MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Seminars in Thoracic and Cardiovascular Surgery' source. Tue, 07 Feb 2012 03:52:38 +0100 http://www.medworm.com/index.php?rid=5502391&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001456%2Fabstract%3Frss%3Dyes Sympathetic ablative surgery (SAS) has been used for more than 50 years to treat a variety of sympathetic disorders. Initially, SAS at the level of T2 was the procedure of choice for palmar hyperhidrosis; however, postoperative reflex sweating was identified as the most common and vexing side effect of this procedure. In 2001, the Lin-Telaranta classification was proposed to explain the mechanism and the route of sympathetic fibers. Under this classification, the procedure of choice for palmar hyperhidrosis is T4 SAS and for axillary hyperhidrosis is T4 and T5 SAS, which lead to excellent symptom control and minimal reflex sweating. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502391 Wed, 14 Dec 2011 22:48:01 +0100 5502391 http://www.medworm.com/index.php?rid=5502389&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001444%2Fabstract%3Frss%3Dyes The purpose of this section is to shed some light on the technical aspects of sympathetic ablative surgery (SAS) for primary palmar hyperhidrosis (PH) and primary axillary hyperhidrosis (AH). The available literature on this subject can be challenging to interpret because there are no uniform nomenclature and no standardized operative technique. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502389 Wed, 14 Dec 2011 22:48:01 +0100 5502389 http://www.medworm.com/index.php?rid=5502388&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001006%2Fabstract%3Frss%3Dyes Left ventricular assist devices (LVADs) are the treatment of choice for advanced heart failure that is refractory to medical therapy for both Bridge to Transplantation and Destination Therapy in appropriately selected patients. The newer continuous flow LVADs are more reliable and durable and have resulted in significant size reduction compared to pulsatile flow LVADs. This “miniaturization” of the LVAD has potential advantages including less surgical trauma for implantation. The HeartWare HVAD is a new continuous flow LVAD, currently in trials, that is designed to be implanted and contained completely within the pericardial space. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502388 Wed, 14 Dec 2011 22:48:01 +0100 5502388 http://www.medworm.com/index.php?rid=5502387&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001390%2Fabstract%3Frss%3Dyes The standard implantation of the Heartmate II left ventricular assist device (LVAD) (Thoratec Inc, Pleasanton, CA) involves a median sternotomy. There are some theoretical advantages to avoiding a median sternotomy in LVAD implantation. Hill et al introduced the concept of implantation of LVADs via a combination of right mini-thoracotomy and left subcostal incision and used this approach to implant the Thoratec paracorporeal LVAD (Thoratec Inc). Gregoric et al subsequently described a less invasive approach for implanting the Heartmate II LVAD without median sternotomy by using a subcostal incision and a right mini-thoracotomy, and they used the approach in 3 patients. With some modifications, we now use this method for routine implantation of the Heartmate II and describe our technique. (... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502387 Wed, 14 Dec 2011 22:48:01 +0100 5502387 http://www.medworm.com/index.php?rid=5502386&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000979%2Fabstract%3Frss%3Dyes Active mitral valve infective endocarditis is a challenging clinical problem with a high rate of mortality. Surgery is currently performed in more than 40% of patients, and selecting those patients who will benefit from surgical intervention and performing a technically sound operation at the proper time are keys to optimizing outcomes. Moderate-to-severe and severe mitral regurgitation, large, mobile vegetations, paravalvular abscess, embolic events, failure of antibiotic therapy, and infection with a fungal organism are indications for prompt operation. The use of computed tomography imaging is important to determine whether there are noncardiac sources of infection, and transesophageal echocardiography is essential to delineate valvular dysfunction, identify paravalvular abscesses, rule... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502386 Wed, 14 Dec 2011 22:48:01 +0100 5502386 http://www.medworm.com/index.php?rid=5502385&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000943%2Fabstract%3Frss%3Dyes Ischemic mitral regurgitation (IMR) continues to challenge surgeons and scientists alike. This vexing clinical entity frequently complicates myocardial infarction and carries a poor prognosis both in the setting of coronary disease and idiopathic dilated cardiomyopathy. Ischemic mitral regurgitation encompasses a difficult patient population that is characterized by high operative mortality, poor long term outcomes, and frequent recurrent insufficiency after standard surgical repair. Yet optimal surgical repair and improved clinical outcomes can only be achieved with better knowledge of the pathophysiology of IMR which is still incompletely understood. The causative mechanism of IMR appears to lie in the annular and subvalvular frame of the valve rather than leaflet or chordal structure le... