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1.
Estima (Online) ; 18(1): e1520, jan.-dez. 2020.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1119360

RESUMO

Objetivo: Produzir e validar um manual sobre cuidados com a ferida pós-pleurostomia aberta para profissionais de saúde. Métodos:Trata-se de um relato de experiência. Inicialmente, foram selecionados artigos em português, espanhol e inglês no período de 2010 a 2018 nas bases de dados bibliográficos e sites de busca da Cochrane, SciELO, LILACS, PubMed e Google Acadêmico para o desenvolvimento do material. Foram utilizados os descritores: "toracotomia", toracostomias", "cavidade torácica", "pleura", "cavidade pleural", "ferimentos e lesões". Após consulta, o texto foi elaborado, seguido das ilustrações e a diagramação. O manuscrito concluído foi encaminhado aos especialistas para validação. O índice de validade de conteúdo (IVC) foi utilizado para validar o manual. Resultados: O manual desenvolvido possui trinta e seis páginas e sete capítulos com os seguintes temas: introdução, cuidados com a ferida pós-pleurostomia aberta, limpeza da ferida/debridamento, coberturas, registro dos cuidados, considerações finais e bibliografia. Conclusão: Foi possível desenvolver e validar um manual de cuidados com a ferida pós-pleurostomia aberta para a consulta de profissionais de saúde.


Assuntos
Ferimentos e Lesões , Toracostomia , Toracotomia , Cavidade Torácica , Cavidade Pleural
2.
Kyobu Geka ; 73(10): 812-818, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130771

RESUMO

In Japan, where the population is aging, the number of elderly lung cancer cases is expected to increase. Therefore, we retrospectively compared and examined about elderly lung cancer. METHOD: There were 1,283 patients undergoing surgery for lung cancer between 2009 and 2018 at our institution. We classified them into 75~85 years old, 85 years old or older, and younger than 75 years, and examined the patient background, surgical procedure, and perioperative complications. RESULT: 96.2% of 75~85 years group and 100% of 85 years old or older group had some history. There was a significant difference between the ages of 85 years old or older in PS 1 and above. There was a significant difference in limited resection between the 2 elderly groups compared to younger than 75 years group. The perioperative complication rates were 75~85 years old group (23.2%), 85 years old or older (30.9%), and younger than 75 years group (23.2%), with no significant difference. There were significant differences in postoperative delirium and chronic respiratory failure in 75~85 years group and 85 years old or older compared with younger than 75 years group. We performed a multivariate analysis of risk factors for complications. Males, PS 1 or higher, approach[ thoracotomy, video-assisted thoracic surgery (VATS)], and limited resection were considered to be independent factors. The 5-year survival rate was 70.9% in 75~85 years group, 39.3% in 85 years old or older group, and 81.0% in younger than 75 years group, and was significantly lower in 85 years old or older group. CONCLUSION: Elderly patients need to be aware of postoperative delirium and chronic respiratory failure. It is possible that the complication rate can be reduced by performing a thorough evaluation of operative resistance and selecting an appropriate surgical procedure in the elderly.


Assuntos
Neoplasias Pulmonares , Pneumonectomia , Idoso , Idoso de 80 Anos ou mais , Humanos , Japão , Neoplasias Pulmonares/cirurgia , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Toracotomia , Resultado do Tratamento
3.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(11): 948-953, 2020 Nov 24.
Artigo em Chinês | MEDLINE | ID: mdl-33210867

