Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2009
Randomized Controlled Trial Comparative StudyComparison of minimally invasive closed circuit versus standard extracorporeal circulation for aortic valve replacement: a randomized study.
To evaluate the clinical results of aortic valve replacement performed with a miniaturized closed circuit extracorporeal circulation (MECC) system and to compare it to standard cardiopulmonary bypass (CPB). One hundred and twenty consecutive patients undergoing isolated aortic valve replacement were randomly assigned to either a miniaturized closed circuit CPB with the maquet-cardiopulmonary MECC System (study group, n=60) or to a standard CPB (control group, n=60). Demographic characteristic and operative data were similar in the two groups. ⋯ Platelet count at ICU arrival was significantly higher in the study group (139+/-40 x 10(9)/l vs. 164+/-75 x 10(9)/l, P=0.05). Peak postoperative troponin I release was significantly lower in the MECC group (3.81+/-2.7 ng/dl vs. 6.6+/-6.8 ng/dl, P<0.05). In this randomized study the MECC system has demonstrated best postoperative clinical results in terms of need for transfusion, platelets consumption and myocardial damage as compared to standard CPB.
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Interact Cardiovasc Thorac Surg · Jul 2009
Comparative StudyTranspulmonary versus continuous thermodilution cardiac output after valvular and coronary artery surgery.
Residual left-sided valvular insufficiencies after valvular surgery may confound transpulmonary thermodilution cardiac output (COtp). We compared the technique with the continuous right-sided thermodilution technique (CCO) after valvular surgery (n=8) and coronary artery surgery (n=8). Patients with pulmonary and femoral artery catheters in the intensive care unit (ICU) were included. ⋯ At fluid-induced CCO increases <20%, the r for changes in cardiac output measured by both techniques was similar after valvular and coronary artery surgery. Thus, COtp and CCO were of similar value in predicting and monitoring fluid responses after both surgery types. This argues against left-sided valvular insufficiencies confounding COtp.
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Interact Cardiovasc Thorac Surg · Jul 2009
Comparative StudyThe maximum standardized 18F-fluorodeoxyglucose uptake on positron emission tomography predicts lymph node metastasis and invasiveness in clinical stage IA non-small cell lung cancer.
In patients with clinical stage IA non-small cell lung cancer (NSCLC), we investigated whether the maximum standardized uptake value (SUVmax) of 18F-fluorodeoxyglucose (FDG) by the tumor correlated with lymph node metastasis, intratumoral lymphatic and vascular invasion of tumor cells, and pleural invasion. From April 2005 to November 2008, 58 patients underwent a lobectomy with systematic hilar and mediastinal lymph node dissection for clinical stage IA NSCLC. ⋯ Compared with tumors with an SUVmax < or = 2.0, tumors with an SUVmax>2.0 had more frequent lymph node metastasis, intratumoral lymphatic and vascular invasion of tumor cells and pleural invasion (all P<0.05). Our results suggest that in patients with clinical stage IA NSCLC, SUVmax is an important predictor of tumor invasiveness.
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Interact Cardiovasc Thorac Surg · Jul 2009
Outcome after reoperation for atrioventricular septal defect repair.
Results of surgical repair of atrioventricular septal defect (AVSD), both partial (PAVSD) and complete (CAVSD), have improved. However, reoperation is not uncommon. This report describes our experience in 59 patients who underwent reoperation after AVSD repair, between 1977 and 2008. ⋯ Overall survival was 91%, and 86% after 5 and 15 years. The most common indication to undergo reoperation is LAVVR. Reoperation is safe and in the majority of cases, a durable repair of the LAVV can still be achieved.
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Interact Cardiovasc Thorac Surg · Jul 2009
Mini re-sternotomy for aortic valve replacement in patients with patent coronary bypass grafts.
As the population ages, an increasing number of patients with patent coronary grafts will require subsequent aortic valve replacement. Major operative problems include those associated with re-entry and, in particular, damage of the patent grafts. Between January 2007 and October 2008, 10 patients who had previous coronary bypass surgery underwent aortic valve replacement through upper j-shaped mini re-sternotomy. ⋯ The in-hospital mortality was 0%. Aortic valve replacement in previous coronary bypass grafting can be performed safely with a mini re-sternotomy. This approach avoids extensive dissection, decreasing the risk of injuries to heart chambers and previous patent coronary grafts with low morbidity and mortality.