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502385 Wed, 14 Dec 2011 22:48:01 +0100 5502385 http://www.medworm.com/index.php?rid=5502384&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001122%2Fabstract%3Frss%3Dyes This article describes a standardized approach that has been consistently successful in our institution. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502384 Wed, 14 Dec 2011 22:48:01 +0100 5502384 http://www.medworm.com/index.php?rid=5502383&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001146%2Fabstract%3Frss%3Dyes The population of adults with congenital heart disease (CHD) (commonly called grown-ups with congenital heart disease or GUCH) is increasing steadily and exceeds the population of children with CHD already. The specificities of GUCH surgery are multiple and include (1) variety of the anatomo-clinical situations (defects repaired during childhood, malformations either nonoperated or palliated, nonreparable defects), (2) usual multiorgan involvement, and (3) many technical differences related to cardiopulmonary bypass, myocardial protection, and surgical technique. The surgical indications should be taken after a precise evaluation of the risk/benefit ratio on an individual basis; a balanced attitude should be kept between unwise interventionism and excessive waiting policy. It is now agreed... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502383 Wed, 14 Dec 2011 22:48:01 +0100 5502383 http://www.medworm.com/index.php?rid=5502382&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001134%2Fabstract%3Frss%3Dyes 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. Excellent outcome is achieved when patients are periodically followed with clinical and echocardiographic examinations and when surgery is performed in expert centers. The strategy is based on the recognition of mitral regurgitation at an early symptomatic stage, avoiding a delayed referral of these patients. There is an ongoing debate about whether surgery should be performed in... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502382 Wed, 14 Dec 2011 22:48:01 +0100 5502382 http://www.medworm.com/index.php?rid=5502381&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306791100147X%2Fabstract%3Frss%3Dyes Ever since the first successful pneumonectomy for lung cancer was performed in 1933, a number of largely historical reports have attempted to look at the physiological consequences of this operation in order to define patient long-term functional status. The pertinence of these contributions is, however, limited because most were performed in patients who had their pneumonectomy for benign diseases or were carried out in small and heterogeneous populations. Thus, several surgical myths and beliefs such as phrenic nerve interruption at the time of operation might be desirable, marked hyperinflation of the residual lung is associated with reduced lung function, and patients develop pulmonary hypertension over time and have poor exercise tolerance have persisted over the years. Our findings b... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502381 Wed, 14 Dec 2011 22:48:01 +0100 5502381 http://www.medworm.com/index.php?rid=5502380&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001365%2Fabstract%3Frss%3Dyes This article reviews the existing data for lobectomy in patients with limited lung function. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502380 Wed, 14 Dec 2011 22:48:01 +0100 5502380 http://www.medworm.com/index.php?rid=5502379&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001158%2Fabstract%3Frss%3Dyes High-resolution esophageal manometry (HRM) is a quantum evolutionary step beyond conventional manometry, the traditional method of assessing esophageal motility for more than 50 years. HRM advances both pressure measurement and its display. Pressure transducers are placed every centimeter along the manometry catheter (). Sophisticated computer algorithms extrapolate between these measurement points, permitting a continuous, seamless assessment of intraluminal esophageal pressure from pharynx to stomach. The display of intraluminal pressure as a color spectrum on a plot of esophageal position (y-axis) against time (x-axis) produces a pressure topograph of swallowing (). This unique format affords a practical, understandable demonstration of this complex three-variable relationship of swallo... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502379 Wed, 14 Dec 2011 22:48:01 +0100 5502379 http://www.medworm.com/index.php?rid=5502378&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001110%2Fabstract%3Frss%3Dyes Achalasia is a primary esophageal motility disorder that is characterized by the inability of the lower esophageal sphincter to relax and by absence of esophageal body peristalsis, causing dysphagia, chest pain, and regurgitation of undigested food. The goal of treatment is to eliminate dysphagia by opening the lower esophageal sphincter, while preventing gastroesophageal reflux. The currently available treatment options include injection of botulinum toxin at the esophagogastric junction, endoscopic pneumatic dilation, and laparoscopic Heller myotomy (LHM); all therapeutic approaches are palliative and centered on relief of esophageal outlet obstruction. With the widespread acceptance of minimally invasive surgical approaches to diseases of the upper abdomen, LHM combined with a partial a... