European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2018
Surgery for acute Type I aortic dissection without resection of supra-aortic entry sites leads to unfavourable aortic remodelling.
This study aimed to evaluate the impact of remnant re-entries in arch branches on postoperative change in the aortic arch and descending aortic diameters and the rate of major adverse aortic events. ⋯ Remnant SAE leads to unfavourable aortic remodelling after acute Type I aortic dissection repair.
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Eur J Cardiothorac Surg · Jul 2018
Second cross-clamping after mitral valve repair for degenerative disease in contemporary practice.
Scanty data are available on 'second cross-clamping' following mitral valve repair in contemporary practice. The aim of this study was to evaluate the incidence, causes and outcomes of this event in patients referred for mitral repair for severe degenerative mitral regurgitation (MR). ⋯ In a large volume centre for mitral repair, a second cross-clamping is still performed in 3-5% of the patients. Because suboptimal immediate results are associated with impaired late outcomes of mitral reconstruction, a low threshold for a second cross-clamping seems to be justified. If the second repair is carried out with a relatively shorter additional cross-clamping time, mortality and morbidity are not increased and immediate and long-term results are very satisfactory.
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Eur J Cardiothorac Surg · Jun 2018
Direct axillary cannulation with open Seldinger-guided technique: is it safe?
Axillary artery cannulation is commonly used in thoracic aortic surgery, often utilizing a sidearm graft. Although our institutional preference is femoral cannulation, we use axillary cannulation in select cases with a 'dirty' aorta on computed tomography scan or intraoperative transoesophageal echocardiography. Since 2011, we have routinely used an open Seldinger-guided approach for axillary cannulation. Here, we report our experience with open Seldinger-guided technique, evaluating its safety and efficacy. ⋯ The open Seldinger-guided technique for axillary artery cannulation is safe and effective. We strongly recommend this technique, given its speed and simplicity. The vessel is not snared, thereby preserving distal arterial flow and minimizing the risk of acute limb ischaemia. Furthermore, the limited manipulation of the artery lowers the risk of local complications.
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Eur J Cardiothorac Surg · Jun 2018
Nomogram prediction of overall survival for patients with non-small-cell lung cancer incorporating pretreatment peripheral blood markers.
The objective of this study is to build a novel prognostic nomogram in non-small-cell lung cancer (NSCLC) incorporating pre-treatment peripheral blood markers beyond known pathoclinical predictors. ⋯ The proposed nomogram incorporating peripheral blood markers and known prognostic factors could accurately predict individualized survival probability of patients with NSCLC. It could be used in treatment planning and stratification in clinical trials.
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Eur J Cardiothorac Surg · May 2018
Nasal high-flow oxygen therapy improves arterial oxygenation during one-lung ventilation in non-intubated thoracoscopic surgery.
Intraoperative hypoxaemia during one-lung ventilation (OLV) remains a major concern in thoracic surgery. Non-intubated video-assisted thoracic surgery (VATS) involves a greater risk of consequent emergent conversion to endotracheal intubation. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) has recently been reported to be beneficial for higher oxygen reserves during difficult intubations and for enhancing postoperative recovery after thoracic surgery. However, the effects of THRIVE on oxygenation and carbon dioxide elimination before and during OLV in non-intubated VATS have not been investigated. ⋯ The results indicated that THRIVE effectively increases the oxygen reserve both during OLV and after anaesthesia. Furthermore, non-intubated VATS is safer if THRIVE with flow adjustment is incorporated into a minimally invasive surgical approach, although carbon dioxide elimination is not facilitated.