications of reflux have been replaced by the malignant complications of reflux disease, with emphasis now on total control of reflux. ⋯ This article summarizes the recommended diagnostic evaluation of patients with reflux symptoms and the current indications for antireflux surgery. The techniques of commonly performed minimally invasive antireflux procedures are described along with a review of the results to be expected. Future prospects for improving the management of reflux are discussed; these include recently described nonsurgical methods for restoring competency to the lower esophageal sphincter.
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Semin. Thorac. Cardiovasc. Surg. · Jul 2000
ReviewMinimally invasive approaches to acquired shortening of the esophagus: laparoscopic Collis-Nissen gastroplasty.
Acquired shortening of the esophagus remains a controversial finding. In some surgical series of patients with gastroesophageal reflux disease, the incidence of clinically significant shortening is low enough that some surgeons have questioned its existence. In the setting of massive hiatial hernia, esophageal shortening has been reported to occur in up to 100% of patients. ⋯ Failure to recognize this shortening may be responsible for a high failure rate after antireflux surgery. Open Collis gastroplasty is an effective way to manage acquired shortening of the esophagus, and it creates a tension-free intra-abdominal segment of neoesophagus for fundoplication. Minimally invasive approaches to Collis-Nissen procedures have been reported by our group and several others with good short-term results.
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Semin. Thorac. Cardiovasc. Surg. · Jul 2000
Review Historical ArticleMechanical cardiac assistance: historical perspectives.
Cardiac transplantation remains the therapeutic option of choice for treating patients with chronic, progressive, end-stage heart failure. However, over the past 40 years, a number of mechanical assist systems have been developed with the goal of treating and rehabilitating patients with severe circulatory compromise. Today, a wide array of devices is available to provide increasing levels of circulatory support. ⋯ Already, clinical trials are underway to test the effectiveness of left ventricular assist devices as long-term support. As smaller, more effective cardiac assist devices become available, they should benefit even more the number of patients who may need permanent circulatory support. The fact that myocardial function can improve enough with chronic ventricular unloading to allow removal of the device may further broaden the use of this technology.