The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy, and systemic chemotherapy in patients with malignant pleural mesothelioma: a 10-year experience.
We evaluated the long-term results of pleurectomy/decortication (P/D), hyperthermic pleural lavage with povidone-iodine, prophylactic chest wall radiotherapy (21 Gy), and systemic chemotherapy in patients with malignant pleural mesothelioma. ⋯ P/D, hyperthermic pleural lavage with povidone-iodine, prophylactic chest wall radiotherapy, and systemic chemotherapy is a safe and well-tolerated multimodality therapy.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Hybrid repair of type A acute aortic dissections with the Lupiae technique: ten-year results.
Replacing the ascending aorta and the arch in patients with type A acute aortic dissection achieves good short-term results, but several patients are left with distal intimal tears or a patent false lumen in the descending aorta. In this series, we report the 10-year experience with the Lupiae technique, a hybrid aortic repair technique for patients with type A acute aortic dissection. ⋯ The availability of a Dacron landing zone on the distal ascending aorta after type A acute aortic dissection repair allows the exclusion, with a thoracic endovascular aortic repair, of any residual intimal tear refilling a patent false lumen. This approach seems to be associated with a high probability of false lumen thrombosis and low rates of reoperations on the distal aorta.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Spinal cord protection via alpha-2 agonist-mediated increase in glial cell-line-derived neurotrophic factor.
Delayed paraplegia secondary to ischemia-reperfusion injury is a devastating complication of thoracoabdominal aortic surgery. Alpha-2 agonists have been shown to attenuate ischemia-reperfusion injury, but the mechanism for protection has yet to be elucidated. A growing body of evidence suggests that astrocytes play a critical role in neuroprotection by release of neurotrophins. We hypothesize that alpha-2 agonism with dexmedetomidine increases glial cell-line-derived neurotrophic factor in spinal cord astrocytes to provide spinal cord protection. ⋯ Astrocytes have been shown to preserve neuronal viability via release of neurotrophic factors. Dexmedetomidine increases glial cell-derived neurotrophic factor from spinal cord astrocytes via the alpha-2 receptor. Treatment with alpha-2 agonist dexmedetomidine may be a clinical tool for use in spinal cord protection in aortic surgery.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Observational StudyMinimal access rapid deployment aortic valve replacement: initial single-center experience and 12-month outcomes.
A single-center observational study was initialized to evaluate the feasibility of rapid deployment aortic valve replacement using the Edwards Intuity valve system (Edwards Lifesciences Corp, Irvine, Calif) in a minimally invasive setting. A total of 60 implantations have been performed at the Ruhr University Hospital Bergmannsheil using a minimal access technique. We present the first short-term and 12-month clinical and hemodynamic results. ⋯ Reproducible short crossclamp and bypass times were achieved in a minimally invasive setting. The valve shows good hemodynamic performance comparable to other sutureless or rapid deployment valves. Nevertheless, future follow-up investigation has to be awaited to gain more data concerning durability and safety issues.