Seminars in thoracic and cardiovascular surgery
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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
Beating heart surgery with pulmonary perfusion and ventilation during cardiopulmonary bypass: target organs' perfusion without plegia.
Myocardial and pulmonary ischemia during cardiopulmonary bypass (CPB) is associated with cardiac and pulmonary dysfunction that may result in poor outcomes after cardiac surgery. Beating heart surgery and continuous pulmonary perfusion and ventilation represent emerging strategies targeting the cardiopulmonary bypass-induced ischemia and ischemia-reperfusion injury in susceptible organs--heart and lungs.
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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
Cerebral protection for aortic arch surgery: deep hypothermia.
The technical aspects of arch surgery have evolved considerably during the last 2 decades. The use of deep hypothermic circulatory arrest has been embraced by many cardiac surgeons to approach aortic arch aneurysms around the world. The branched graft technique that we have been using since the late 1990s has improved surgical outcomes and simplified the treatment considerably. We describe our technique of total arch replacement by using deep hypothermia and selective cerebral perfusion in aortic arch surgery.
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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.