The Annals of thoracic surgery
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In addition to severe hypoxia and hypercapnia, acute respiratory distress syndrome (ARDS) can present with substantial hemodynamic compromise, requiring inotropic or vasopressor support or both. Either venovenous (VV) or venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can be offered in this situation. However, a contemporary comparison of these two cannulation strategies has yet to be well described. ⋯ In this review of ARDS patients requiring pre-ECMO hemodynamic support, VV ECMO was not associated with worse survival or complication rates compared with VA ECMO. These data suggest that, in appropriately selected patients, it may be reasonable to initially institute VV ECMO support, reserving VA ECMO for conversion for refractory hypotension.
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Clamshell (bilateral anterolateral thoracotomy combined to transverse sternotomy) is an invasive surgical approach that is helpful in particular situations, especially bilateral lung transplantation. The closure technique remains challenging because clamshell incision can end with override, separation, or sternal pseudarthrosis complications. We describe the use of new absorbable sternal pins to stabilize the sternal closure and to help avoid additional sternal complications.
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Tricuspid regurgitation (TR) often accompanies ischemic mitral regurgitation and is generally assumed to be a secondary consequence of altered hemodynamics of the left-sided regurgitation. We hypothesized that it may also be a direct consequence of right-sided ischemic disease. Therefore, our objectives were to (1) characterize the nature of this TR and (2) describe its time course after mitral valve surgery for ischemic mitral regurgitation, with or without concomitant tricuspid valve repair. ⋯ Tricuspid regurgitation accompanying ischemic mitral regurgitation is associated with right-side heart remodeling and dysfunction often mirroring that occurring in the left side of the heart-ischemic TR. Tricuspid valve repair is effective initially, but as with mitral valve repair, TR progressively returns. Therefore, when the severity of TR and right-sided remodeling reaches the point of irreversibility, it may be an indication to eliminate the TR by replacing the tricuspid valve.
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Review
Clinical Trials in Thoracic Surgery: A Report From Ginsberg Day 2017 and Early Risers at STS 2017.
No unified source lists clinical trials relevant to general thoracic surgery. This description summarizes the current offerings across the National Cancer Institute Cooperative Group-sponsored clinical trials, and includes trials involving surgery for lung cancer and esophageal cancer, and in some instances, perioperative management of patients undergoing thoracic surgery.
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Multicenter Study
Coronary Artery Bypass Graft Surgery Using the Radial Artery, Right Internal Thoracic Artery, or Saphenous Vein as the Second Conduit.
It is not clear whether radial artery (RA), right internal thoracic artery (RITA), or saphenous vein (SV) is the preferred second bypass graft during coronary artery bypass graft surgery using the left internal thoracic artery (LITA) in patients aged less or greater than 70 years. ⋯ For patients aged less than 70 years, the optimal grafting strategy is using either RA or RITA as the second preferred graft. In patients aged 70 years or more, RA and RITA grafting should be used selectively. Multiple arterial grafting using either RA or RITA should be more widely utilized during coronary artery bypass graft surgery for patients less than 70 years of age.