Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
-
Ann Thorac Cardiovasc Surg · Apr 2007
ReviewThe present status of postoperative adjuvant chemotherapy for completely resected non-small cell lung cancer.
Non-small cell lung cancer (NSCLC) constitutes approximately 85% of all lung cancers, with patients having a poor prognosis. Approximately one third of NSCLC patients present with early-stage disease in which potentially curative resection and multi-modality therapy. Although adjuvant chemotherapy is the standard practice for patients with stages I-III breast and colorectal cancer, the therapeutic efficacy of adjuvant chemotherapy, following complete surgical resection of early stage NSCLC, has not been fully established. ⋯ This analysis has suggested that platinum-based adjuvant chemotherapy may have no benefit for patients with stage IA and only a marginal benefit for patients with stage IB. Thus, the information available at the current time supports the administration of adjuvant chemotherapy for patients who have undergone complete resection of stages IB-IIIA NSCLC. Further research is needed to define the role of adjuvant platinum-based chemotherapy and its use, in conjunction with chest radiotherapy as the treatment for patients with resected stages IB and IIIA NSCLC.
-
Ann Thorac Cardiovasc Surg · Apr 2007
Case ReportsSuccessful repair using innominate vein flap, pericardial flap and thymus pedicle flap for tracheo-innominate artery fistula.
Tracheo-innominate artery fistula (TIF) is a rare but frequently fatal complication after tracheostomy. Without operation, the mortality is nearly 100% because of acute massive tracheal hemorrhage. ⋯ We report on a successful surgical management of one case by patch closure with an innominate vein flap, wrapping of the innominate artery with a pericardial flap, and interposition of a thymus pedicle flap between the innominate artery and the trachea. Our surgical procedure is effective in maintaining the patency of the innominate artery preventing neurological deficits, and in preventing postoperative recurrent bleeding.
-
Ann Thorac Cardiovasc Surg · Apr 2007
Comparative StudyAntegrade selective cerebral perfusion combined with deep hypothermic circulatory arrest on cerebral circulation: comparison between pulsatile and nonpulsatile blood flows.
In aortic arch surgeries, antegrade selective cerebral perfusion (SCP) combined with deep hypothermic circulatory arrest (DHCA) has been recently widely used in institutions as one of the most reliable methods for cerebral protection. However, some studies reported a 3.7-9.3% incidence of postoperative cerebral complications. To perform antegrade SCP more safely, we sought to examine the impact of pulsatile flow perfusion during DHCA on cerebral tissue metabolism, focusing on physiological effects of pulsatile flow perfusion. ⋯ Our results suggest that the pulsatile flow circulation method shows cerebral protection effects with increasing blood flow in small cerebral tissues. In addition, it is effective for improving the imbalance between oxygen supply and demand, especially in the process of rewarming from hypothermic conditions. This method seems to be useful as an adjunct in hypothermic circulatory arrest procedures.
-
Ann Thorac Cardiovasc Surg · Feb 2007
High thoracic epidural analgesia reduces the risk of long-term depression in patients undergoing coronary artery bypass surgery.
High thoracic epidural analgesia (HTEA) has been shown to reduce psychological morbidity in the early period following coronary artery bypass graft surgery (CABG). Our aim was to identify whether the effect persists in the longer term. ⋯ The use of HTEA results in a lower risk of depression 6 months or more following CABG.
-
Ann Thorac Cardiovasc Surg · Dec 2006
Limitations of retrograde continuous tepid blood cardioplegia for myocardial remodeling.
We assessed potential limitations of retrograde continuous tepid blood cardioplegia (RCTBC) for myocardial remodeling, represented by hypertrophied and/or dilated myocardium in patients with severe cardiomyopathy following single aortic valve replacement. ⋯ The study suggests preoperative high DeltaPG, small aortic root diameter, and low LVEDV, namely, concentrically hypertrophied myocardium, as risk factors for severe cardiomyopathy after RCTBC. RCTBC in patients with any risk factor should be accompanied by an increase in initial continuous perfusion flow and/or aggressive use of intermittent antegrade coronary perfusion.