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502378 Wed, 14 Dec 2011 22:48:01 +0100 5502378 http://www.medworm.com/index.php?rid=5502377&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001377%2Fabstract%3Frss%3Dyes Normothermic ex vivo lung perfusion and extracorporeal life support have re-invigorated lung transplantation. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502377 Wed, 14 Dec 2011 22:48:01 +0100 5502377 http://www.medworm.com/index.php?rid=5502376&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001420%2Fabstract%3Frss%3Dyes Citius, Altius, Fortius (Faster, Higher, Stronger). It was carved in stone at the main entrance of the Lycée Albert Legrand and later cited by Father Dideon and Baron de Coubertin to eulogize the human ambition to excel. Finally it became the official motto of the Olympic Games. Citius, Altius, Fortius could be impersonated by Mark Cavendish, Samuel Sanchez, and Thor Hushovd, winners of different jerseys or stages at the Tour de France 2011. All three are brilliant cyclists; all three ride on similar bikes, but they differ in anatomy, attitude, and mental and physical skills. Their career-long training and race-specific preparation were also totally different. Their superspecialization allowed them to achieve top performances, but nevertheless, the Tour de France was won by the Australian... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502376 Wed, 14 Dec 2011 22:48:01 +0100 5502376 http://www.medworm.com/index.php?rid=5502375&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001432%2Fabstract%3Frss%3Dyes If the splintering and fragmentation of surgery continues to the end that an established surgeon, whether in the academic arena or in community surgery, addresses himself to the acquisition of mastership of a few operations, certainly he will do these operations better than the wide ranging surgical generalist … If the surgical specialist is to dominate the scene completely, the future advance of surgery in my opinion will be retarded. Owen Wangensteen (American surgical pioneer), 1972 (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502375 Wed, 14 Dec 2011 22:48:01 +0100 5502375 http://www.medworm.com/index.php?rid=5502373&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001559%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502373 Wed, 14 Dec 2011 22:48:01 +0100 5502373 http://www.medworm.com/index.php?rid=5502372&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001535%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502372 Wed, 14 Dec 2011 22:48:01 +0100 5502372 http://www.medworm.com/index.php?rid=5502371&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001511%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5502371 Wed, 14 Dec 2011 22:48:01 +0100 5502371 http://www.medworm.com/index.php?rid=5377877&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001079%2Fabstract%3Frss%3Dyes Segmentectomy for early-stage non-small cell lung cancer (NSCLC) is gradually gaining acceptance on the basis of the results of prospective series, and ongoing trials (CALGB 140503 and JCOG0802/WJOG4607L) that compare lobectomy versus sublobar resection for stage Ia NSCLC underscore the potential role of segmentectomy as effective therapy for lung cancer. Furthermore, the preliminary results from the National Lung Screening Trial could lead to an increase in the number of patients diagnosed with early-stage NSCLC who are treatable with segmentectomy. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377877 Sat, 05 Nov 2011 15:30:38 +0100 5377877 http://www.medworm.com/index.php?rid=5377876&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001031%2Fabstract%3Frss%3Dyes The successful use of esophageal stents for anastomotic leaks and perforations mandates careful patient selection. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377876 Sat, 05 Nov 2011 15:30:38 +0100 5377876 http://www.medworm.com/index.php?rid=5377874&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001055%2Fabstract%3Frss%3Dyes It is currently our practice to consider esophageal stent placement for any esophageal perforation, fistula, or anastomotic leak. This is based on the results of our 4 reported patient series and subsequently treated patients (). This is regardless of the duration of the perforation or fistula before treatment or whether a previous operative repair has been performed. Included are patients who have a relatively large esophageal diameter and patients with systemic manifestations of infection related to their esophageal injury. We have also successfully treated acute perforations and fistulae of the esophagus in the setting of an esophageal malignancy. Although generally considered an indication for esophagectomy rather than operative repair, esophageal injury or fistula in the setting of ma... