European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · May 2014
Minimally invasive oesophagectomy more expensive than open despite shorter length of stay.
The minimally invasive oesophagectomy (MIO) approach offers a number of advantages over open approaches including reduced discomfort, shorter length of stay and a faster recovery to baseline status. On the other hand, minimally invasive procedures typically are longer and consume greater disposable instrumentation, potentially resulting in a greater overall cost. The objective of this study was to compare costs associated with various oesophagectomy approaches for oesophageal cancer. ⋯ The operating theatre costs associated with minimally invasive oesophagectomy are significantly higher than OTT or OTH approaches. Unfortunately, a shorter hospital stay after MIO does not consistently offset higher surgical expense, as total hospital costs trend higher in the MIO patients. In an increasingly strained health care economy, efforts to reduce costs associated with the minimally invasive approach should address the inpatient hospitalization as well as operating theatre expenses.
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Eur J Cardiothorac Surg · May 2014
The use of robotic endovascular catheters in the facilitation of transcatheter aortic valve implantation.
The use of transcatheter aortic valve implantation (TAVI) is rapidly increasing with advances in technology and improved clinical outcomes. Adoption of robotic catheter technologies could have a role in TAVI, in different stages of the procedure, to improve endovascular tool manipulation and potentially reduce the risk of cerebral embolization. The aim was to determine whether there are advantages in using a robotic catheter for TAVI in the initial stages of the procedure; aortic arch navigation and valve crossing. ⋯ Use of robotic catheter technology is feasible in the initial stages of TAVI. Although it takes longer, robotic navigation reduces contact with the aortic arch wall, potentially reducing the embolic risk during endovascular manipulation. Using a robotic catheter is possible without increasing the number of wall-hits during valve crossing. This may provide a stable platform for wire positioning in the ventricle. With improvements in technology, perhaps allowing valve deployment, the stability and accuracy of the robotic arm may further improve performance.
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Eur J Cardiothorac Surg · May 2014
Modified Nikaidoh procedure for the correction of complex forms of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction: mid-term results.
Different surgical techniques for the treatment of complex transposition of the great arteries (TGA) with ventricular septal defect and left ventricular outflow tract obstruction (LVOTO) have been developed, in particular the Rastelli operation, the réparation à l'étage ventriculaire procedure and the Nikaidoh procedure. The hitherto published results of the Nikaidoh procedure and its modifications compare favourably with those of other techniques; however, experience with the Nikaidoh procedure is still limited. Here, we report our institutions' early and mid-term results with modifications of the Nikaidoh procedure. ⋯ The aortic translocation procedure is a valuable surgical option for patients with complex (TGA) with ventricular septal defect and LVOTO. The mid-term results document excellent performance of the reconstructed LVOT. Modifications of the Nikaidoh procedure that preserve pulmonary valve tissue may further reduce the need for right ventricular outflow tract reoperation.
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Eur J Cardiothorac Surg · May 2014
Haemodynamic outcome at four-dimensional flow magnetic resonance imaging following valve-sparing aortic root replacement with tricuspid and bicuspid valve morphology.
To provide a more complete characterization of aortic blood flow in patients following valve-sparing aortic root replacement (VSARR) compared with presurgical cohorts matched by tricuspid and bicuspid valve morphology, age and presurgical aorta size. ⋯ VSARR restored a cohesive flow pattern independent of native valve morphology but resulted in increased peak velocities throughout the aorta. 4D flow MRI methods can assess the clinical implications of altered aortic flow dynamics in patients undergoing VSARR.
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Eur J Cardiothorac Surg · May 2014
Practice GuidelineEuropean guidelines on structure and qualification of general thoracic surgery.
To update the recommendations for the structural characteristics of general thoracic surgery (GTS) in Europe in order to provide a document that can be used as a guide for harmonizing the general thoracic surgical practice in Europe. ⋯ This document will hopefully represent the first step of a process of revision of the modern thoracic surgeons' curricula, which need to be qualitatively rethought in the setting of the qualification process. The structural criteria highlighted in the present document are meant to help and tackle the challenge of cultural and language barriers as well as of widely varying national training programmes.