European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 2011
The management of post-intubation tracheal stenoses with self-expandable stents: early and long-term results in 11 cases.
The optimal management of post-intubation tracheal stenoses is surgical reconstruction of the airway. Stenting of the trachea using silastic T-tubes or one of the various types of tracheal stents are the alternative ways to surgical reconstruction for the management of post-intubation tracheal stenoses. The early and long-term results of 11 patients with post-intubation tracheal stenosis, who underwent tracheal stenting with self-expandable metallic stents (SEMSs), are presented. ⋯ The application of SEMS in post-intubation tracheal stenoses results in immediate improvement of obstructive symptoms without significant perioperative complications. SEMSs have the potential risks of migration and of granulation tissue formation at the end of the stent. SEMS should be applied only in strictly selected patients with post-intubation tracheal stenosis, who are considered unfit for surgery and/or with limited life expectancy.
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Eur J Cardiothorac Surg · Oct 2011
Randomized Controlled TrialThe efficacy of paravertebral block using a catheter technique for postoperative analgesia in thoracoscopic surgery: a randomized trial.
The analgesic scheme combining paravertebral block (PVB) and intravenous non-steroidal anti-inflammatory drug (NSAID) has proven to be effective for postoperative pain control after thoracotomy. The hypothesis tested in this study was that this policy was also suitable to improve pain control after video-assisted thoracic surgery (VATS). ⋯ The analgesic regimen combining PVB and NSAID provided an excellent level of pain control. Thoracoscopy assisted positioning of the paravertebral catheter is simple and effective, and allows direct visualization of correct delivery of local anesthetic. It represents a valuable addition to any VATS procedure.
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Eur J Cardiothorac Surg · Oct 2011
Multicenter StudyTraining in mitral valve surgery need not affect early outcomes and midterm survival: a multicentre analysis.
Mitral valve surgery may be regarded as less favourable for training, due to greater mortality risk, technical complexity, and difficulty for the supervisor to observe. We examined this perception by reviewing a multicentre experience. ⋯ Trainee outcomes are not inferior even when corrected for risk. This suggests that excellent operative training and supervision can be achieved in mitral valve surgery.
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Eur J Cardiothorac Surg · Oct 2011
Awake coronary artery bypass grafting under thoracic epidural anesthesia: great impact on off-pump coronary revascularization and fast-track recovery.
The ultimate goal of minimally invasive coronary artery bypass grafting (CABG) is day surgery. We evaluated the potential of a new awake CABG protocol using only epidural anesthesia in realizing day surgery. ⋯ Despite the presence of severe preoperative comorbidities in this series, good surgical outcome was obtained. Almost all the patients were able to drink water and walk very soon after surgery, suggesting the potential of this protocol as one-day or day surgery. Awake OPCAB is a promising modality of ultra-minimally invasive cardiac surgery.