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377874 Sat, 05 Nov 2011 15:30:38 +0100 5377874 http://www.medworm.com/index.php?rid=5377873&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001067%2Fabstract%3Frss%3Dyes Postesophagectomy anastomotic leaks and esophageal perforations are serious morbid events. Despite advances in surgical and intensive unit care, the morbidity (10%-60%) and mortality (4%-50%) associated with esophageal leaks and perforations are still very high; furthermore, 10%-50% of patients develop strictures requiring dilations. In recent years, several investigators have described the use of endoscopically placed esophageal stents for the treatment of leaks and perforations. Reported success rates range from 60% to 90%; however, the successful application of endoluminal stents for esophageal leaks and perforations requires careful patient selection, proper stent choice, experienced operators, adequate drainage of deep space infection, and meticulous follow-up. Although esophageal ste... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377873 Sat, 05 Nov 2011 15:30:38 +0100 5377873 http://www.medworm.com/index.php?rid=5377872&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001109%2Fabstract%3Frss%3Dyes In the setting of aortic regurgitation caused by leaflet prolapse, aortic valve replacement has traditionally been the recommended treatment. However, the advent of effective and durable leaflet repair techniques has enabled the repair of the regurgitant aortic valve. As for the mitral valve, repair has the potential to reduce the incidence of prosthesis-related complications including endocarditis, thromboembolism, anticoagulant-related hemorrhage, and reoperation. In this article, we describe our systematic approach to the assessment and repair of aortic leaflet prolapse. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377872 Sat, 05 Nov 2011 15:30:38 +0100 5377872 http://www.medworm.com/index.php?rid=5377871&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306791100102X%2Fabstract%3Frss%3Dyes Aortic valve sparing operations were developed to preserve the aortic valve in patients with ascending aortic aneurysm and aortic insufficiency or patients with aortic root aneurysm. There are 2 types of aortic valve sparing operations, remodeling of the aortic root and reimplantation of the aortic valve. The author believes that remodeling of the aortic root is more appropriate for older patients with ascending aortic aneurysm, dilated aortic sinuses, and normal aortic annulus, whereas reimplantation of the aortic valve is more appropriate for young patients with aortic root aneurysm in whom dilation of the aortic annulus is commonly associated. Although remodeling of the aortic root has been extensively used in patients with aortic root aneurysm, the long-term results are somewhat inferi... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377871 Sat, 05 Nov 2011 15:30:38 +0100 5377871 http://www.medworm.com/index.php?rid=5377870&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000864%2Fabstract%3Frss%3Dyes Historically, lung cancer has been viewed as a male disease, but during the past 50 years there has been a dramatic increase in the incidence of lung cancer in women. Lung cancer is currently the most common cause of cancer death in American women, accounting for more than one quarter of all cancer deaths. This has been attributed to a significant increase in tobacco consumption by women; however, approximately 1 in 5 women with lung cancer never smoked. As the incidence of lung cancer in women has increased, significant gender-based differences in epidemiology, biology, and treatment responses have become evident and warrant further investigation to advance the treatment of lung cancer in all patients. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377870 Sat, 05 Nov 2011 15:30:38 +0100 5377870 http://www.medworm.com/index.php?rid=5377869&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001080%2Fabstract%3Frss%3Dyes The esophagus has a single rudimentary function of active transport of solids and liquids from the pharynx to the stomach and, rarely, venting of the stomach with retrograde passage of gastric contents into the pharynx. It is void of any digestive, absorptive, metabolic, or endocrine functions. Despite this simplicity of function, sex (biological and physiological characteristics, ie, male versus female) and gender (roles, behaviors, activities, and attributes that a given society considers appropriate, ie, man versus woman) differences exist in both normal esophageal function and esophageal disease. Some components of esophageal function are sex-dependent, and these differences must be considered in the interpretation of functional testing. In esophageal disease, particularly gastroesopha... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377869 Sat, 05 Nov 2011 15:30:38 +0100 5377869 http://www.medworm.com/index.php?rid=5377868&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000980%2Fabstract%3Frss%3Dyes Significant sex differences exist between men and women with regard to coronary artery disease. Most notably, this lethal disease kills more women than men each year and remains the leading cause of death for both men and women. Women and men clearly have different risk profiles when diagnosed with coronary artery disease and fare much differently after myocardial infarction and coronary artery bypass grafting. This review summarizes the sex differences in clinical presentation, diagnosis, and the surgical treatment of coronary artery disease between men and women; and potential multifactorial reasons for sex disparities are suggested. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377868 Sat, 05 Nov 2011 15:30:38 +0100 5377868 http://www.medworm.com/index.php?rid=5377867&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001092%2Fabstract%3Frss%3Dyes Disease of the aorta affects more than 40,000 Americans annually, with a portion of these presentations involving the thoracic aorta. Studies have revealed gender differences in the presentation, management, and outcome of patients with aortic disease. However, most of this work focuses on the abdominal aorta; the data are then extrapolated to the thorax. It is currently established that women with abdominal aortic disease have worse outcomes, are less likely to undergo surgical treatment, and have higher morbidity and mortality. Similar results are seen in the management of women with thoracic aortic dissection. Herein we review the issue of sex and gender differences in thoracic aortic disease. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377867 Sat, 05 Nov 2011 15:30:38 +0100 5377867 http://www.medworm.com/index.php?rid=5377866&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000955%2Fabstract%3Frss%3Dyes 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. The different surgical techniques of subcoronary and full root methods will be discussed and important technical aspects reviewed. 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. (Sourc... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377866 Sat, 05 Nov 2011 15:30:38 +0100 5377866 http://www.medworm.com/index.php?rid=5377865&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000967%2Fabstract%3Frss%3Dyes Mitral regurgitation (MR) is the most frequent valve disease. Nevertheless, evaluation of MR severity is difficult because standard color flow imaging is plagued by considerable pitfalls. Modern surgical indications in asymptomatic patients require precise assessment of MR severity. MR severity assessment is always comprehensive, utilizing all views and methods. Determining trivial/mild MR is usually easy, based on small jet and flow convergence. Specific signs of severe MR (pulmonary venous flow systolic reversal or severe mitral lesion) are useful but insensitive. Quantitative methods, quantitative Doppler (measuring stroke volumes) and flow convergence (aka PISA method), measure the lesion severity as effective regurgitant orifice (ERO) and volume overload as regurgitant volume (RVol). ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377865 Sat, 05 Nov 2011 15:30:38 +0100 5377865 http://www.medworm.com/index.php?rid=5377864&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001018%2Fabstract%3Frss%3Dyes Risk stratification is an important and essential component in appropriately informing patients electing to undergo coronary artery bypass graft or percutaneous coronary intervention. This process is an integral part of the SYNTAX pioneered Heart Team approach in selecting the most appropriate revascularization modality in patients with complex coronary artery disease. The SYNTAX score was pioneered as an anatomical-based risk score that aided in this decision-making process. The purpose of this review is to examine the SYNTAX score and subsequent risk models that have been developed on the basis of this landmark anatomical-based risk score. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377864 Sat, 05 Nov 2011 15:30:38 +0100 5377864 http://www.medworm.com/index.php?rid=5377863&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000876%2Fabstract%3Frss%3Dyes In a recent article published in The Lancet, investigators studied the impact of daily aspirin use on subsequent cancer deaths. Utilizing data from more than 25,000 patients enrolled in 8 large trials, which were originally intended to study the impact of daily aspirin use on the incidence of cardiovascular events, the authors found a substantial decrease in risk of fatal solid organ malignancies. In particular, the risk reduction was specific to adenocarcinomas. The findings from this study are highly relevant to the thoracic surgeon, with adenocarcinomas of the lung and esophagus among those tumors demonstrating the most profound risk reduction. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377863 Sat, 05 Nov 2011 15:30:38 +0100 5377863 http://www.medworm.com/index.php?rid=5377862&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000177%2Fabstract%3Frss%3Dyes This study, published recently in the Journal of Clinical Oncology, is a retrospective review of data collected by the Amsterdam Cancer Registry. This study highlights many of the difficulties encountered when comparing the effectiveness of surgical resection and SBRT. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377862 Sat, 05 Nov 2011 15:30:38 +0100 5377862 http://www.medworm.com/index.php?rid=5377861&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306791100089X%2Fabstract%3Frss%3Dyes Lungs suitable for organ donation are a scarce resource. Recent efforts with alternative ventilatory strategies have yielded promise to the potential expansion of lungs suitable for transplantation. