Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
Current status of left ventricular assist device technology.
The use of long-term left ventricular assist devices (LVADs) has revolutionized the treatment of end-stage heart failure. The most significant advance in this field has been the longer durability of devices secondary to a simpler pump design with fewer or no mechanical bearings and valves. ⋯ As LVAD technology moves forward and new miniaturized, more durable, and reliable pumps are being developed, the number of recipients who will benefit from this technology continues to grow. Elimination of the driveline with fully implantable pumps, implantation of miniature pumps with minimally invasive surgical techniques, wireless data transmission, and improved patient selection will further transform this field in the next few years.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewHow to follow up patients after curative resection of lung cancer.
Survivors of lung cancer surgery are among the highest-risk patients for developing another lung cancer, yet there is no clear consensus on the method of surveillance for patients after curative surgical resection. Surveillance is no longer futile because the emergence of computed tomography screening has allowed the detection of recurrences and new metachronous cancers at an early stage. In selected patients, lung cancer identified recently on routine computed tomography scan is amenable to curative treatment and is associated with longer survival.
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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 management of tetralogy of fallot: in defense of the infundibulum.
Surgical treatment of the Tetralogy of Fallot (ToF) is one of the great successes of medicine and also a topic of controversy. Different strategies have been proposed, including age-based (neonatal) management strategies as well as anatomic-based management strategies. ⋯ The goals of current surgical therapy should be to mitigate the late right ventricular (RV) dysfunction that may occur by minimizing the extent of surgical injury during the intial repair. As the surgical techniques continue to advance, the outcomes will continue to improve.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewCurrent readings: sublobar resection for non-small-cell lung cancer.
The Lung Cancer Study Group consensus recommending lobectomy for stage I non-small-cell lung cancer (NSCLC) to reduce local recurrence associated with sublobar resections has directed NSCLC care since its 1995 publication. However, enhancements in imaging technology and in our understanding of the molecular biology of NSCLC over the past 2 decades have produced large cohorts of patients with smaller, better staged, and more indolent tumors than evaluated by the Lung Cancer Study Group. Numerous single-institution trials have demonstrated that in well-selected patients, sublobar resection can afford comparable survival and recurrence rates with lobectomy with a more favorable risk profile. This review of recent literature will focus on 2 separate issues with regard to the use of sublobar resections for stage I NSCLC: (1) a comparison to nonoperative ablative therapies in medically unfit patients, and (2) identifying in which subset of the noncompromised standard-risk population, sublobar resections provide equivalent outcome to lobectomy.