The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Aug 2012
Beating heart surgery via right thoracotomy for reoperative mitral valve surgery: a safe and effective operative alternative.
Right thoracotomy using ventricular fibrillation with cooling has been used for redo mitral valve surgery. This approach avoids the complications of redo sternotomy, such as injury to prior grafts and hemorrhage. As a further refinement, we have used a beating heart technique to further minimize complications while simplifying the operation. ⋯ As reoperative cardiac surgery continues to increase, techniques that safely facilitate operation while improving outcome should be adopted. As an operative alternative, redo right thoracotomy mitral valve surgery on the beating heart is associated with shorter bypass time, less transfusion requirements, shorter postoperative ventilation, and lower mortality. This safe and effective approach should be considered for this complex operation.
-
J. Thorac. Cardiovasc. Surg. · Aug 2012
Case ReportsThe "growing teratoma syndrome" in primary mediastinal nonseminomatous germ cell tumors: criteria based on current practice.
Criteria for the growing teratoma syndrome in patients with primary mediastinal nonseminomatous germ cell tumors have not been well established according to current practice. ⋯ The growing teratoma syndrome should be defined not only as a growing mediastinal mass but also with secondary cardiopulmonary deterioration precluding safe completion of planned chemotherapy in the presence of declining serum tumor markers. Prompt recognition of this syndrome, discontinuation of chemotherapy, and surgical intervention can result in cure.
-
J. Thorac. Cardiovasc. Surg. · Aug 2012
Reduction of sternal wound infections in diabetic patients undergoing off-pump coronary artery bypass surgery and using modified pedicle bilateral internal thoracic artery harvest technique.
We compared sternal wound infections between diabetic patients undergoing off-pump coronary artery bypass surgery using bilateral internal thoracic artery grafting or single internal thoracic artery grafting and nondiabetic patients receiving bilateral internal thoracic artery or single internal thoracic artery grafting using a modified pedicled harvest technique of internal thoracic artery. ⋯ The results of the present study show that there is no increase in the incidence of sternal wound infections in diabetic patients undergoing coronary artery bypass surgery with bilateral internal thoracic artery grafting by using a modified pedicle bilateral internal thoracic artery harvesting technique with sparing of the communicating bifurcation of internal thoracic artery to the chest wall and preservation of pericardiacophrenic artery branch.
-
J. Thorac. Cardiovasc. Surg. · Aug 2012
Gene polymorphisms and cytokine plasma levels as predictive factors of complications after cardiopulmonary bypass.
Cardiopulmonary bypass remains associated with significant morbidity and mortality, in part caused by a systemic inflammatory response that is unpredictable and variable among patients. Several limited studies have suggested associations of cytokine plasma levels or gene polymorphisms with outcome after cardiopulmonary bypass. The present study was to determine the relationships between several circulating cytokines and their polymorphisms (single nucleotide polymorphisms), and the occurrence of postoperative clinical events in patients who underwent coronary artery bypass grafting under cardiopulmonary bypass. ⋯ Our data suggest that focused genetic testing of the IL6-572G>C and IL10-592C>A single nucleotide polymorphisms might be a tool for identifying patients at the highest risk of poor tolerance to the inflammatory response to cardiopulmonary bypass and for implementing strategies to mitigate it, provided the generalization of these tests makes them reasonably affordable and thus favorably shifts their cost-to-benefit ratio.
-
J. Thorac. Cardiovasc. Surg. · Aug 2012
Effects of gender and ethnicity on outcomes after aortic valve replacement.
To evaluate the clinical outcomes after aortic valve replacement or aortic valve replacement and coronary artery bypass grafting in a large contemporary population, and to determine if outcomes are associated with patient ethnicity and gender status. ⋯ Ethnicity and gender were not associated with greater 30-day and 1-year mortality after aortic valve replacement or aortic valve replacement and coronary artery bypass grafting. Differences in postoperative outcomes were not observed between ethnic groups.