Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Feb 2012
ReviewDoes the use of extended criteria donors influence early and long-term results of lung transplantation?
A best evidence topic was constructed according to a structured protocol. The question addressed was whether the presence of extended criteria donors influences the early and long-term results in patients referred for lung transplantation. Of the 30 papers found using a report search, 14 presented the best evidence to answer the clinical question. ⋯ Finally, the importance of avoiding the donation of the lung from an MD to a high-risk recipient emerged, whereas the association with single or bilateral transplants remains more controversial. Hence, current evidence suggests that there are no contraindications-given the absence of negative impact on survival-for the use of MDs for the transplant of a proposed standard receiver. However, given the low level of evidence of published studies, caution is necessary in order to avoid organ shortage, despite these encouraging results.
-
Interact Cardiovasc Thorac Surg · Feb 2012
Pulmonary metastasectomy: a multivariate analysis of 440 patients undergoing complete resection.
Surgical resection is currently a standard approach for isolated lung metastases from different primary tumours. The aim of the present analysis is to evaluate the outcome of patients submitted to complete resection of pulmonary metastases and to determine prognostic factors for long-term survival. A group of 440 consecutive patients previously diagnosed with primary malignant solid tumours and submitted to complete surgical resection of lung nodules with suspected or diagnosed metastatic lesion were retrospectively reviewed. ⋯ Multivariate analysis: number of malignant nodules resected (P = 0.01), size of the largest nodule resected (P = 0.001), DFI >36 months (P < 0.001) and histology of the primary tumour (P = 0.017) had significant impact on survival. The benefit of such an aggressive surgical approach is only limited to selected subgroups of patients. The decision to consider a patient for resection of metastastic disease should include factors beyond the feasibility of complete removal.
-
Interact Cardiovasc Thorac Surg · Feb 2012
Surgical treatment of stage IV non-small cell lung cancer.
Most stage IV non-small-cell lung cancer (NSCLC) patients are not amenable to curative treatment. The purpose of this study was to analyse our initial experience with an aggressive surgical strategy for stage IV NSCLC, and to define which patients can benefit from this treatment. Forty-six stage IV NSCLC patients who underwent surgical resection of both primary lung cancer and metastatic sites from April 1989 to December 2010 were included in this study. ⋯ Patients with the pN2 status had a significantly worse survival than patients with a pN0 or pN1 status (8.6 versus 33.1%, P = 0.0497). According to a multivariate Cox proportional hazards analysis, no independent predictor of survival was identified. The results of our study suggest that surgical treatment can extend the survival in stage IV NSCLC patients if the patients can tolerate surgery.
-
Interact Cardiovasc Thorac Surg · Feb 2012
Case ReportsFolding mitral valvuloplasty without posterior leaflet resection for calcified mitral annulus.
Mitral valve annular calcification has long been a challenge in repairing posterior mitral valve prolapse. Folding valvuloplasty of the posterior leaflet without resection provides a means of circumventing common procedural complications. This report demonstrates the success of folding valvuloplasty without resection in the treatment of mitral valve prolapse and severe annular calcification.
-
Interact Cardiovasc Thorac Surg · Jan 2012
Randomized Controlled Trial Comparative StudyAdenosine in cold blood cardioplegia--a placebo-controlled study.
OBJECTIVE Adenosine as an additive in blood cardioplegia is cardioprotective in animal studies, but its clinical role in myocardial protection remains controversial. The aim of this study was to investigate whether the addition of adenosine in continuous cold blood cardioplegia would enhance myocardial protection. METHODS In a prospective double-blind study comparing adenosine 400 μmol l(-1) to placebo in continuous cold blood cardioplegia, 80 patients undergoing isolated aortic valve replacement were randomized into four groups: antegrade cardioplegia with adenosine (n = 19), antegrade cardioplegia with placebo (n = 21), retrograde cardioplegia with adenosine (n = 21) and retrograde cardioplegia with placebo (n = 19). ⋯ When compared with the antegrade groups, the retrograde groups showed higher myocardial oxygen uptake (17.3 ± 11.4 versus 2.5 ± 3.6 ml l(-1) at 60 min of aortic occlusion, P < 0.001) and lactate accumulation (43.1 ± 20.7 versus 36.3 ± 23.0 µmol g(-1) at 60 min of aortic occlusion, P = 0.052) in the myocardium during aortic occlusion, and lower postoperative left ventricular stroke work index (27.2 ± 8.4 versus 30.1 ± 7.9 g m m(-2), P = 0.034). CONCLUSIONS Adenosine 400 μmol l(-1) in cold blood cardioplegia showed no cardioprotective effects on the parameters studied. Myocardial ischaemia was more pronounced in patients receiving retrograde cardioplegia.