The Annals of thoracic surgery
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A growing number of adults with functional single ventricles are presenting as candidates for first-time and redo-Fontan operations. This study describes the clinical presentation and early operative results of adults who have undergone Fontan modifications. ⋯ The Fontan operation can be performed in adults with minimal morbidity and improved NYHA functional class. New onset arrhythmias requiring treatment are sources of perioperative morbidity. Complete arrhythmia resolution of the preoperative arrhythmia may not be achieved in the immediate postoperative period in redo-Fontan patients. However, modification (intraoperative radiofrequency ablation-right atrial debulking) of the atrial tachycardia circuits in the redo-Fontan patients can result in complete resolution of preoperative atrial tachyarrhythmias at early follow-up.
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The objective of this study was to identify the predictors of prolonged air leak (air leak longer than 7 days) in patients submitted to pulmonary lobectomy for lung cancer. ⋯ We report that a low predicted postoperative forced expiratory volume in 1 second, the presence of pleural adhesions, and the upper lobectomy or bilobectomy increased the risk of air leak persisting for more than 7 days. A model was generated to calculate this risk and assist the surgeon in taking extra measures to prevent such complication (ie, optimizing bronchodilator treatment, pleural tent, sealants, buttressed staple lines, water seal, and chest tube drainage).
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End-organ malperfusion is a dreaded complication of type A aortic dissections. Different strategies have been proposed to manage this complex cohort of patients. Ideal management includes the rapid restoration of organ perfusion while avoiding catastrophic rupture and tamponade. We present our experience with primary aortic repair as the optimal method of patient management. ⋯ Patients with malperfusion in the setting of acute type A dissection should undergo immediate aortic reconstruction as the primary means of reestablishing end-organ perfusion. Early postoperative intervention for persistent deficits leads to a gratifyingly high rate of end-organ salvage.
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Whether the bidirectional Glenn procedure is better performed without the support of cardiopulmonary bypass is still a matter for debate. In this paper we discuss the indications and methods for bidirectional Glenn shunt without cardiopulmonary bypass. ⋯ The adverse effects of cardiopulmonary bypass could be eliminated by this method. This is an advantage during the postoperative recovery, but patients should be strictly chosen.
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Editorial Comment
The Society of Thoracic Surgeons Practice Guidelines.