Seminars in thoracic and cardiovascular surgery
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2015
Comparative StudyElevated Stroke Risk Associated With Femoral Artery Cannulation During Mitral Valve Surgery.
Minimally invasive mitral valve (MV) surgery, often requiring femoral artery (FA) cannulation, is increasingly being adopted. There is concern about increased stroke rates associated with minimally invasive MV surgery. This study aims to examine whether FA cannulation is independently associated with increased stroke rates in minimally invasive MV procedures. ⋯ In conclusion, FA cannulation may be associated with increased stroke rates in isolated MV surgery. Antegrade arterial cannulation (direct aortic or axillary cannulation) may be preferable in minimally invasive MV procedures. Randomized trial data are needed.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2015
ReviewMinimally Invasive Valve Surgery: When Less Is More.
Sternotomy has been the gold standard in cardiac surgery and generally provides and unobstructed view of the heart. However, expertise in this traditional method may no longer suffice for the professional survival of cardiac surgeons, We must consider minimally invasive approaches to treating diseases of the heart. As such, the focus of this article will be on the past, present, and future of mini-valve surgery.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2015
Preoperative Determinants of Outcomes of Infant Heart Surgery in a Limited-Resource Setting.
We studied the effect of preoperative determinants on early outcomes of 1028 consecutive infant heart operations in a limited-resource setting. Comprehensive data on pediatric heart surgery (January 2010-December 2012) were collected prospectively. Outcome measures included in-hospital mortality, prolonged ventilation (>48 hours), and bloodstream infection (BSI) after surgery. ⋯ Although severe failure to thrive was common, it did not adversely affect outcomes. In conclusions, preoperative BSI, preoperative intensive care, and mechanical ventilation are strongly associated with adverse outcomes after infant cardiac surgery in this large single-center experience from a developing country. Failure to thrive and low birth weight do not appear to adversely affect surgical outcomes.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2015
Unsatisfactory Early and Late Outcomes After Fontan Surgery Delayed to Adolescence and Adulthood.
The ideal age to perform the Fontan procedure is still unknown. The aim of this study is to determine outcomes after Fontan surgery delayed to adolescence and adulthood in Australia and New Zealand. Patients who had undergone a Fontan procedure at 15 years of age or older were identified in the 1133 patients registered in the Australia and New Zealand Fontan Registry until December 2012. ⋯ Freedom from all adverse events at 10 years was 30% (95% CI: 16-45). Outcomes of the Fontan procedure in adolescents and adults are poor, with disproportionately high hospital mortality and late adverse events. The Fontan procedure should not be delayed to adolescence and adulthood and should be performed electively in childhood.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2015
Comparative StudyThe 3-Hole Minimally Invasive Esophagectomy: A Safe Procedure Following Neoadjuvant Chemotherapy and Radiation.
Induction therapy followed by esophagectomy has become standard for treatment of intermediate-stage esophageal cancer in many centers. Herein we evaluate the feasibility and safety of the 3-hole minimally invasive esophagectomy (3HMIE) approach in patients who received induction radiation and chemotherapy. Between 2003 and 2012, the records of 119 consecutive patients with esophageal cancer who underwent 3HMIE were reviewed for perioperative complications and long-term outcomes. ⋯ No conduit necrosis or need for diversion was recorded. Overall, 5-year survival was 62% among the 107 patients with early-stage esophageal cancer. 3HMIE is feasible with low mortality and acceptable morbidity even in patients with locally advanced esophageal cancer who received neoadjuvant radiochemotherapy. Overall perioperative and survival outcomes are similar to or better than those reported in the published literature on esophagectomy after induction therapy.