The Annals of thoracic surgery
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Multicenter Study Comparative Study
Endoscopic management of idiopathic tracheal stenosis.
Idiopathic tracheal stenosis (ITS) is a rare condition representing a difficult therapeutic challenge. Endoscopic management is a therapeutic option but long-term results are not established. The aim of this retrospective multicenter study was to analyze long-term outcome after endoscopic management of ITS. ⋯ Endoscopic management of ITS provides a safe and efficient therapeutic option but late recurrences are frequent and require long-term follow-up.
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The management of bronchial fistula associated with acute lung injury raises two major concerns: (1) high ventilation pressures are necessary for lung recruitment but detrimental for fistula healing, and (2) adequate lung recruitment is prevented by large air leak. Primary surgical closure of bronchial fistula should be attempted but is rarely successful during mechanical ventilation. We sought to evaluate the efficacy of extracorporeal membrane oxygenation associated with lung-protective ventilation in case of failure of conventional management. ⋯ If correctly timed, extracorporeal membrane oxygenation can provide a therapeutic bridge to lung-protective ventilation and allow bronchial fistula healing in case of refractory respiratory failure.
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Comparative Study
Fate of functional mitral regurgitation and predictors of persistent mitral regurgitation after isolated aortic valve replacement.
There are no clear guidelines in regard to optimal management of functional mitral regurgitation (MR) in patients undergoing aortic valve replacement (AVR). This study evaluated changes in functional MR and determined predictors of persistent MR after isolated AVR. ⋯ Functional MR improved in most patients after AVR alone. Postoperative persistent MR affects long-term survival in functional MR. Preoperative RV systolic pressure is an independent risk factor predicting persistent MR.
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Comparative Study
Staged approach prevents spinal cord injury in hybrid surgical-endovascular thoracoabdominal aortic aneurysm repair: an experimental model.
In a porcine model, we investigated the impact of sudden stent graft occlusion of thoracic intercostal arteries after open lumbar segmental artery (SA) ligation. ⋯ These results underline the potential of the staged approach in hybrid procedures. Furthermore they highlight the need for established adjuncts for preventing paraplegia in hybrid and pure stent-graft protocols in which sudden occlusion of multiple SAs occurs.
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Comparative Study
Endobronchial-ultrasound guided miniforceps biopsy of mediastinal and hilar lesions.
Linear array endobronchial ultrasound (EBUS) has greatly improved the diagnostic yield of transbronchial needle aspiration (TBNA) for the diagnosis of non-small cell lung carcinoma though its yield in granulomatous disease and lymphoproliferative disorders is less robust. The EBUS-miniforceps biopsy (MFB) uses miniforceps and the convex probe EBUS bronchoscope to obtain forceps biopsies of centrally located lesions under continuous ultrasound guidance. In this prospective study we evaluate the efficacy of this technique for diagnosing mediastinal and hilar abnormalities in patients with a low suspicion for non-small cell lung carcinoma. ⋯ The EBUS-miniforceps biopsy is an effective, safe, and efficient method of obtaining histopathologic specimens from mediastinal and hilar abnormalities in patients with a low likelihood of non-small cell lung carcinoma, particularly when the technique is combined with EBUS-TBNA.