RESUMO

Objective: To investigate the long-term incidence of coronary events and related factors in patients undergoing cardiac thoracotomy without preoperative coronary angiography (CAG). Methods: This was a retrospective study. The clinical data of patients, aged between 40 and 49 years old, who underwent cardiothoracic surgery, including heart valve surgery, congenital heart disease surgery, cardio great vessels surgery and other non-coronary artery disease (CAD) surgery, in Nanjing Drum Tower Hospital from December 2009 to May 2017, were enrolled. Patients with suspected CAD, or patients with coronary CTA defined calcified coronary arteries received CAG examination prior operation, and the rest patients did not receive routine CAG examinations. The patients who did not receive routine CAG examinations were followed up by telephone. The primary endpoints include death related to coronary arteries, coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI). The secondary endpoints include the new onset angina, clinically diagnosed CAD or receiving the first and second prevention for CAD. The other outcome events included cardiac death and all-cause mortality. The primary and secondary endpoints were all regarded as coronary events. The patients without preoperative CAG were divided into two groups: the positive group and the negative group, according to the incidence of coronary events during follow-up. Clinical data were compared between the two groups. Results: A total of 952 patients were included. The age was (45.2±2.7) years old, 406(42.65%) patients were male. Preoperative CAG was performed in 73 patients, among whom 9 (12.32%) patients underwent simultaneous CABG. Among the 879 cases who did not undergo coronary angiography before the operation, 18(2.05%) died during perioperative period (hospitalization and within 30 days after discharge). The patients were followed up for (61.6±25.8) months, and 28(3.25%) patients were lost to follow up. During long-term follow up, there were no fatal cases due to severe coronary events and no cases of CABG or PCI. Only 4.41% (38/861) patients had the secondary endpoints, namely the occasional onset of atypical angina. The incidence rate of the long-term coronary events, all-cause mortality and cardiac death were 4.41% (38/861), 1.16% (10/861), 0.46% (4/861) during long-term follow-up. The prevalence of hypertension was significantly higher in positive group than negative group (34.21% (13/38) vs. 20.89% (164/785), P=0.045). Conclusions: It is feasible not to perform preoperative CAG examination for non-CAD patients aged 40-49 years who will undergo cardiac thoracotomy. However, we need to be aware the risk of coronary events in the patients complicating with risk factors of CAD, such as hypertension.


Assuntos
Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Adulto , Angiografia Coronária , Doença da Artéria Coronariana/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Toracotomia , Resultado do Tratamento
4.
Georgian Med News ; (306): 23-27, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33130640

RESUMO

The efficacy and safety of mini-thoracotomy with video tracking in the treatment of complicated forms of tuberculous pleurisy was studied. The study included 78 patients who were treated in the department of extrapulmonary surgery of the Aktobe Regional TB Dispensary in the period from 2016 to 2019. A mini-thoracotomy with video-assistant, and a control (41 patients) group - standard thoracotomy was performed in patients of the main (37 patients) group. Early surgical interventions according to the VATS method in the treatment of complicated forms of tuberculous pleurisy reduced the patient's stay in the ICU by 1.6 times, reduced intraoperative blood loss by 3.3 times, the average duration of surgery 2.5 times, improve the dynamics of the restoration of external respiratory function, reduce the number of postoperative complications 2.1 times. The timing of reexpansion (straightening) of the lung, the elimination of residual cavities and a smaller number of patients with chest deformity indicated a greater efficacy of VATS in comparison with traditional surgical interventions.


Assuntos
Neoplasias Pulmonares , Tuberculose Pleural , Humanos , Tempo de Internação , Duração da Cirurgia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Toracotomia , Resultado do Tratamento , Tuberculose Pleural/cirurgia
5.
Artigo em Alemão | MEDLINE | ID: mdl-33053588

RESUMO

Chest Trauma is a complex injury pattern whose diagnostics and therapy demand everything from an emergency response team. Chest trauma subsumes thoracic injuries in all facets from the bounce mark of a seat belt to fatal rollover trauma with contusion or disruption of organs located in the thorax. Possible causes comprise blunt or penetrating trauma, as well as decelerations, chemical and thermal damage. Sonographic assessment according to a protocol plays a major role in diagnosis of underlying conditions and treatment indications. Therapeutic management may include invasive emergency techniques: Decompression of a tension pneumothorax is a fundamental life-saving intervention. Pericardiocentesis seldomly is necessary or possible in order to drain a cardiac tamponade. In case of traumatic cardiac arrest and under defined circumstances, resuscitative thoracotomy may be indicated. The out-of-hospital management may require transfusion of blood components. As with all procedures, which are performed seldomly but under emergency conditions, invasive techniques require clear communication, precise structured working procedures and especially continuous training, team briefing, and debriefing.


