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Mustafa Ozbaran, Tahir Yagdi, Cagatay Engin, Sanem Nalbantgil, Pelin Ozturk
OBJECTIVES: Standard implantation of the HeartWare left ventricular assist system is performed using the full sternotomy approach. However, successful implantation of left ventricular assist devices in patients with a previous median sternotomy, especially in high-risk patients, remains challenging. Herein, we compared the HeartWare left ventricular assist system implantation by thoracotomy with anastomosis of the outflow graft to the descending aorta with the standard sternotomy approach...
March 15, 2018: Interactive Cardiovascular and Thoracic Surgery
Diana Vargas, Carolina López, Edward Acero, Edgar Benitez, Angélica Wintaco, Jaime Camacho, Marisol Carreño, Juan Umaña, Daniela Jimenez, Said Díaz, Fernando Lizcano
The anatomical location of adipose tissue might have direct implications for its functionality and risk of cardiovascular disease. Adipose tissue surrounding blood vessels may be thermogenically more active in specific areas of the body, releasing substances that regulate vascular metabolism. In humans, the phenotypic characteristics of adipose tissue surrounding the aorta and the cardiovascular disease risk that it might entail remain largely unknown. Here, we compared thermogenesis-related molecular features of human periaortic adipose tissue samples with those of subcutaneous adipose tissue, obtained by sternotomy from 42 patients undergoing cardiovascular surgery...
2018: PloS One
Dario Amore, Roberto Scaramuzzi, Davide Di Natale, Carlo Curcio
The advantages of thymectomy as part of the treatment of myasthenia gravis has been demonstrated repeatedly in the literature. Both single-institution and multi-institution trials have shown robotic thymectomy to be safe, feasible and associated with better early clinical outcomes than the trans-sternal approach. Most reports have also documented the superiority of robotic technology in the dissection of the superior mediastinum over conventional thoracoscopy, thanks to instruments with more degrees of movement and freedom...
2018: Journal of Visualized Surgery
Carl A Johnson, Amber L Melvin, Brandon F Lebow, Amanda Yap, Peter A Knight
Aortic valve replacement through minimally invasive access is increasing. These procedures have several advantages over conventional sternotomy including decreased intensive care unit and hospital length of stay and decreased ventilation time. The right anterior mini-thoracotomy (RAM) approach is potentially attractive in that it completely spares the sternum leading to improved cosmesis, reduced blood loss, and improved patient satisfaction. However, this approach is underutilized due to anticipated technical challenges including difficulty with visualization and annular suture placement...
2018: Journal of Visualized Surgery
Carl A Johnson, Katherine L Wood, Amber L Melvin, Brandon F Lebow, Peter A Knight
Aortic root replacement is typically performed through a median sternotomy. The right anterior mini-thoracotomy approach has been shown to decrease hospital length of stay in aortic valve surgery when compared to sternotomy. This approach is rare in ascending aortic surgery due to technical challenges which include exposure and annular suture placement. Automated suturing technology is now available to facilitate the placement of annular sutures. The use of a camera greatly enhances visualization of the aortic root...
2018: Journal of Visualized Surgery
Hui Li, Miguel Castro, Pascal Haigron, Jean-Philippe Verhoye, Vito Giovanni Ruggieri
PURPOSE: Minimally invasive aortic valve replacement (MIAVR) procedures remain more complex and technically challenging compared to conventional full sternotomy surgery. This technique involves a restricted surgical field and a limited workspace, which is, at present, strictly reserved for the most experienced surgeons. The MIAVR clinical outcomes are strongly dependent on the appropriate choice of the thoracic incision. This work presents a decision support system to optimize, through an interactive visualization interface, the exposure of the target structure in a limited field of view...
March 17, 2018: International Journal of Computer Assisted Radiology and Surgery
Hyun-Chel Joo, Young-Nam Youn, Seung-Hyun Lee, Sak Lee, Byung-Chul Chang, Kyung-Jong Yoo
BACKGROUND: The aim of this study was to evaluate clinical outcomes of different approaches to patients with proximal descending thoracic aneurysm (DTA) involving the distal arch. METHODS: From January 2002 to December 2016, 229 consecutive patients with proximal descending aorta aneurysm involving the distal arch underwent surgery using different approaches: total arch and DTA replacement via sternotomy (TAR group; n = 98), hemiarch and DTA replacement via thoracotomy (DTR group; n = 84), or hybrid arch repair (HAR group; n = 47)...
