Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewEndobronchial valves for the treatment of emphysema.
Although lung volume reduction surgery (LVRS) improves quality of life, pulmonary function, exercise ability, and even survival for selected patients, several bronchoscopic procedures are being developed to reduce the morbidity and mortality. For heterogeneous emphysema, bronchial blockers, bronchial valves, and biologic glue have been used in an attempt to emulate volume reduction. ⋯ For homogeneous emphysema, airway bypass stents seem to be effective. This article reviews the results for the current procedures under investigation.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewContinuous-flow rotary left ventricular assist devices with "3rd generation" design.
Left ventricular assist device (LVAD) therapy has become an established treatment option for patients with advanced heart failure. Broader application of this therapy has been limited by the risk profile of the current generation of devices. The development of continuous-flow rotary pump technology with noncontact bearing design offers the promise of improved device durability and safety profile. Clinical evaluation of these innovative pump designs are currently underway.
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The initial approach to penetrating thoracic trauma is directed towards the pathophysiologic syndrome upon presentation. Most patients are successfully treated with drainage tubes. The unstable patient may necessitate thoracotomy at the emergency room to drain cardiac tamponade, provide cardiac massage and control bleeding. ⋯ Need for further work-up of potential injuries to other mediastinal organs is frequently screened by computerized tomography. Surgery might still be needed, on a less emergent basis, in order to repair injuries to the trachea/esophagus, retained hemothorax, or to rule out diaphragmatic injury. Laparoscopic and thoracoscopic procedures may be used in specific situations.
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The multiply injured patient with significant thoracic and extra-thoracic injuries poses a number of challenges. Pericardial tamponade, tension pneumothorax and massive hemothorax can and should be diagnosed clinically. ⋯ Beta-blockade of patients with blunt thoracic aortic injuries can be used as a temporizing damage control measure when the risks of operation or intervention are very high (traumatic brain injury, severe right or bilateral pulmonary contusion, unstable pelvic fractures). Patients with multiple penetrating wounds require the surgical team to be expeditious and flexible, and damage control is a helpful strategy in these patients.
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Flail chest is most often accompanied by a significant underlying pulmonary parenchymal injury and can be a life-threatening thoracic injury. Its management is often complicated by the other injuries it is frequently associated with. ⋯ In those patients requiring mechanical ventilatory support, or who require ipsilateral thoracocotomy, rib stabilization may be considered depending on a host of potentially conflicting indications and contraindications. At the end of this section are listed the current major recommendations and their levels of evidence.