Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jul 2000
ReviewMinimally invasive approaches to acquired shortening of the esophagus: laparoscopic Collis-Nissen gastroplasty.
Acquired shortening of the esophagus remains a controversial finding. In some surgical series of patients with gastroesophageal reflux disease, the incidence of clinically significant shortening is low enough that some surgeons have questioned its existence. In the setting of massive hiatial hernia, esophageal shortening has been reported to occur in up to 100% of patients. ⋯ Failure to recognize this shortening may be responsible for a high failure rate after antireflux surgery. Open Collis gastroplasty is an effective way to manage acquired shortening of the esophagus, and it creates a tension-free intra-abdominal segment of neoesophagus for fundoplication. Minimally invasive approaches to Collis-Nissen procedures have been reported by our group and several others with good short-term results.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2000
Comparative StudyStroke prevention as an indication for the Maze procedure in the treatment of atrial fibrillation.
The Maze procedure has proven to be extremely effective in curing medically refractory atrial fibrillation. This analysis of our surgical results with the Maze procedure indicates that the Maze procedure, with or without associated cardiac surgery, has the lowest perioperative stroke rate of any major cardiac surgical procedure. ⋯ Only 1 patient has had a stroke in the 12-year follow-up period following the Maze procedure. This is comparable to the risk of stroke in the general population and indicates that the Maze procedure essentially abolishes the risk of stroke associated with atrial fibrillation.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2000
ReviewObservations on the perioperative management of patients undergoing the Maze procedure.
In addition to the usual measures that constitute optimal perioperative care after cardiac surgery, the Maze procedure demands several other measures because of certain complications that are unique to this particular operation. These complications include preoperative conditions such as amiodarone therapy, thromboembolism, diastolic dysfunction of the left ventricle, and associated valvular heart disease, as well as intraoperative differences that include multiple atriotomies and excision of both atrial appendages. The most common postoperative complications are atrial arrhythmias, excessive fluid retention, and pulmonary complications. In this article, we outline our own approach to the perioperative care of patients undergoing the Maze procedure.
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Semin. Thorac. Cardiovasc. Surg. · Oct 1999
Potential preoperative markers for the risk of developing atrial fibrillation after cardiac surgery.
Postoperative atrial arrhythmias after cardiac surgical procedures are common, with a reported overall incidence of approximately 50%. The pathophysiological mechanisms responsible for atrial fibrillation after a cardiac procedure remain unclear, although several clinical studies published during the past decade have identified certain preoperative risk factors associated with postoperative atrial fibrillation. In this study, we attempted to identify the histopathological changes in atrial cardiomyocytes that might predict the development of atrial fibrillation during the postoperative period. ⋯ The only clinical independent risk factor for the development of postoperative atrial fibrillation was chronic obstructive pulmonary disease (COPD) (P = .037). Histologically, there were 3 findings in the atrial myocardium that were more common in patients who developed postoperative atrial fibrillation: (1) vacuolation size (P = .017), (2) vacuolation frequency (P = .0136), and (3) lipofuscin content (P = .013). The identification of these histological markers for the development of postoperative atrial fibrillation may contribute not only to our understanding of the underlying pathophysiology that leads to postoperative atrial fibrillation but also to a method of preventing this troublesome complication of cardiac surgery.
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Semin. Thorac. Cardiovasc. Surg. · Oct 1999
ReviewA perspective on postoperative atrial fibrillation.
Some patients develop atrial fibrillation after any type of surgery, some patients develop atrial fibrillation only after cardiac surgery, and still other patients never develop postoperative atrial fibrillation. Despite the inherent difficulty in identifying the causes of postoperative atrial fibrillation, several important observations have been made during the recent past that may play a role in treating or even preventing this common and serious postoperative problem. This communication provides a framework within which the problem of postoperative atrial fibrillation can be evaluated and treated.