Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2002
ReviewCurrent status and future directions in computer-enhanced video- and robotic-assisted coronary bypass surgery.
Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic and computer-enhanced, robotic-enabling technology for coronary revascularization. ⋯ Bleeding, ventilatory times, arrhythmias, hospital lengths of stay, and return to normal activity have been reduced. Recently, we have developed a new robotic revascularization strategy called Atraumatic Coronary Artery Bypass that is a promising mid-term step on the pathway to totally endoscopic, beating-heart coronary artery bypass. We conclude that computer-enhanced robotic techniques are safe, and further clinical studies are required to define the full potential of this evolving technology.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2002
The role of pulmonary metastasectomy in soft tissue sarcoma.
Pulmonary metastases are common in patients with soft tissue sarcoma. The majority of patients who develop pulmonary metastases are asymptomatic and are diagnosed during routine follow-up visits. There is evidence to suggest that pulmonary metastasectomy is associated with improved overall survival but only in patients with complete surgical resection. ⋯ The majority of resectable patients have peripheral lesions that are amenable to wedge resection. There is little evidence to suggest that chemotherapy improves survival. Future research is needed to better identify patients for metastasectomy, to determine the role of minimally invasive procedures, and to develop better adjuvant therapy.
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Semin. Thorac. Cardiovasc. Surg. · Oct 2001
Clinical outcomes and indicators of normalization of left ventricular dimensions after Ross procedure in children.
Between 1993 and 2000, 50 patients (age range, 1 month to 18 years) who had left ventricular outflow tract (LVOT) disease and had undergone a Ross procedure were assessed using echocardiography. Aortic annulus size, valvular gradient, valve insufficiency, LV dimensions at end-systole and end-diastole, LV interventricular septal and posterior wall thickness, and LV mass index (LVMI) were measured. There was 1 early and 2 late deaths, and 5 reoperations. ⋯ Peak pressure gradients declined from 73 +/- 18 mm Hg to 7 +/- 7 mm Hg, and LVMI regressed (167 +/- 6 g/m(2) v 108 +/- 6 g/m(2), P <.001) after 3 years. The degree of AI ranged from none to mild, and no patient has LVOT stenosis. Regression of LV dilatation and hypertrophy, good autograft valve function and durability, and a high survival rate suggest that the Ross procedure is preferred for most children who require aortic valve replacement.
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Semin. Thorac. Cardiovasc. Surg. · Oct 2001
Echocardiographic correlates of Freestyle stentless tissue aortic valve endocarditis.
Echocardiography plays a critical role in assessing prosthetic valve endocarditis. Because normal paravalvular findings can mimic paraprosthetic infection early after implantation of a stentless bioprosthesis, we sought to define echocardiographic characteristics associated with infective endocarditis (IE) complicating stentless tissue aortic valve replacement. Between September 1992 and October 2000, 388 patients underwent aortic valve replacement with a Freestyle stentless tissue aortic valve. ⋯ In addition, no control patient developed new or progressive AR, diffuse leaflet thickening, or vegetations. TEE is useful in detecting valvular and paravalvular involvement of IE complicating stentless tissue aortic valve replacement. Because incremental change in paravalvular appearance from post-pump TEE is an important finding, intraoperative post-pump TEE should be performed and recorded in all patients undergoing stentless tissue aortic valve replacement.
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Semin. Thorac. Cardiovasc. Surg. · Jul 2001
ReviewEsophageal motility in the assessment of esophageal function.
Esophageal manometry assesses lower esophageal sphincter (LES) pressure and its relaxation. In addition, it detects the ability of the esophageal body to initiate a peristaltic contraction and the contraction's amplitude in response to a water bolus. ⋯ The most common disorders diagnosed by esophageal manometry are the primary motility disorders, such as achalasia. Manometry is indicated in the subset of patients with gastroesophageal reflux disease (GERD) who are being considered for antireflux surgery or have symptoms after antireflux surgery.