Assuntos
Parada Cardíaca , Traumatismos Torácicos , Ferimentos Penetrantes , Humanos , Ressuscitação , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Traumatismos Torácicos/terapia , Toracotomia
6.
PLoS One ; 15(10): e0237363, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017425

RESUMO

OBJECTIVE: To evaluate the analgesic efficacy and safety of paravertebral block (PVB) versus intercostal nerve block (INB) in thoracic surgery and breast surgery. METHODS: The PubMed, Web of Science, Embase and the Cochrane Library were searched up to February 2020 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of PVB compared with INB after thoracic surgery and breast surgery. For binary variables, odds ratio (OR) and 95% confidence interval (CI) was used. For continuous variables, weighted mean difference (WMD) and 95% confidence interval (CI) were used. RevMan5. 3 and Stata/MP 14.0 were used for performing the meta-analysis. RESULTS: A total of 9 trials including 440 patients (PVB block:222 patients; INB: 218 patients) met the inclusion criteria. In the primary outcome, there was no significant differences between the two groups with respect to postoperative visual analogue scale (VAS) at 1h (Std. MD = -0. 20; 95% CI = -1. 11to 0. 71; P = 0. 66), 2h (Std. MD = -0. 71; 95% CI = -2. 32to 0. 91; P = 0. 39), 24h (Std. MD = -0. 36; 95% CI = -0. 73 to -0. 00; P = 0. 05) and 48h (Std. MD = -0. 04; 95% CI = -0. 20 to 0. 11; P = 0. 57). However, there was significant difference in VAS of non Chinese subgroup at 1h (Std. MD = 0. 33; 95% CI = 0. 25to 0. 41; P<0. 00001) and VAS of Chinese subgroup at 24h (Std. MD = -0.32; 95% CI = -0.49 to-0.14; P = 0.0003). In the secondary outcome, the analysis also showed no significant difference between the groups according to the rates of postoperative nausea and vomit (OR = 0. 63; 95% CI = 0. 38 to 1. 03; P = 0. 06) and the rates of postoperative additional analgesia (OR = 0. 57; 95% CI = 0. 21 to 1. 55; P = 0. 27). There was significant difference in postoperative consumption of morphine (Std. MD = -14. 57; 95% CI = -26. 63 to -0.25; P = 0. 02). CONCLUSION: Compared with INB, PVB can provide better analgesia efficacy and cause lower consumption of morphine after thoracic surgery and breast surgery.


Assuntos
Mama/cirurgia , Bloqueio Nervoso/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Analgesia/métodos , Feminino , Humanos , Nervos Intercostais , Masculino , Mastectomia , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Segurança , Coluna Vertebral/inervação , Toracoscopia , Toracotomia , Resultado do Tratamento
7.
Emerg Med Clin North Am ; 38(4): 891-901, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981624

RESUMO

Evaluating and treating traumatic cardiac arrest remains a challenge to the emergency medicine provider. Guidelines have established criteria for patients who can benefit from treatment and resuscitation versus those who will likely not survive. Patient factors that predict survival are penetrating injury, signs of life with emergency medical services or on arrival to the Emergency Department, short length of prehospital cardiopulmonary resuscitation, cardiac motion on ultrasound, pediatric patients, and those with reversible causes including pericardial tamponade and tension pneumothorax. Newer technologies such as resuscitative endovascular balloon occlusion of the aorta, selective aortic arch perfusion, and extracorporeal membrane oxygenation may improve outcomes, but remain primarily investigational.


Assuntos
Parada Cardíaca/terapia , Ferimentos e Lesões/complicações , Abdome/diagnóstico por imagem , Aorta , Oclusão com Balão , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Coração/diagnóstico por imagem , Parada Cardíaca/etiologia , Humanos , Guias de Prática Clínica como Assunto , Ressuscitação , Ordens quanto à Conduta (Ética Médica) , Toracotomia , Ultrassonografia
8.
Zhonghua Wai Ke Za Zhi ; 58(9): 677-682, 2020 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-32878413

