Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2011
Ex vivo lung perfusion and extracorporeal life support in lung transplantation.
Normothermic ex vivo lung perfusion and extracorporeal life support have re-invigorated lung transplantation.
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Reperfusion injury after reestablishing coronary flow by releasing the aortic cross clamp after cardiac surgery with cardioplegic arrest causes myocardial damage and even death. Attenuation of this reperfusion response by controlling the biochemical and physical environment can avoid morbidity and mortality. Use of a warm reperfusate with addition of drugs that are known to decrease reperfusion injury with manipulation of coronary vascular resistance and the physical parameters of the reperfusion environment helps the heart to reestablish coronary perfusion while decreasing the harm produced by the period of ischemia that occurs during cardiac surgery with intermittent cardioplegic arrest.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2011
Hybrid video-assisted thoracic surgery basilar (S9-10) segmentectomy.
We perform segmentectomy for patients with cT1N0 non-small cell lung cancer (NSCLC) of 2 cm or less, even in good-risk patients. Hilar dissection and intersegmental dissection are performed by using mainly direct visualization through the access thoracotomy, which is called hybrid video-assisted thoracic surgery (VATS). ⋯ With this method, the segment to be removed can be inflated, while the segments to be preserved are kept deflated. When the intersegmental plane is being divided by electrocautery, direct visualization during the hybrid VATS approach is extremely important, because a 3-dimensional understanding of the pulmonary anatomy is crucial to avoid ambiguous procedures.
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Aortic valve sparing operations were developed to preserve the aortic valve in patients with ascending aortic aneurysm and aortic insufficiency or patients with aortic root aneurysm. There are 2 types of aortic valve sparing operations, remodeling of the aortic root and reimplantation of the aortic valve. ⋯ Although remodeling of the aortic root has been extensively used in patients with aortic root aneurysm, the long-term results are somewhat inferior to reimplantation in most series. The late results of aortic valve sparing operations have been excellent, and these operations have become an important addition to the surgical armamentarium to treat patients with proximal aortic aneurysms.