The Annals of thoracic surgery
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Case Reports
Extracardiac Fontan operation with tube fenestration allowing transcatheter coil occlusion.
A fenestration may improve the immediate postoperative course after a Fontan procedure by preserving the cardiac output. We describe a simple and safe technique of fenestration amenable to coil occlusion, which can be carried out in most cardiac catheterization laboratories.
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Clinical Trial
A dual-vent left heart deairing technique markedly reduces carotid artery microemboli.
Cerebral embolization, mainly bubbles, follows aortic declamping in left heart valve operations. Embolization is not prevented by conventional left heart deairing methods. We have validated a "dual-vent" deairing technique, which uses high-flow left ventricular and aortic venting from the working heart into the cardiopulmonary bypass venous line before aortic declamping. ⋯ Cerebral embolization after aortic declamping in left heart valve operations was significantly reduced by this dual-vent deairing technique.
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To achieve complete myocardial revascularization in patients with diffuse coronary artery disease and patients at high risk if they undergo cardiopulmonary bypass such as severe systemic disease or diffuse arteriosclerosis of the aorta, we have adopted the technique of combining direct coronary artery bypass grafting without cardiopulmonary bypass with transmyocardial laser revascularization. ⋯ Transmyocardial laser revascularization is an excellent adjunct to minimally invasive coronary artery bypass grafting to achieve complete myocardial revascularization in patients with graftable vessels in the anterior wall and ungraftable vessels in the posterior and inferior wall. This achieves complete myocardial revascularization without compromising safety in patients who are at high risk if they undergo cardiopulmonary bypass. Minimal morbidity and mortality in the present series revealed that this procedure is safe, and postoperative follow-up of these patients showed significant functional improvement as well as an improvement in myocardial perfusion scan.
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There is renewed interest in coronary artery bypass grafting without cardiopulmonary bypass using the anterolateral minithoracotomy approach. We evaluated 209 patients who underwent minimally invasive direct coronary artery bypass grafting using an anterolateral minithoracotomy. The anastomosis was performed under direct vision on the beating heart without using cardiopulmonary bypass. ⋯ With the help of the local immobilization systems off-pump coronary artery bypass grafting was safely performed through a minithoracotomy. The incidence of intraoperative and postoperative complications was low and follow-up showed good results. Thus, minimally invasive direct coronary artery bypass grafting is an excellent technique for arterial revascularization in patients having symptomatic left anterior descending coronary artery disease.
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Patients often undergo limited resection instead of lobectomy for non-small cell lung cancer because of a low preoperative forced expiratory volume in 1 second (FEV1). Our goal is to define criteria that will preoperatively identify a group of patients who will not lose further function after lobectomy. ⋯ Patients with a very low preoperative FEV1 and FEV1 to forced vital capacity ratio are less likely to lose ventilatory function after lobectomy and may actually improve it.