RESUMO

It has been nearly 70 years since the first attempt of surgical treatment for gastroesophageal reflux disease in Western countries, while in China, it is still in initial stage. Allison first attempted to control gastroesophageal reflux through surgical approach in 1951, but single hiatal hernia repair was inadequate to control reflux. Nissen developed fundoplication in 1955, and Rossetti modified it for reduction of the mobilized extent and related damage. The anti-reflux effect has been greatly improved but with high incidence of dysphagia and gas related complications. In order to solve these troublesome symptoms, Toupet and Dor came up with partial fundoplication, DeMeester and Donahue came up with "short floppy" Nissen fundoplication, they all successfully reduced the incidence of dysphagia and gas related complications but with preservation of anti-reflux effect.Thereafter, the three main stream fundoplication was formed (short floppy Nissen, Toupet and Dor procedures). In addition, other attempts for surgical control of gastroesophageal reflux were made, such as Belsey Mark Ⅳ, Hill and Collis procedures, but they are not as popular as fundoplication for a variety of reasons. In the meantime, the operative approach was converted from traditional laparotomy and thoracotomy to laparoscopic or robot-assisted laparoscopic era, and the anti-reflux effect was preserved with reduction in the duration of hospital stay and incidence of complications. Although plenty of anti-reflux procedures exists, they all with their own advantages and disadvantages, the concern for inadequate long-term anti-reflux effect and post-operative complications remains the main obstacle to the widespread of anti-reflux surgery. Better and more minimally invasive anti-reflux treatments should be explored.


Assuntos
Refluxo Gastroesofágico/cirurgia , Fundoplicatura , Humanos , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Toracotomia , Resultado do Tratamento
9.
Surgery ; 168(5): 948-952, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32680746

RESUMO

BACKGROUND: Thoracoscopic pneumonectomy commonly requires conversion to thoracotomy. We hypothesize that conversion would lead to worse short- and long-term outcomes compared with operations completed thoracoscopically. METHODS: The National Cancer Database identified patients who underwent a pneumonectomy from 2010 to 2016. Trends in conversion were described using linear regression. Multivariable regression of factors associated with conversion was performed. Short-term outcomes included duration of stay, number of lymph nodes harvested, margin status, readmission, and 90-day mortality. Long-term outcome was evaluated as overall survival. RESULTS: A total of 8,037 patients underwent a pneumonectomy. The rate of attempted thoracoscopic pneumonectomies increased from 11% to 22% (P < .001) and the rate of conversion decreased from 39% to 33% (P = .011). On multivariable analysis, a greater patient comorbidity index and pathologic nodal-stage 2 disease were associated with an increased rate of conversion. The mean number of lymph nodes evaluated was greater as was the duration of stay in the conversion group, but conversion to open thoracotomy was not associated with positive surgical margins, readmission rate, 90-day mortality, or survival. CONCLUSION: Thoracoscopic pneumonectomy is performed with increasing frequency and decreasing conversion rate. Conversion is associated with a greater duration of stay but other short- and long-term outcomes are similar. This observation suggests minimal harm in conversion from minimally invasive to open pneumonectomy.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Toracoscopia/métodos , Idoso , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Toracotomia
10.
J Card Surg ; 35(8): 2050-2052, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652608

RESUMO

Acute pulmonary embolism (APE) is a well-described complication following surgical procedures. The incidence of such a complication can be related to the presence of a peculiar patient's condition. Cryoglobulinemia, which consists in the presence of one or more immunoglobulins in the serum that precipitate at temperatures below 37°C and redissolve on warming, seems to increase the risk of thrombotic events. Treatment options of APE, according to clinical severity, include systemic thrombolysis, surgical embolectomy, and systemic anticoagulation. Thrombolysis is considered the first-line treatment, whereas surgery is reserved in case of extremely-compromised hemodynamic conditions related to massive central embolism, and in case of contraindication to thrombolysis. Here, we report a case of acute massive pulmonary embolism occurring at the end of a surgical procedure for a thymic carcinoma resection, in a patient with cryoglobulinemia, which required an emergent surgical pulmonary embolectomy.


