European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Sep 1999
Clinical TrialTotal thoracic oesophagectomy for oesophageal carcinoma: has it been worth it?
Anastomotic recurrence is a major cause of late mortality following oesophago-gastrectomy (OG) for carcinoma of the oesophagus and oesophago-gastric junction using either the Ivor Lewis or left thoraco-abdominal approach with intra-thoracic anastomosis. The aim of this study was to determine whether the more extensive total thoracic oesophagectomy (TTO) with cervical anastomosis would reduce the anastomotic recurrence rate while maintaining acceptable operative morbidity and mortality. ⋯ Total thoracic oesophagectomy can be performed in oesophageal cancer patients with comparable morbidity to that of lesser resections. Incomplete proximal resection and anastomotic recurrence did not occur in this series of 108 total thoracic oesophagectomies and this is reflected in an increased medium term survival. The improved survival is most apparent for tumours of the oesophago-gastric junction.
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Eur J Cardiothorac Surg · Sep 1999
Clinical TrialIndication and patient selection in minimally invasive and òff-pump' coronary artery bypass grafting.
The selection criteria to perform 'off-pump' coronary bypass (OPCAB) grafting are not well defined. The aim of this presentation is to outline the indications and the patient selection on the basis of 2 years experience with 572 OPCAB procedures. ⋯ To maintain excellent results after single LAD revascularization using the MIDCAB-approach, appropriate patient selection is crucial. Indication for sternotomy and 'off-pump' single LAD revascularization should made in those patients excluded for MIDCAB and in patients scheduled for multiple vessel-CABG who are at high risk for CPB (concomitant pulmonary, renal, neurological diseases or severely impaired left ventricular dysfunction) and have suitable target coronary arteries in term of location and quality.
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Eur J Cardiothorac Surg · Sep 1999
Case ReportsIntraoperative localisation and management of coronary artery fistula using transesophageal echocardiography.
Coronary artery fistula is a rare congenital malformation that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, coronary aneurysm and sudden death. Clinical symptomatology depends upon the underlying anatomy and the size of the fistulous connection between the left or right side of the heart. ⋯ Intraoperative transesophageal echocardiography with colour flow Doppler was used for precise location of the fistulous communication, selective demonstration of vessels feeding the fistula and documentation of abolition of fistulous flow all without the need for cardiopulmonary bypass. Furthermore the effect of shunt occlusion on regional wall motion was documented which facilitated the successful ligation of the fistula.
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Eur J Cardiothorac Surg · Sep 1999
Comparative Study Clinical TrialLocal control of disease and survival following bronchoplastic lobectomy for non-small cell lung cancer.
This study was designed to determine whether bronchoplastic resection could be an alternative to pneumonectomy in patients with operable primary lung cancer. ⋯ Bronchoplastic resections achieve local control and long-term survival comparable to standard resections in patients with stage I or II disease, and may be considered as a valuable alternative to pneumonectomy.
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Eur J Cardiothorac Surg · Sep 1999
Clinical TrialOff-pump arterial grafting: 125 cases using the Medtronic-Utrecht Octopus.
The use of arterial grafts in coronary bypass surgery requires a high degree of cardiac stabilization, traditionally achieved with cardiopulmonary bypass and cardioplegic arrest. The Medtronic-Utrecht Octopus has recently been developed as an advanced cardiac stabilization device, based on its unique suction method for regional epicardial immobilization and retraction. The objective of this study was to investigate the feasibility of using this device to enable total arterial revascularization on the beating, working heart. ⋯ The Octopus maintains excellent local cardiac immobilization--enabling the routine use of arterial grafts in off-pump coronary surgery. It allows easy access to anterior wall vessels on the heart, and relatively straightforward access to the posterior wall. Circumflex branches are graftable with careful case selection and adjunctive technical maneuvers.