Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2018
Is Surgical or Catheter-based Interventions an Option After an Unsuccessful Mitral Clip?
The objective of this study was to assess the results of catheter-based and surgical reinterventions in primary mitral regurgitation after failed MitraClip therapy. We report on 21 consecutive symptomatic patients with primary mitral regurgitation (median age 78 years) who underwent either repeat MitraClip therapy (n = 7) or mitral valve surgery (n = 14) after failure of the index procedure with 1-2 MitraClip implantations. At the time of reinterventions, 193 (interquartile range [IQR]: 32-622) days after the index procedure, patients had recurrent or persistent grade 3 mitral regurgitation. ⋯ Recurrence of significant mitral regurgitation was absent in all but 1 patient with unsuccessful repeat MitraClip therapy who was deemed inoperable. Our data show that both repeat MitraClip and also mitral valve surgery are feasible and safe alternatives in patients without an excessively increased perioperative risk. We conclude that whenever leaflet insertion is not compromised, repeat catheter-based repair is a reasonable redo concept; in the remaining cases, surgery should be offered to the patient.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2018
Onset and Evolution of Clinically Apparent Myasthenia Gravis After Resection of Non-myasthenic Thymomas.
Patients with thymoma and without clinical or electromyographical myasthenic signs may occasionally develop myasthenia several years after thymectomy. Hereby, we investigated the predictors and the evolution of this peculiar disease. We performed a retrospective analysis in 104 consecutive patients who underwent thymectomy between 1987 and 2013 for thymoma without clinical or electromyographic signs of myasthenia gravis. ⋯ No patient under medical treatment has yet developed a complete remission. In our study the presence of preoperative high-level serum acetylcholine receptor antibodies was the only factor significantly associated with the development of post-thymectomy myasthenia gravis. The persistence of residual islet of ectopic thymic tissue was one of the causes of the onset of myasthenia and its surgical removal was successful.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2017
Comparative StudyIntercostal Nerve Blocks With Liposomal Bupivacaine: Demonstration of Safety, and Potential Benefits.
Liposomal bupivacaine is designed to allow drug diffusion for up to 96 hours following a single administration. Our study aimed to evaluate the safety of liposomal bupivacaine as an intercostal nerve block as part of an enhanced recovery pathway using standardized multimodality pain regimen compared with epidural analgesia in propensity score-matched patients undergoing lung resection. Patients undergoing lung resection (n?=?1737; 2010-2015) were stratified by treatment with intraoperative liposomal bupivacaine intercostal block vs epidural analgesia. ⋯ In the second analysis (n?=?494), there were no differences in the rate of postoperative complications between the groups. The use of liposomal bupivacaine is not associated with a rise in perioperative complications when compared with epidural analgesia. Liposomal bupivacaine is a safe adjunct to the management of pain of patients undergoing pulmonary surgery.