Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Aug 2009
Prognosis of patients undergoing cardiac surgery and treated with intra-aortic balloon pump counterpulsation prior to surgery: a long-term follow-up study.
The aim of this study was to evaluate short- and long-term outcome in patients undergoing coronary artery bypass grafting (CABG), who received an intra-aortic balloon pump (IABP) prior to surgery. Between January 1990 and June 2004, all patients (n=154) who received an IABP prior to on-pump CABG in our center were included. Patients received the IABP for vital indications (i.e. either unstable angina refractory to medical therapy or cardiogenic shock; group 1: n=99) or for prophylactic reasons (group 2: n=55). ⋯ A decrease in 30-day mortality occurred in group 2 (median predicted mortality was 7.2% and observed was 0%). Cumulative 1-, 5-, and 6-year survival was 82.8+/-3.8%, 70.1+/-4.9%, and 67.3+/-5.1% for group 1 vs. 98.2+/-1.8%, 84.0+/-5.6% and 84.0+/-5.6% for group 2 (Log-rank: P=0.02). Logistic EuroSCORE (HR 1.03 [1.01-1.05], P=0.007) was an independent predictor of long-term all-cause mortality.
-
Interact Cardiovasc Thorac Surg · Aug 2009
Multicenter Study Clinical TrialThe role of thoracoscopy for the diagnosis of hidden diaphragmatic injuries in penetrating thoracoabdominal trauma.
Patients with a thoracoabdominal stab wound may have hidden diaphragmatic injuries that could finally lead to chronic diaphragmatic hernia. In this study, we analyzed 30 patients with penetrating thoracoabdominal injuries that were stable hemodynamically and did not need emergency exploration. They underwent thoracoscopy in order to find a probable diaphragmatic injury from March 2005 to October 2007. ⋯ We performed thoracoabdominal CT-scan 6 months later and chronic diagrammatic hernias were not reported. Diagnostic accuracy of thoracoscopy was 100%. Owing to the high diagnostic accuracy rate, minimal invasiveness and therapeutic potency of thoracoscopy we recommend it to be performed in all clinically stable patients with penetrating thoracoabdominal penetrating injury especially in the 8th intercostal space.
-
Interact Cardiovasc Thorac Surg · Aug 2009
ReviewIs ministernotomy superior to conventional approach for aortic valve replacement?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is ministernotomy superior to conventional approach for aortic valve replacement (AVR)? Altogether, more than 115 papers were found using the reported search, of which six represented the best evidence to answer the clinical question. ⋯ We conclude that ministernotomy can be performed safely for AVR, without increased risk of death or other major complication; however, few objective advantages have been shown. Ministernotomy can be offered on the basis of patient choice and cosmesis rather than evident clinical benefit.
-
Interact Cardiovasc Thorac Surg · Aug 2009
Comparative StudyPreliminary experience for the evaluation of the intraoperative graft patency with real color charge-coupled device camera system: an advanced device for simultaneous capturing of color and near-infrared images during coronary artery bypass graft.
We developed a new color charge-coupled device (CCD) camera for the intraoperative indocyanine green (ICG) angiography. This device consists of a combination of custom-made optical filters and an ultra-high sensitive CCD image sensor, which can detect simultaneously color and near-infrared (NIR) rays from 380 to 1200 nm. We showed a comparison between our system and other devices for the preliminary experience. ⋯ When the CCD camera suspected a graft failure, CCD camera and angiography showed a comparable graft failure. The unique device that visualized ICG-enhanced structures against a background of natural myocardial color improved the visibility of abnormality in flow and perfusion. Our findings show that this device may become a standard intraoperative graft and perfusion assessment tool in coronary artery bypass graft (CABG).
-
Interact Cardiovasc Thorac Surg · Aug 2009
Endobronchial ultrasound-guided transbronchial needle aspiration of undiagnosed intrathoracic lesions.
Endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-FNA) is a minimally invasive method used routinely for mediastinal staging of patients with lung cancer. We have used it in 135 consecutive patients with a radiologically suspicious intrathoracic lesion that remained undiagnosed despite bronchoscopy and CT-guided fine-needle aspiration (CT-FNA). There was no operative mortality or surgical complications. ⋯ However, a final diagnosis was only reached in 45% of the patients and further investigations led to malignancy in 13. We believe that EBUS-FNA represents a good alternative to more invasive diagnostic procedures when conventional methods fail, even though the diagnostic yield is lower compared with mediastinal staging in patients with known lung cancer. In almost half of the cases, EBUS-FNA provides the final diagnosis without exposing the patient to the risk of complications from more invasive procedures.