The Annals of thoracic surgery
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A variety of surgical techniques has been developed to attempt to minimize the risk of paraplegia after descending thoracic aortic aneurysm repair. This study reviews our institutional experience with several basic techniques over a period of 10 years. ⋯ The risks associated with elective descending thoracic aortic aneurysm repair were extremely low using an operative strategy that was flexible but skewed toward perfusion with somatosensory evoked potential monitoring. In perfused patients, paraplegia did not occur when distal pressure was greater than 55 mm Hg and somatosensory evoked potentials remained intact. However, the risks of death and paraplegia were primarily related to emergent presentation, not to technique, and the technique of cross clamping with controlled distal exsanguination was found to be valuable in unstable or in anatomically complicated subsets of patients.
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Whether any difference exists in clinical characteristics between resected non-small cell lung cancer with either skip or ordinary mediastinal lymph node metastases (N2 disease) needs to be clarified. ⋯ These results suggest that patients with skip mediastinal lymph node metastases represent a unique subgroup of N2 disease.
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Intraaortic balloon pumping is known to be ineffective in severe cardiogenic shock. The efficacy of balloon volumes larger than those commonly used is examined. ⋯ Experimental and clinical data indicate that the effectiveness of intraaortic balloon pumping in severe cardiogenic shock may be improved by increasing the volume of the balloon (i.e., until it fully occupies the aorta).
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Comment Letter
Lobectomy versus limited resection in T1 N0 lung cancer.
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Composite aortic root replacement is accepted treatment for aneurysms of the ascending aorta involving the root with aortic valve regurgitation, but controversy continues regarding the best technique of operation. We excise the aneurysm, implant a composite valve graft, directly attach the coronary arteries to the aortic graft, and make the distal anastomosis to the divided aorta. ⋯ Composite aortic root replacement with direct coronary implantation is effective and durable treatment for a variety of aortic pathologic conditions in elective and emergency situations.