European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Sep 2012
Randomized Controlled Trial Multicenter Study Comparative StudyComplications following lung surgery in the Dutch-Belgian randomized lung cancer screening trial.
To assess the complication rate in participants of the screen arm of the NELSON lung cancer screening trial who underwent surgical resection and to investigate, based on a literature review, whether the complication rate, length of hospital stay, re-thoracotomy and mortality rates after a surgical procedure were different from those of the non-screening series, taking co-morbidity into account. ⋯ In conclusion, mortality rates after surgical procedures are lower in the NELSON lung cancer screening trial than those in the non-screening series. The rate of complications is within the same range as in the non-screening series.
-
Eur J Cardiothorac Surg · Sep 2012
Comparative StudyComparison of perioperative outcomes following open versus minimally invasive Ivor Lewis oesophagectomy at a single, high-volume centre.
With the increasing popularity of minimally invasive oesophageal resections, equivalence, if not superiority, to open techniques must be demonstrated. Here we compare our open and minimally invasive Ivor Lewis oesophagectomy (MIE) experience. ⋯ Open and MIE appear equivalent with regard to early oncological outcomes. A minimally invasive approach, however, appears to lead to a significant reduction in the rate of postoperative pulmonary complications. Length of ICU and hospital stay, as well as intraoperative blood loss and intravenous fluid requirements are also reduced in the setting of MIE. Long-term survival data will need to be followed closely. A large, multi-centred, randomized, controlled trial is warranted to confirm these results.
-
Eur J Cardiothorac Surg · Sep 2012
Comparative StudyAge and neo-adjuvant chemotherapy increase the risk of atrial fibrillation following oesophagectomy.
Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic strategies. ⋯ Despite the identification of age and neo-adjuvant chemotherapy as predictors of AF, the moderate discriminative ability of predictive modelling does not support the use of prophylactic anti-arrhythmic drugs. However, the high incidence of AF after major thoracic surgery makes it necessary to understand its underlying mechanisms better before prophylactic strategies are considered.
-
Eur J Cardiothorac Surg · Sep 2012
Comparative StudyRisk factors for post-transplant low output syndrome.
Due to a serious heart donor shortage, the criteria for acceptance for transplantation have been expanded. This study assesses donor-related factors associated with postoperative low output syndrome (LOS) and long-term survival of recipients. ⋯ Cautious donor selection is essential when the donor heart has a small ventricular diameter or requires a high level of inotropic support. However, long-term survival in recipients with marginal donor hearts can be anticipated with adequate treatment.
-
Eur J Cardiothorac Surg · Sep 2012
Case ReportsMassive haemoptysis on veno-arterial extracorporeal membrane oxygenation.
A 49-year old female presented with severe heart failure with end-organ dysfunction and was placed on veno-arterial extracorporeal membrane oxygenation (ECMO) as a bridge to a decision for end-organ recovery. While on ECMO, the patient developed massive haemoptysis after a Swan-Ganz catheter manipulation. The haemoptysis was not controllable by conventional methods including bronchoscopy with cold saline and epinephrine lavage, bronchial blocker or angiography. ⋯ After the haemoptysis resolved, the endotracheal tube was unclamped. The patient developed adult respiratory distress syndrome and was ventilated using the ARDSnet protocol with continued support from ECMO. On post-ECMO day 20, the patient underwent a successful ECMO wean and a Heart Mate II left ventricular assist device placement.