Seminars in thoracic and cardiovascular surgery
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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.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewThe state of the art in the technical performance of lung-sparing operations for malignant pleural mesothelioma.
Malignant pleural mesothelioma remains an incurable disease for which the role of surgery remains controversial. Though not yet clearly defined there does appear to be a subset of patients who benefit from a surgery-based multimodal treatment plan, beyond what would be expected with current nonoperative therapies. As with other pleural cancers it is probably not possible to achieve a microscopic complete resection with any operation. ⋯ Many of these cases involved bulky cancers, some exceeding two liters in volume, and often with extensive invasion of the pulmonary fissures. With the described technique there has not yet been an instance where conversion to extrapleural pneumonectomy would have contributed to the ability to achieve a macroscopic complete resection. Whether or not radical pleurectomy is the optimal approach for any or all patients undergoing surgery-based multimodal treatment for malignant pleural mesothelioma is not known, but the described technique does offer an operation that can serve as a consistent foundation for any surgery-based treatment strategy where achieving a macroscopic complete resection, while sparing the lung, is desired.