February 20, 2018: Journal of Thoracic and Cardiovascular Surgery
Prateek Bhatnagar, Shubhi Bhatnagar
Mesocardia is an extremely rare congenital cardiac anomaly of counter clockwise rotation of the heart. We report here a case of coronary artery bypass grafting in mesocardia, which has not been described in medical literature earlier. A 52 years male suffered an anterior wall myocardial infarction. Chest X Ray, 2 D Echocardiography and computed tomography of chest confirmed the presence of mesocardia. Off pump total arterial revascularization was done. Exposure of aorta and right atrium through the standard median sternotomy is very difficult in mesocardia due to cardiac rotation and should be kept in mind in this surgery...
March 13, 2018: Annals of Thoracic Surgery
Pouya Nezafati, Ali Shomali, Mahdi Kahrom, Sahar Omidvar Tehrani, Minoo Dianatkhah, Mohammad Hassan Nezafati
BACKGROUND: The present study aimed to compare postoperative complications commonly revealed after sternotomy closure by new sternal ZipFix™ (Synthes GmbH, Oberdorf, Switzerland) implant and conventional steel wire. METHODS: Among the initial 360 subjects, 326 patients enrolled in this randomised control trial who were candidates for cardiac surgery from April 2014 to March 2015. After the surgery, the sternal closure was randomly done with poly-ether-ether-ketone (PEEK) based sternal ZipFix (ZF) on the sternal body (n=168) or with conventional wires (CWs) (n=158)...
February 8, 2018: Heart, Lung & Circulation
Giuseppe Marulli, Giovanni Maria Comacchio, Marco Schiavon, Alessandro Rebusso, Marco Mammana, Davide Zampieri, Egle Perissinotto, Federico Rea
OBJECTIVES: Minimally invasive techniques seem to be promising alternatives to open approaches in the surgical treatment of early-stage thymoma, although there are controversies because of lack of data on long-term results. The aim of the study was to evaluate the surgical and oncological results after robotic thymectomy for early-stage thymoma compared to median sternotomy. METHODS: Between 1982 and 2017, 164 patients with early-stage thymoma (Masaoka I and II) were operated on by median sternotomy (108 patients) or the robotic approach (56 patients)...
March 13, 2018: European Journal of Cardio-thoracic Surgery
Gaby Aphram, Laurent De Kerchove, Stefano Mastrobuoni, Emiliano Navarra, Silvia Solari, Saadallah Tamer, Jerome Baert, Alain Poncelet, Jean Rubay, Parla Astarci, Philippe Noirhomme, Gebrine El Khoury
OBJECTIVES: Mitral valve (MV) repair is the gold standard for treatment of degenerative mitral regurgitation. A variety of surgical techniques allow surgeons to achieve a high rate of MV repair even with MV diseases of other aetiologies. However, a certain number of repairs fail over time. The aim of this study was to review our single-centre experience of MV re-repair and analyse the mode of repair failure, re-repair safety and efficiency in relation to the initial aetiology. METHODS: Between 1997 and 2015, 91 patients underwent redo MV re-repair...
March 14, 2018: European Journal of Cardio-thoracic Surgery
Yuriy Mandryk, Markus Czesla, Parwis Massoudy
The strategy for the successful removal of gigantic myxoma of the left atrium obstructing inflow into the left ventricle is presented. We consider an anterolateral minithoracotomy approach superior to median sternotomy for complete and comfortable atrial tumour excision because of the excellent exposure and the cosmetic outcome. After removal, local cryodestruction of potential remnant cells is mandatory to prevent recurrency.
March 12, 2018: Interactive Cardiovascular and Thoracic Surgery
Ching-Shu Chiang, Po-Lin Chen, Tzu-Ting Kuo, I-Ming Chen, Nai-Yuan Wu, Hsiao-Huang Chang
RATIONALE: Intravascular leiomyomatosis (IVL) is a rare nonmalignant tumor that can be fatal if untreated. PATIENT CONCERNS: A 49-year-old nulliparous Asian woman who underwent hysterectomy and left salpingo-oophorectomy for multiple uterine leiomyomas 18 months prior presented complaining of intermittent palpitation and chest tightness for approximately 1 month. Echocardiography revealed a large mobile tumor mass extending from the inferior vena cava (IVC) to the right atrium that partially obstructed IVC flow and tricuspid inflow...