Assuntos
Crioglobulinemia/complicações , Embolectomia/métodos , Posicionamento do Paciente/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Doença Aguda , Ecocardiografia Transesofagiana , Emergências , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Índice de Gravidade de Doença , Toracotomia , Tomografia Computadorizada por Raios X
11.
J Card Surg ; 35(8): 2103-2105, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652642

RESUMO

A 59-year-old man with acute mitral regurgitation due to papillary muscle rupture after myocardial infarction was admitted to our hospital. He underwent emergent mitral valve replacement with a mechanical valve by median sternotomy. Although postoperative echocardiography showed no sign of a ventricular aneurysm, echocardiography performed 5 weeks after the surgery showed enlarging left ventricular pseudoaneurysm of the inferior to the posterior cardiac wall. He underwent dacron patch closure of the orifice by fifth intercostal left thoracotomy. The postoperative course was uneventful and he was discharged on postoperative day 10. The patient was successfully treated for two life-threatening complications occurring subsequently after myocardial infarction.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Cardíaco/cirurgia , Ruptura Cardíaca Pós-Infarto/cirurgia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/cirurgia , Valva Mitral/cirurgia , Infarto do Miocárdio/complicações , Músculos Papilares , Complicações Pós-Operatórias , Toracotomia/métodos , Falso Aneurisma/etiologia , Aneurisma Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
J Card Surg ; 35(8): 2070-2072, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652682

RESUMO

OBJECTIVE: Highlight our management of a Pasteurella Multiocida-infected descending thoracic aorta mycotic pseudoaneurysm. METHODS: Report a case of a canine bite resulting in a P. Multiocida descending thoracic aorta mycotic pseudoaneurysm. RESULTS: We present a 61-year-old gentleman who was initially seen in an emergency department after a canine bite. He was admitted and treated with a course of IV antibiotics for P. Multiocida bacteremia and discharged. Three weeks after discharge, he continued to feel generalized malaise and work-up was significant for a descending thoracic aorta mycotic pseudoaneurysm. The patient underwent a low left posterior lateral thoracotomy and femoral-femoral cardiopulmonary bypass for complete pseudoaneurysm resection and aortic replacement with a 24-mm Gelweave graft. Given purulence and gross infection, we planned for a staged approach, with a secondary washout and omental flap for biologic coverage of the graft. The patient did well clinically and was discharged at 14 days to rehabilitation with 6-week intravenous course of antibiotics. CONCLUSIONS: The patient's clinical course with subsequent follow-up suggest that complete resection of the mycotic pseudoaneurysm, followed by omental flap coverage is a viable strategy to manage mycotic aortic infections with virulent organisms.


Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Aneurisma Infectado/etiologia , Aneurisma Infectado/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/cirurgia , Bacteriemia/etiologia , Mordeduras e Picadas/complicações , Infecções por Pasteurella/etiologia , Infecções por Pasteurella/cirurgia , Pasteurella multocida , Animais , Implante de Prótese Vascular/métodos , Ponte Cardiopulmonar , Cães , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Toracotomia/métodos
13.
J Card Surg ; 35(8): 2067-2069, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652695

RESUMO

A 43-year-old gentleman was transferred for management of acute on chronic cardiogenic shock (left ventricular ejection fraction < 10%). Upon arrival, we inserted a left axillary intra-aortic balloon pump for hemodynamic support. He underwent an emergent left and right-heart catheterization which showed patent stents and coronaries, in the setting of severely elevated pulmonary artery and pulmonary capillary wedge pressure. On hospital day 35, we escalated support to Centrimag in conjunction with a 31 French Protek Duo Rapid Deployment cannula. A centrimag cannula apical sewing cuff was sewn in continuous fashion along the left ventricular apex. Via modified seldinger technique, we tunneled the Protek Duo Rapid Deployment cannula through the silastic sewing cuff and the ventricular apex, traversing the aortic valve. On hospital day 50, he underwent left anterior thoracotomy and mini-sternotomy for implantation of durable Heartware left ventricular assist device. He was discharged home off inotropes and had resumed his normal activities. He is currently listed as status four for heart transplantation.


Assuntos
Cateterismo Cardíaco/métodos , Coração Auxiliar , Implantação de Prótese/métodos , Choque Cardiogênico/terapia , Doença Aguda , Adulto , Doença Crônica , Transplante de Coração , Hemodinâmica , Humanos , Balão Intra-Aórtico , Masculino , Pressão Propulsora Pulmonar , Choque Cardiogênico/fisiopatologia , Esternotomia/métodos , Toracotomia/métodos , Listas de Espera
14.
J Card Surg ; 35(8): 2053-2055, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652732

RESUMO

Colonoscopy is generally considered a safe procedure, with a low rate of complications. Although rare, the migration of the colonoscope may represent life-threatening events, requiring emergency treatment. We, herein, describe the case of an elective colonoscopy complicated by an irretrievable colonoscope that migrated, through a previous traumatic diaphragmatic hernia, in the chest cavity. This hernia was likely a chronic complication of a previous abdominal trauma. Several attempts to retrieve the scope were unsuccessful. After further investigations and collegial discussion, a left thoracotomy was performed, with the aim to retrieve the colonoscope and to reduce the hernia.


