Seminars in thoracic and cardiovascular surgery
-
Modern cardiac practice in the United States is conservative when it comes to using bilateral internal mammary or radial artery grafts in coronary artery bypass surgery. Here, we examine the evidence regarding using other arterial grafts instead of veins as a complement to left internal mammary artery in surgical revascularization. In addition, we put our report in perspective relative to prevailing practice, professional societal guidelines, and future directions in coronary artery bypass grafting.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2013
Lobar lung transplantation: emerging evidence for a viable option.
The field of lung transplantation has seen an exciting evolution recently, with novel approaches to increasing the number of organs available for patients with end-stage lung disease. We review 2 recent reports describing the approach of lobar lung transplant as a successful and viable option for those recipients who are challenged by size mismatch and clinical course decline while on the transplant waiting list.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewCoronary artery bypass graft surgery remains the standard of care for patients with diabetes.
Coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) are proven effective treatments of coronary artery disease (CAD), however, the optimal revascularization strategy remains unclear in certain patient subsets. The recently published "Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM)" trial is a randomized study evaluating the use of CABG vs PCI in diabetic patients with multivessel coronary disease. The purpose of this editorial is to review the FREEDOM trial and the available literature guiding clinicians to make evidence-based decisions when treating diabetic patients with multivessel coronary disease. The current evidence suggests that CABG should remain the standard of care for this patient population.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewThe state of the art in preventing postthoracotomy pain.
Pain after thoracic surgery can be intense and prolonged. Inadequate pain management can have several detrimental effects, including increased postoperative morbidity and delayed recovery as well as occurrence of postthoracotomy syndrome. Therefore, establishing an adequate analgesic regimen for thoracic surgery is critical. ⋯ When these techniques are either contraindicated or not possible, intercostal analgesia or intrathecal opioids are recommended. These techniques should be combined with nonopioid analgesics, such as acetaminophen, nonsteroidal anti-inflammatory drugs, or cyclooxygenase-2-specific inhibitors, administered on a regular "round-the-clock" basis, with opioids used as "rescue" analgesics. Finally, the integration of multimodal analgesia techniques with multidisciplinary rehabilitation program can enhance recovery, reduce hospital stay, and facilitate early convalescence.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewHow to follow up patients after curative resection of lung cancer.
Survivors of lung cancer surgery are among the highest-risk patients for developing another lung cancer, yet there is no clear consensus on the method of surveillance for patients after curative surgical resection. Surveillance is no longer futile because the emergence of computed tomography screening has allowed the detection of recurrences and new metachronous cancers at an early stage. In selected patients, lung cancer identified recently on routine computed tomography scan is amenable to curative treatment and is associated with longer survival.