The Annals of thoracic surgery
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Because the traditional open lung approach with en bloc chest wall resection carries substantial risk for complications and death, we studied our thoracoscopic approach for this operation. ⋯ Thoracoscopic chest wall resection was feasible, expanded our case selection, and reduced prosthetic reconstruction. It did not, however, protect frail, elderly patients reliably. Briefer, less traumatic operations may be needed for this cohort.
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The use of mechanical assist devices has been established as an effective therapy for patients with end-stage heart failure. Implantable left ventricular assist devices are becoming more common in the clinical practice of cardiac surgery. This report illustrates the use of a HeartMate II (Thoratec Pleasanton, CA) left ventricular assist device in a patient with a single lung and dilated cardiomyopathy. To our knowledge, this is the first report of a left ventricular assist device placement in a patient with a prior pneumonectomy.
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Preoperative Aspirin Use and Its Effect on Adverse Events in Patients Undergoing Cardiac Operations.
Preoperative aspirin use within 5 days of cardiac operations is controversial. Aspirin could reduce cardiovascular complications and yet might increase risk of bleeding. Recent reports showed conflicting results, and whether aspirin has variable effects for different cardiac surgical procedures is unclear. ⋯ Preoperative aspirin use in all patients undergoing cardiac operations was not associated with risks of major cardiac, cerebral, or renal complications and infections and death; however, the risk of reoperation for bleeding was elevated among preoperative aspirin users compared with nonusers in a subpopulation of patients undergoing valve operations only.
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Endobronchial ultrasound (EBUS) is the preferred minimally invasive technique for the evaluation of intrathoracic lymphadenopathy. Enlarged lymph nodes on computed tomography (CT) are defined as those 1 cm or larger in short-axis diameter. Whether there is agreement between the measurements of lymph node size on CT and EBUS remains unknown. ⋯ Despite a significant correlation between CT of the chest and EBUS for measuring the size of intrathoracic lymph nodes, the limits of agreement were fairly wide enough to be clinically acceptable for allowing the use of the two modalities interchangeably for this purpose.
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Case Reports
CorMatrix Extracellular Matrix Used for Valve Repair in the Adult: Is There De Novo Valvular Tissue Seen?
Decellularized extracellular matrix from porcine intestinal submucosa is available as an approved material for the repair of tissues including cardiac structures. Although pathologic findings of explanted CorMatrix (CorMatrix Cardiovascular, Inc, Roswell, GA) used for valvular repair have been reported in the pediatric population, there is a paucity of data in the adult population. Herein, we report the histologic changes in explanted CorMatrix from 2 adults at 10 and 18 months post-implant.