March 2018: Medicine (Baltimore)
Tetyana Leinberger, Claudia Heilmann, Stefan Sorg, Matthias Mueller, Sami Kueri, Claudia Schmoor, Matthias Siepe, Friedhelm Beyersdorf
BACKGROUND:  Median sternotomy in patients with risk factors for wound healing is associated with high rates of postoperative wound infections and sternum instability. METHODS:  A total of 338 patients with elective first median sternotomy and at least four predefined risk factors were randomized between Sternal Talon (Gebrüder Martin GmbH & Co. KG-KLS Martin Group, Tuttlingen, Germany) and wire cerclage. The primary end point was mediastinitis and/or sternal instability within 30 ± 5 days, and the secondary end points were mediastinitis and/or sternal instability within 60 ± 5 days; incidence of pneumonia during hospitalization within the first 30 (±5) days and chest pain intensity...
February 2, 2018: Thoracic and Cardiovascular Surgeon
M H Zou, L Ma, Y S Xia, S C Yang, W D Chen, F Cao, X X Chen
Objective: To review the early and mid-term results of end-to-side anastomosis technique for interrupted aortic arch in neonates and infants. Methods: Clinic data of 46 patients were diagnosed as interrupted aortic arch in Department of Cardiac Surgery, Guangzhou Women and Children's Medical Center between January 2010 and December 2016 were analyzed retrospectively. Twenty-six cases were neonates. The median age underwent surgery was 23 days (range: 2 days to 8 years). Anatomical subtypes included 36 cases of type A and 10 cases of type B...
March 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Harry H Ching, Jacob B Kahane, Megan J Foggia, Annabel E Barber, Robert C Wang
BACKGROUND: Resection of massive goiters with suprahyoid, retropharyngeal, and substernal extension may not be amenable to standard approaches. This study evaluates a surgical approach allowing resection of massive goiters with minimal substernal and deep neck dissection. METHODS: Cases of thyroidectomy for goiters with substernal, retropharyngeal, or suprahyoid extension at a single institution from 2006 to 2017 were reviewed. The technique involves initial complete division of the medial thyroid tracheal attachments after identification of the RLN medial-inferiorly or superiorly...
March 12, 2018: World Journal of Surgery
Qiang Wang, Jia-Xin Ye, Min Ge, Dong-Jin Wang
This study reviews our results and experience with cardiothoracic surgery via RVIAT over the past 15 years. This retrospective overview summarises our results, describing the early and late clinical outcomes of 1,126 patients, including 370 ASD closures, 488 VSD closures and 268 valve surgeries, at a single center between October 2001 and December 2015. The mean follow-up time was 52 ± 35 months (range 8-120 months). The mean incision length was 6 ± 2.22 cm (range 3.9-8.9 cm). No patient required conversion to median sternotomy...
March 12, 2018: Scientific Reports
Tommaso Claudio Mineo, Alessandro Tamburrini, Orazio Schillaci, Vincenzo Ambrogi
BACKGROUND: Patients with thymoma and without clinical or electromyographical myasthenic signs may occasionally develop myasthenia several years after thymectomy. Hereby, we investigated the predictors and the evolution of this peculiar disease. METHODS: We performed a retrospective analysis in 104 consecutive patients undergoing thymectomy between 1987 and 2013 for thymoma without clinical nor electromyographic signs of myasthenia gravis. Predictors of post-thymectomy onset of myasthenia gravis were investigated with univariale time-to-disease analysis...
March 6, 2018: Seminars in Thoracic and Cardiovascular Surgery
Suneel Ramesh Desai, Nian Chih Hwang
Recent technologic advances have resulted in the availability of percutaneous and minimally invasive surgical devices for temporary mechanical circulatory support. These may be deployed rapidly without the requirement for sternotomy or cardiopulmonary bypass. In addition, third generation implantable left ventricular assist devices have been compared with second generation devices in 2 recent randomized controlled trials. The aim of this article is to provide a current review of the recent literature relating to left ventricular assist devices and mechanical circulatory support...
January 31, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Tresson Philippe, Ballabio Fabrizia, Manceau Gilles, Adam Nicolas, Lawton James, Davaine Jean-Michel, Koskas Fabien
Pseudoaneurysm due to a swallowed fish bone rarely involves subclavian arteries. A 46-year-old male with non-aberrant right subclavian artery presented pseudoaneurysm and brachial plexus septic necrosis. Open surgery with sternotomy and right transverse supraclavicular cervicotomy was done in emergency to achieve revascularization by in situ cryopreserved arterial allograft. Infection severity led to septic allograft rupture that necessitated ligation without new arterial reconstruction. During follow-up patient remained alive 8 months after surgery...
March 5, 2018: Annals of Vascular Surgery
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