European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jun 2012
Comparative StudyMediastinal lymph node dissection in early-stage non-small cell lung cancer: totally thoracoscopic vs thoracotomy.
Although major pulmonary resections for early-stage non-small cell lung cancer (NSCLC) are more and more frequently performed through thoracoscopy, the adequacy of lymphadenectomy achieved via this approach is still questioned. The aim of this study was to evaluate the results of lymph node dissection (LND) during totally thoracoscopic (TT) major pulmonary resections. ⋯ For patients undergoing thoracoscopic lobectomy or segmentectomy for clinical early-stage NSCLC, the quality of mediastinal LND is equivalent to that performed by thoracotomy.
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Eur J Cardiothorac Surg · Jun 2012
Does listing for heart transplant for longer than 30 days before ventricular assist device implantation influence utilization of psychotherapeutic support and outcome?
Previous studies indicate that patients with mechanical ventricular assist devices (VADs) experience high psychosocial and emotional distress. Listing for transplant may trigger psychosocial adjustment to the transplantation as an upcoming critical life-event. We hypothesized that patients could profit from this adaptation when implantation of a VAD becomes necessary. ⋯ Our data indicate that listing for HTX for >30 days before VAD implantation does not reduce the utilization of psychotherapeutic support by VAD patients. We assume that structured emotional and psychosocial support by the interdisciplinary VAD team, including professional supportive psychotherapy, is indispensable for successful coping of VAD patients and their families.
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Eur J Cardiothorac Surg · Jun 2012
Ventricular assist device implantation in patients on percutaneous extracorporeal life support without switching to conventional cardiopulmonary bypass system.
Ventricular assist device (VAD) implantation using cardiopulmonary bypass (CPB) is an established procedure. However, the well-described complications of CPB may exacerbate multiple organ failure and increase blood product transfusions especially in end-stage heart failure patients. ⋯ Our experience suggests that VAD implantation using percutaneous ECLS without switching to conventional CPB is a safe alternative in the bridge to bridge concept, especially in high-risk patients with cardiogenic shock who would benefit from the avoidance of the adverse sequels associated with conventional CPB.
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Eur J Cardiothorac Surg · Jun 2012
Aortic valve calcium scoring is a predictor of significant paravalvular aortic insufficiency in transapical-aortic valve implantation.
Transapical-aortic valve implantation (TA-AVI) has evolved as routine for selected high-risk patients. However, paravalvular leaks >1+ remain an unsolved issue using current generations of transcatheter valve devices. The purpose of this study was to investigate the impact of native aortic valve calcification on paravalvular leaks and outcomes using the Edwards SAPIEN™ prosthesis. ⋯ Severe native valve calcifications are predictive for postoperative relevant paravalvular leak. AVCS prior to TA-AVI might serve as an additional tool to reconsider the TAVI indication to reduce the risk of paravalvular leaks especially in so-called operable patients.
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Eur J Cardiothorac Surg · Jun 2012
Multicenter Study Clinical TrialTransapical transcatheter aortic valve implantation using the JenaValve™ system: acute and 30-day results of the multicentre CE-mark study.
Transcatheter aortic valve implantation (TAVI) has shown promising results in patients with severe aortic stenosis (AS) at high risk for conventional heart surgery. The safety and efficacy of transapical aortic valve implantation using the JenaValve™, a second-generation TAVI device, were evaluated. The system consists of a tested porcine root valve mounted on a nitinol stent with feeler-guided positioning and clip fixation on the diseased leaflets. ⋯ Transapical JenaValve™ implantation was safe and effective in the treatment of severe AS in elderly patients at high risk for surgery. Active clip fixation on the native leaflets and anatomically correct feeler-guided positioning led to good functionality and prevented ostial coronary impairment. Implantation without the need for rapid pacing prevented haemodynamic compromise during valve implantation.