Assuntos
Colonoscópios/efeitos adversos , Colonoscopia/efeitos adversos , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/cirurgia , Cavidade Torácica , Toracotomia/métodos , Traumatismos Abdominais/complicações , Idoso , Hérnia Diafragmática/etiologia , Humanos , Masculino
15.
J Card Surg ; 35(7): 1570-1582, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32652784

RESUMO

BACKGROUND: While minimally invasive techniques for aortic valve replacement (AVR) have been shown to be safe, limited data exist comparing the varying approaches. This study aimed to compare the outcomes between two minimally invasive approaches for AVR: mini-sternotomy (MS) and right anterior thoracotomy (RAT). MATERIALS AND METHODS: A systematic search of MEDLINE, EMBASE, and OVID was conducted for the period 1990-2019. Nine observational studies (n = 2926 patients) met the inclusion criteria. RESULTS: There was no difference in operative mortality between MS and RAT (odds ratio [OR]: 0.87, 95% confidence interval [CI]: 0.41-1.85; P = .709). Meta-analyses favored MS over RAT in reoperation for bleeding (OR: 0.42, 95% CI: 0.28-0.63; P < .001), aortic cross-clamp time (standardized mean difference [SMD]: -0.12, 95% CI: -0.20 to 0.029; P = .009), and the rate of conversion to sternotomy (OR: 0.32, 95% CI: 0.11-0.93; P = .036). The rate of permanent pacemaker insertion approached borderline significance in favor of MS (OR: 0.54, 95% CI: 0.26-1.12; P = .097). In-hospital outcomes of stroke, atrial fibrillation, and surgical site infection were similar between the two groups. The length of hospital stay was shorter for RAT (SMD: 0.12, 95% CI: 0.027-0.22; P = .012) and the length of postoperative ventilation was borderline significant in favor of RAT (SMD: 0.16, 95% CI: -0.027 to 0.34; P = .095). CONCLUSIONS: This study highlights important differences in short-term outcomes between MS and RAT as approaches for AVR. This has important implications for patient selection, especially in the elderly, where such approaches are becoming more common-place.


Assuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Esternotomia/métodos , Toracotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
16.
J Card Surg ; 35(10): 2853-2856, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32683721

RESUMO

BACKGROUND: Outflow graft (OG) obstruction is a dangerous complication that may occur for various reasons after left ventricular assist device (LVAD) implantation. CASE SUMMARY: We describe the case of a 51-year-old patient on LVAD support who developed significant OG kinking and external OG obstruction due to a fibrin mass causing severe stenosis. Both the OG kinking and external obstruction were eliminated via a left lateral thoracotomy.


Assuntos
Fibrina , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/cirurgia , Coração Auxiliar/efeitos adversos , Implantação de Prótese/efeitos adversos , Toracotomia/métodos , Trombose/etiologia , Oclusão de Enxerto Vascular/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Asian Cardiovasc Thorac Ann ; 28(8): 482-487, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32722914

