Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Multicenter StudyThe role of papillary muscle relocation in ischemic mitral valve regurgitation.
Aim of our study was to compare the results of combined approach papillary muscles relocation (PPMr) + mitral annuloplasty (MA) vs only restrictive annuloplasty (RA) in ischemic mitral regurgitation, guided by 3-dimensional (3D) echocardiography. Sixty-nine patients with severe ischemic mitral regurgitation who had PPMr + MA and coronary artery bypass grafting were matched 1:1 with patients who underwent isolated RA and coronary artery bypass grafting. A comprehensive pre- and postoperatory 2-dimensional and 3D transesophageal echocardiographic examination followed by a 3D offline assessment of the mitral valve apparatus was performed. ⋯ Recurrent mitral regurgitation equal to or greater than moderate occurred in 2 (2.8%) and 8 (11.5%) in PPMr + MA group and RA group, respectively (P < 0.02). The PPMr promoted a significant reversal in left ventricle remodeling compared with the isolated RA. PPMr + MA reduce the tenting area and the coaptation depth with respect to RA, with less incidence of recurrent mitral regurgitation.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Historical ArticleRigid plate fixation promotes better bone healing after sternotomy.
Sternotomy is the most common surgically created osteotomy in surgery. Rigid fixation of osteotomies are important for stability and bony union. This review shows the superiority of rigid plate fixation in achieving better bone healing after sternotomy. It also highlights use of plate fixation for mini-sternotomies and rib fractures.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Extrapleural catheters: an effective alternative for treating postoperative pain for thoracic surgical patients.
Pain control is an important aspect of video-assisted thoracoscopic surgery (VATS) procedures. Offering an effective and low-risk method of postoperative pain control is thus vital to a patient's recovery. Hotta and colleagues report the results of a clinical study comparing efficacy of epidurals vs extrapleural catheters in VATS procedures. They found that extrapleural catheters provided equivalent postoperative pain relief when compared to thoracic epidural catheters.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Thoracoscopic mediastinal lymph node dissection for lung cancer.
Mediastinal lymph node staging is an important component of the assessment and management of patients with operable non-small cell lung cancer and is necessary to achieve complete resection. During minimally invasive surgery, performance of an equivalent oncologic resection, including adequate lymph node dissection similar in extent to open thoracotomy, is absolutely necessary. ⋯ In our series, we removed about 25 lymph nodes per case in both complete VATS and R-VATS. A thorough lymph node dissection in lung cancer is possible with either VATS or R-VATS technique without oncological compromise.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Nighttime intensivist staffing: is there evidence for a need?
Postoperative critical care provided by critical care specialists, or intensivists, improves outcomes after surgery. Although there are data supporting daytime intensivist coverage in the intensive care unit, it is not clear how nighttime specialist coverage impacts the quality of care or outcomes. Many surgical intensive care units have adopted continuous 24-hour critical care coverage. Here, we highlight an important study by Wallace and colleagues that reports the impact of nighttime intensivist staffing on outcomes in critically ill patients.