Seminars in thoracic and cardiovascular surgery
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The purpose of this paper is to review the current literature and practice of the Ross concept of using the autologous pulmonary valve to replace a diseased aortic valve. The potential advantages and disadvantages of these operations will be evaluated in the context of alternative options and relative risks. ⋯ Long-term outcomes will be described to the extent these are available, including recent publications describing a survival advantage for the Ross. Brief discussions will be presented regarding hemodynamics, child-bearing, endocarditis, and the use of the Ross in pediatric patients as well as biological adaptability of the living pulmonary autograft.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2011
ReviewCurrent surgical therapy for stage IIIA (N2) non-small cell lung cancer.
Local therapy alone (surgery or radiation) leads to poor overall survival in patients with stage III non-small cell lung cancer because most of these patients die of distant metastases. During the past 20 years, studies have focused on developing effective chemotherapy regimens that can be combined with local therapies (surgery and/or radiation). The role of surgery has been evaluated, and the selection criteria for resection have been defined.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2011
Ex vivo lung perfusion and extracorporeal life support in lung transplantation.
Normothermic ex vivo lung perfusion and extracorporeal life support have re-invigorated lung transplantation.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2011
Hybrid video-assisted thoracic surgery basilar (S9-10) segmentectomy.
We perform segmentectomy for patients with cT1N0 non-small cell lung cancer (NSCLC) of 2 cm or less, even in good-risk patients. Hilar dissection and intersegmental dissection are performed by using mainly direct visualization through the access thoracotomy, which is called hybrid video-assisted thoracic surgery (VATS). ⋯ With this method, the segment to be removed can be inflated, while the segments to be preserved are kept deflated. When the intersegmental plane is being divided by electrocautery, direct visualization during the hybrid VATS approach is extremely important, because a 3-dimensional understanding of the pulmonary anatomy is crucial to avoid ambiguous procedures.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2011
ReviewWatchful waiting for severe mitral regurgitation.
Watchful waiting is an established treatment strategy for asymptomatic patients with severe organic mitral regurgitation. It is based on indications for surgery that are based on current European Society of Cardiology and American Heart Association/American College of Cardiology guideline recommendations, which are defined by symptom onset, impairment of left ventricular function, and left ventricular enlargement. ⋯ There is an ongoing debate about whether surgery should be performed in asymptomatic patients with preserved ventricular function. Ultimately, decision-making needs to be individualized and to take individual patient-related factors and local resources (including the natural history of the disease, the risk of surgery, and the likelihood of successful mitral valve repair) into consideration to obtain an optimal outcome with medical and surgical management.