RESUMO

BACKGROUND: We reviewed the midterm results of our approach for mitral valve repair with the use of standardized loops. METHODS: In a retrospective single-center study, mitral repairs performed between November 2015 and December 2019 with the standardized loop technique were included. Predefined loops of 15 and 25 mm (Gore-Tex) were implanted for posterior or anterior mitral prolapses, respectively. Isolated or concomitant mitral repairs were performed by either a sternotomy or minithoracotomy. Mean follow-up was 25.3 ± 14.7 months. RESULTS: Among 92 patients operated on for mitral repair during this period, 65 had repair with the standardized loop technique. They were mostly men (73.8%) and the mean age was 65.1 ± 9.7 years. Valve prolapse was mainly posterior (87.7%), and cordal rupture was seen in 81.5% of cases. The procedures were carried out by a minithoracotomy in 49.2% of patients. Isolated mitral repairs represented 63.1% of cases. Crossclamp and bypass times were 102 ± 22.8 min and 144.7 ± 34.9 min, respectively. The mean number of loops implanted was 2.7 ± 0.9. No patient left the operating room with moderate or severe mitral regurgitation. Postoperative morbidity was 18.4% (12 patients) and 30-day mortality was 3.1% (2 patients). Overall 4-year survival and freedom from reoperation for mitral repair failure were 84.4% and 91.7%, respectively. CONCLUSIONS: The standardized loop technique for mitral repair showed good midterm results. This technique can be valuable in the armamentarium of mitral repairs. Further evaluation is needed for long-term follow-up.


Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Técnicas de Sutura , Idoso , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Prolapso da Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Esternotomia , Técnicas de Sutura/efeitos adversos , Toracotomia , Fatores de Tempo , Resultado do Tratamento
18.
Am Surg ; 86(5): 538-540, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684024

RESUMO

Blunt traumatic cardiac rupture is an uncommon event in trauma and survival is rare. While multiple isolated accounts of repair of blunt cardiac rupture have been reported in the literature, there is not a single report of survival from right ventricular rupture following an emergency department thoracotomy (EDT). We report 2 cases where patients have survived such injuries and have made a full recovery. These patients are from a single institution who lost pulses on arrival to the emergency department; then underwent EDT with relief of cardiac tamponade with hemorrhage control by temporary closure, and subsequent definitive repair of right ventricular rupture in the operating room. Both were multiply injured and survived to discharge without neurologic sequelae and have made a full recovery back to their baseline function. This setting may represent an important use of EDT among blunt trauma patients, where time to survival and recovery may dependent on the speed of hemorrhage control and return of cardiac activity.


Assuntos
Traumatismos Cardíacos/cirurgia , Toracotomia , Ferimentos não Penetrantes/cirurgia , Idoso , Serviço Hospitalar de Emergência , Tratamento de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão
19.
Kyobu Geka ; 73(7): 484-489, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32641666

RESUMO

Minimally invasive cardiac surgery (MICS) through partial sternotomy or parastenal incision was introduced for valvular heart disease in 1990s, it has gradually faded because it was somehow challenging without standardized manner or positive merits for the patients. Conversely, MICS via mini-thoracotomy has been started for mostly the patients undergoing mitral valve repair in 2000s, the number of MICS through mini-thoracotomy cases has increased progressively with the supports by academic societies and a national registry database system. Some enthusiasm for less invasiveness fashion oriented smaller skin incision and endoscopic procedures. Recently, robotically-assisted mitral valve surgery has taken place under strict regulation. Performing MICS requires not only surgeon's skills but also heart team strength including anesthesiologists and perfusionists. MICS should give cosmetic benefit and patient satisfaction, and credibility for cardiologists and society. Past and current status of MICS in Japan is described based on over 20-year author's experience from partial sternotomy MICS to robotically-assisted surgery for valvular heart disease.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Japão , Procedimentos Cirúrgicos Minimamente Invasivos , Toracotomia
20.
Kyobu Geka ; 73(7): 490-495, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32641667

RESUMO

Minimally invasive cardiac surgery (MICS) via mini-right thoracotomy approach has been developed and standardized in the last 30 years, aiming to facilitate postoperative recovery and to minimize surgery-related complications. Mitral regurgitation is the major target of this MICS approach. In our institute, MICS mitral valve repair by direct vision under thoracoscopy guidance has been performed in 139 cases between 2011 and March 2018. Subsequently, robot-assisted surgery program was launched to perform mitral valve repair for 130 patients in the last 2 years. In-hospital and mid-term outcome post-mitral valve repair was not significantly different among sternotomy, MICS direct vision and MICS robot-assist approaches, though there were several pitfalls through the launch of the MICS program. Standardization of the MICS approach of mitral valve repair and other cardiac surgeries was herein summarized and associated pitfalls were explained from surgeons' view.


Assuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral/cirurgia , Esternotomia , Toracotomia , Resultado do Tratamento
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