Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewCoronary artery bypass graft surgery remains the standard of care for patients with diabetes.
Coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) are proven effective treatments of coronary artery disease (CAD), however, the optimal revascularization strategy remains unclear in certain patient subsets. The recently published "Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM)" trial is a randomized study evaluating the use of CABG vs PCI in diabetic patients with multivessel coronary disease. The purpose of this editorial is to review the FREEDOM trial and the available literature guiding clinicians to make evidence-based decisions when treating diabetic patients with multivessel coronary disease. The current evidence suggests that CABG should remain the standard of care for this patient population.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewOpen aortic arch repair: state-of-the-art and future perspectives.
Surgical procedures for the treatment of complex aortic arch pathology remain among the most challenging cardiovascular operations, incurring considerable risk for death and stroke. The purpose of this article is to describe the evolution of our approach to open repair of the aortic arch. ⋯ Modifications in surgical technique, including arch reconstruction with the trifurcated graft, and the classical and frozen elephant trunk techniques have simplified the conduct of the operation. Experimental and clinical research supporting the evolution of our approach is discussed in this paper.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewThe state of the art in preventing postthoracotomy pain.
Pain after thoracic surgery can be intense and prolonged. Inadequate pain management can have several detrimental effects, including increased postoperative morbidity and delayed recovery as well as occurrence of postthoracotomy syndrome. Therefore, establishing an adequate analgesic regimen for thoracic surgery is critical. ⋯ When these techniques are either contraindicated or not possible, intercostal analgesia or intrathecal opioids are recommended. These techniques should be combined with nonopioid analgesics, such as acetaminophen, nonsteroidal anti-inflammatory drugs, or cyclooxygenase-2-specific inhibitors, administered on a regular "round-the-clock" basis, with opioids used as "rescue" analgesics. Finally, the integration of multimodal analgesia techniques with multidisciplinary rehabilitation program can enhance recovery, reduce hospital stay, and facilitate early convalescence.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewArtificial lung and novel devices for respiratory support.
There is a growing demand for new technology that can take over the function of the human lung, whether it is to assist an injured or recently transplanted lung or to completely replace the native lung. The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation was reported for the first time more than 3 decades ago; nevertheless, its use in lung transplantation was largely abandoned owing to poor patient survival and frequent complications. ⋯ The use of ECMO is now being considered in awake and nonintubated patients so as to improve oxygenation, facilitate ambulation, and improve physical conditioning before transplant. Several programs have developed ambulatory capability of most forms of ECMO, and ambulatory ECMO is now often referred to as the "artificial lung." We present a brief description of the evolution of the use of ECMO in lung transplantation and summarize the available technology and current approaches to provide ECMO support.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewSurgical treatment of hypertrophic cardiomyopathy.
Hypertrophic cardiomyopathy (HCM) is a unique primary myocardial disease characterized by unexplained left ventricular hypertrophy in absence of another etiology. One of the key features is the presence of systolic anterior motion of the anterior leaflet of the mitral valve which causes left ventricular outflow tract obstruction with various degrees of mitral valve regurgitation. Surgical septal myectomy is the preferred treatment of choice if medical treatment is unsuccessful or intolerable. We summarize in this review the available treatment options for HCM.