Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2014
Case ReportsOutflow graft thrombectomy during HeartMate II left ventricular assist device exchange.
We report the pump exchange secondary to a detached bend relief sheath of a HeartMate II (Thoratec Corporation, Pleasanton, CA, USA) left ventricular assist device, consistent with previous Food and Drug Administration warnings. This report highlights a thrombectomy technique and reuse of the outflow graft during subcostal pump exchange in a patient with relative contraindications to repeat sternotomy.
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Interact Cardiovasc Thorac Surg · Oct 2014
Case ReportsExtracorporeal membrane oxygenation as a support for emergency bronchial reconstruction in a traumatic patient with severe hypoxaemia.
Extracorporeal membrane oxygenation (ECMO) is an extracorporeal life support technique to provide cardiac and/or respiratory assistance to patients. ECMO has been demonstrated to be beneficial for the life support of selected traumatic individuals. However, the application of arteriovenous ECMO as an intraoperative support strategy in emergency operations has rarely been described. ⋯ His right main bronchus was sewn completely closed during the first operation in a local hospital, and he developed refractory hypoxaemia and haemodynamic instability. Although general anaesthesia was not applicable, arteriovenous ECMO was applied as a support to perform the second operation to reconstruct successfully his right main bronchus. As a result, he recovered from this injury.
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Interact Cardiovasc Thorac Surg · Oct 2014
Endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymphadenopathy: effect of the learning curve.
This study aimed to evaluate the learning curve and efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the examination of mediastinal or hilar lymph nodes suspected of having cancer or of benign disease such as sarcoidosis. A success-adjusted cumulative sum model was used to evaluate the learning curve for diagnostic rates and operation time. A total of 99 patients (77 men and 22 women) who underwent EBUS-TBNA from April 2011 to March 2012 in a single centre were analysed retrospectively. ⋯ The sensitivity, specificity, and positive and negative predictive values and diagnostic accuracy for EBUS-TBNA were 80, 100, 100, 87.1 and 91.5%, respectively. According to the learning curve analysis, the ability to perform EBUS required performing approximately 37 procedures for the trials. In conclusion, more successful results are obtained after a certain learning curve, as is the case for every other invasive procedure.
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Interact Cardiovasc Thorac Surg · Oct 2014
Randomized Controlled Trial Comparative StudyLow protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy.
Owing to the great absorption capability of the pleura for transudates, the protein content of draining pleural fluid may be considered as a more adequate determinant than its daily draining amount in the decision-making for earlier chest tube removal. In an a priori pilot study, we observed that the initially draining protein-rich exudate converts to a transudate quickly in most patients after lobectomies. Thus, chest tubes draining high-volume but low-protein fluids can safely be removed earlier in the absence of an air leak. This randomized study aims to investigate the validity and clinical applicability of this hypothesis as well as its influence on the timing for chest tube removal and earlier discharge after lobectomy. ⋯ Regardless of the daily drainage, chest tubes can safely be removed earlier than anticipated in most patients after lobectomy if the protein content of the draining fluid is low.
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Interact Cardiovasc Thorac Surg · Oct 2014
Case ReportsSingle-port thoracoscopic lobectomy in a nonintubated patient: the least invasive procedure for major lung resection?
General anaesthesia with single-lung ventilation was always considered a condition for thoracoscopic major pulmonary resections. However, nonintubated thoracoscopic lobectomy has been reported recently by using conventional video-assisted thoracoscopic surgery (VATS), epidural anaesthesia and vagus blockade. Here, we present a technique that reduces the surgical access trauma even more: single-incision VATS approach with no need for epidural or vagus blockade in a nonintubated patient. ⋯ Single-port video-assisted thoracoscopic lobectomy in nonintubated patients seems to be feasible and safe, and probably represents the least invasive approach to lobectomy. Further studies are necessary to evaluate the results with a series of patients.