The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2012
Avoiding sternotomy in repeat coronary artery bypass grafting: Feasibility, safety, and mid-term outcome of the transabdominal off-pump technique using the right gastroepiploic artery.
Repeat sternotomy is associated with a substantial risk of cardiovascular injury. We evaluated the feasibility and clinical outcome of a transabdominal approach without sternotomy and without cardiopulmonary bypass in repeat coronary artery bypass grafting, using the right gastroepiploic artery to graft vessels of the inferior wall of the heart. ⋯ Transabdominal off-pump coronary artery bypass grafting using the right gastroepiploic artery is a safe and effective procedure with low in-hospital mortality and morbidity and favorable mid-term outcome. In redo operations, this technique excludes the risk of cardiovascular injury.
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J. Thorac. Cardiovasc. Surg. · Jul 2012
Optimization of mediastinal staging in potential candidates for stereotactic radiosurgery of the chest.
Patients with medically inoperable nonsmall-cell lung cancer generally have limited staging of the mediastinum using computed tomography and combined positron emission tomography and computed tomography, before stereotactic radiosurgery. Historical data have demonstrated the superiority of tissue sampling techniques such as endobronchial ultrasonography and mediastinoscopy compared with imaging studies in accurately determining the nodal stage. We believe, that at a minimum, mediastinal interrogation with endobronchial ultrasonography should be performed before patients undergo stereotactic radiosurgery. ⋯ Endobronchial ultrasonography-transbronchial needle aspirates is more accurate than computed tomography and positron emission tomography in staging the mediastinum, can be performed with minimal morbidity, and should be considered for all patients considered candidates for stereotactic radiosurgery.
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J. Thorac. Cardiovasc. Surg. · Jul 2012
Transapical beating heart cardioscopy technique for off-pump visualization of heart valves.
Endoscopic methods to perform intracardiac procedures are of enormous interest, with the introduction of transcatheter techniques for complex cardiac procedures. In the present study, we demonstrate the use of a novel transapical cardioscopy system to visualize intracardiac structures in a porcine model. ⋯ Transapical cardioscopy is a novel approach that allows for precise visualization of intracardiac structures within a beating porcine heart without the use of cardiopulmonary bypass. This technique might allow for more successful minimally invasive valvular, intracardiac, or ascending aortic procedures without the use of radiation.