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377861 Sat, 05 Nov 2011 15:30:38 +0100 5377861 http://www.medworm.com/index.php?rid=5377860&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000888%2Fabstract%3Frss%3Dyes In a recent publication, investigators examined the ways in which learners most effectively acquired new knowledge. The authors found that students achieved the most meaningful and long-lasting learning through retrieval practice, a method consisting of taking tests on the curricular material covered as part of the primary learning activity. The findings from this study may be useful in enhancing the ways that we prepare our surgical trainees. Further, these data have important implications as we consider our own processes for lifelong learning. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377860 Sat, 05 Nov 2011 15:30:38 +0100 5377860 http://www.medworm.com/index.php?rid=5377859&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000554%2Fabstract%3Frss%3Dyes Monjazeb et al performed a single-institution, retrospective study of 163 patients with histologically confirmed stage I to IVa esophageal cancer to assess the utility of positron-emission tomography (PET) in delineating which patients would most likely benefit from esophagectomy after induction chemoradiation therapy. They found that patients who achieve a PET complete response after definitive chemoradiation therapy had similar outcomes to patients treated with trimodal therapy and concluded that patients who achieve a PET complete response after induction therapy may not benefit from esophagectomy. Though their study is interesting, their results should be validated by a prospective trial before they are incorporated into clinical practice. (Source: Seminars in Thoracic and Cardiovascul... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377859 Sat, 05 Nov 2011 15:30:38 +0100 5377859 http://www.medworm.com/index.php?rid=5377858&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000992%2Fabstract%3Frss%3Dyes PARTNER trial, cohort B has taken our cardiovascular community to new heights in multidisciplinary collaboration while raising awareness in the primary care community regarding the shortcomings of noninterventional treatment of symptomatic AS. With a rate of death from any cause at 1 year that is 20% lower with transcatheter aortic valve replacement (TAVR) in comparison with standard medical therapy, TAVR should be considered the new standard of care for patients with AS who are not suitable candidates for surgery. Despite TAVR’s initial success, this landmark trial leaves questions about durability, paravalvular regurgitation, and procedural complications unanswered. Nonetheless, TAVR is clearly and unequivocally a new and successful treatment for symptomatic AS. Complication rates in t... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377858 Sat, 05 Nov 2011 15:30:38 +0100 5377858 http://www.medworm.com/index.php?rid=5377857&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001249%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377857 Sat, 05 Nov 2011 15:30:38 +0100 5377857 http://www.medworm.com/index.php?rid=5377856&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001225%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377856 Sat, 05 Nov 2011 15:30:38 +0100 5377856 http://www.medworm.com/index.php?rid=5377855&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911001201%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5377855 Sat, 05 Nov 2011 15:30:38 +0100 5377855 http://www.medworm.com/index.php?rid=5085712&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000517%2Fabstract%3Frss%3Dyes Among patients with early-stage lung cancer, more than 20% cannot tolerate surgery because of comorbid conditions. We propose the use of computed tomography (CT)–guided microwave ablation under local anesthesia for treatment of early-stage lung cancer in patients deemed inoperable for medical reasons () . The system uses microwave energy that emanates from the radiating section of an antenna to cause tissue coagulation. The microwave energy creates heat by generating friction through the vibration of water molecules. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085712 Tue, 02 Aug 2011 06:59:58 +0100 5085712 http://www.medworm.com/index.php?rid=5085711&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000591%2Fabstract%3Frss%3Dyes Port placement is described in and . This standardized port configuration can be used for all segmental resections. On the left, the port arrangement is shifted slightly posterior to account for the heart/mediastinum. A metal 10-mm port is introduced for the camera at the level of the 7th interspace in the midaxillary line. Instruments/staplers are introduced through the remaining incisions without ports, unless required. Rib spreading is avoided. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085711 Tue, 02 Aug 2011 06:59:58 +0100 5085711 http://www.medworm.com/index.php?rid=5085710&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000499%2Fabstract%3Frss%3Dyes 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). Identification of the intersegmental plane is performed by selective jet ventilation under bronchofiberscopy. 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. (Sour... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085710 Tue, 02 Aug 2011 06:59:58 +0100 5085710 http://www.medworm.com/index.php?rid=5085709&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000505%2Fabstract%3Frss%3Dyes We describe our technique of basilar segmentectomy by using a totally thoracoscopic approach without utility incision. We have performed 65 anatomical segmentectomies by using this approach. Nineteen of these were basilar segmentectomies. On the basis of this experience, we report useful technical details and our results. There was 1 conversion to thoracotomy because of inflammatory and fused fissure (1.5%). In the 18 remaining patients who had a totally endoscopic resection, the mean operative time was 191 minutes (range, 116-315 minutes). The mean operative blood loss was 73 mL (range, 10-150 mL). The postoperative course was uneventful in all but 1 patient who developed pulmonary edema that resolved after 2 days. Chest tubes were removed after a mean time of 2.8 days (range, 2-5 days), ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085709 Tue, 02 Aug 2011 06:59:58 +0100 5085709 http://www.medworm.com/index.php?rid=5085708&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000578%2Fabstract%3Frss%3Dyes Although individual basilar segments may be resected, most basilar resections include all 4 segments (ie, segments 7-10). Computed tomography is used preoperatively to determine lesion size, segment location, the presence of adenopathy, and the presence of metabolically active nodal disease (via positron emission tomography), as well as to ascertain that the lesion is not too close to the superior segment to exclude the option of basilar segmentectomy. Anesthesia is administered in the usual fashion, with single-lung ventilation achieved by double-lumen endotracheal tube or bronchial blocker placement. After bronchoscopy and mediastinosopy (when indicated), single-lung anesthesia is established. The patient is positioned in the lateral decubitus position with slight flexion of the table at... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085708 Tue, 02 Aug 2011 06:59:58 +0100 5085708 http://www.medworm.com/index.php?rid=5085707&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000608%2Fabstract%3Frss%3Dyes Postesophagectomy anastomotic leaks and esophageal perforations are serious morbid events. Despite advances in surgical and intensive unit care, the morbidity (10%-60%) and mortality (4%-50%) associated with esophageal leaks and perforations are still very high; furthermore, 10%-50% of patients develop strictures requiring dilations. In recent years, several investigators have described the use of endoscopically placed esophageal stents for the treatment of leaks and perforations. Reported success rates range from 60% to 90%; however, the successful application of endoluminal stents for esophageal leaks and perforations requires careful patient selection, proper stent choice, experienced operators, adequate drainage of deep space infection, and meticulous follow-up. Although esophageal ste... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085707 Tue, 02 Aug 2011 06:59:58 +0100 5085707 http://www.medworm.com/index.php?rid=5085706&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000645%2Fabstract%3Frss%3Dyes Transcatheter aortic valve implantation (T-AVI) has been introduced into clinical practice to treat high-risk elderly patients with aortic stenosis. T-AVI can be performed by using a retrograde transfemoral (TF), transsubclavian, transaortic, and/or antegrade transapical (TA) approach. For TA-AVI, CE mark approval was granted in 2008 for the Edwards SAPIEN (Edwards Lifesciences, Irvine, CA) prosthesis with the Ascendra delivery system and in 2010 for the second-generation Edwards SAPIEN XT prosthesis and the Ascendra II delivery system, with 23-mm and 26-mm valves. In 2011, CE mark approval has been granted for TA-AVI by using the SAPIEN XT 29-mm prosthesis. Several other devices from different companies (Jenavalve, Jena Valve Inc, Munich, Germany; Embracer, Medtronic Inc, Guilford, CT; Ac... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085706 Tue, 02 Aug 2011 06:59:58 +0100 5085706 http://www.medworm.com/index.php?rid=5085705&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000530%2Fabstract%3Frss%3Dyes We describe a step-by-step approach to performing TAVR with the SAPIEN XT valve. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085705 Tue, 02 Aug 2011 06:59:58 +0100 5085705 http://www.medworm.com/index.php?rid=5085704&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306791100061X%2Fabstract%3Frss%3Dyes We present the current optimal uses and limitations of positron emission tomography/computed tomography (PET/CT) as it relates to the diagnosis and staging of non-small cell lung cancer (NSCLC). PET/CT demonstrates increased accuracy in the workup of solitary pulmonary nodules for malignancy compared with CT alone, and we discuss its benefits and limitations. We review pitfalls in measured standardized uptake values of lung lesions caused by respiratory artifacts, the lower sensitivity for detection of small lung nodules on non-breath-hold CT, and the benefits of obtaining an additional diagnostic CT for the maximum sensitivity of lung nodule detection. There are limitations of quantitatively comparing separate PET/CT examinations from different facilities with standardized uptake values. ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085704 Tue, 02 Aug 2011 06:59:58 +0100 5085704 http://www.medworm.com/index.php?rid=5085703&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000074%2Fabstract%3Frss%3Dyes We have developed a robotic video-assisted thoracoscopic technique (RVATS) for lung resection that could encourage broader use of minimally invasive lobectomy. During December 2006 to September 2010, RVATS was performed in 200 consecutive patients (90 women, 110 men) with the da Vinci Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA). Pulmonary resection was performed through ports without the need for a utility incision. Data on patients' perioperative results were collected retrospectively. Robotic video-assisted pulmonary resection was accomplished in 197 of 200 patients. A total of 154 patients underwent lobectomy; 4 patients required bilobectomy, and 35 patients underwent segmentectomy. Three patients underwent a sleeve lobectomy, and 3 patients had an en-bloc resection with lo... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085703 Tue, 02 Aug 2011 06:59:58 +0100 5085703 http://www.medworm.com/index.php?rid=5085702&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000219%2Fabstract%3Frss%3Dyes Hyperbole about “personalized” or “individualized” medicine continues to increase exponentially. To leverage this concept, most major academic medical centers in the United States have been unable to resist the temptation to rebrand a portion of their infrastructure as a “Center for Individualized Medicine” or some reasonable facsimile. Cancer care has been at the forefront of this movement. Although the grizzled skeptic might observe this as the latest iteration of undeliverable hype in cancer treatment, recent advances do suggest a changing landscape in how we approach management decisions for the patient with non–small cell lung cancer (NSCLC). An expanding and functionally useful toolbox of novel targeted agents and biomarkers to drive therapeutic choices is beginning to ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085702 Tue, 02 Aug 2011 06:59:58 +0100 5085702 http://www.medworm.com/index.php?rid=5085701&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000633%2Fabstract%3Frss%3Dyes Despite encouraging advances in our knowledge of the prevention and treatment of atherothrombosis, cardiovascular (CV) disease remains the leading cause of death worldwide. The impressive growth of this epidemic during the last decade is due largely to the increasing incidence of CV diseases in low- and middle-income countries (LMICs). The uncontrolled rise in the incidence of risk factors (obesity, hypertension, tobacco, high cholesterol, diabetes) in these countries accounts largely for the increasing incidence of CV diseases. Lifestyle modification and pharmacologic treatment have been very effective in improving the risk profile in those individuals at high risk. In Western countries the impact of all these preventive and therapeutic interventions has been a substantial decline in CV m... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085701 Tue, 02 Aug 2011 06:59:58 +0100 5085701 http://www.medworm.com/index.php?rid=5085700&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000566%2Fabstract%3Frss%3Dyes During the last decade the number of patients undergoing tissue rather than mechanical valve replacement has increased to a point that more than three-quarters of implants are bioprostheses. Three main reasons underlie this change in practice. First, bioprosthetic valves are usually the implant of choice in elderly patients, who represent a steadily increasing proportion of patients undergoing valve replacement. Second, there is increasing recognition that the excellent durability associated with mechanical valves does not appear to confer a significant long-term survival benefit over bioprostheses in most patients, with consensus guidelines emphasizing the importance of informed patient consent when making a decision that is focused on a choice between the relatively distant risk of reope... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085700 Tue, 02 Aug 2011 06:59:58 +0100 5085700 http://www.medworm.com/index.php?rid=5085699&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000621%2Fabstract%3Frss%3Dyes Off pump coronary artery bypass grafting remains an important technique particularly in the care of high-risk patients. Consistently successful adoption of this technique requires a cooperative team approach and standardization across all phases of patient care. This review describes our approach to off pump coronary surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085699 Tue, 02 Aug 2011 06:59:58 +0100 5085699 http://www.medworm.com/index.php?rid=5085698&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000153%2Fabstract%3Frss%3Dyes The recognition of cardiothoracic critical care as a separate and integral component of the care of the thoracic surgical patient is emerging. We review the recent exciting emergence of this area of specialization and its important future. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085698 Tue, 02 Aug 2011 06:59:58 +0100 5085698 http://www.medworm.com/index.php?rid=5085697&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000189%2Fabstract%3Frss%3Dyes During the past few decades, particles of various compositions have been engineered in ever smaller sizes to function in both diagnostic and therapeutic capacities. Nanoparticles are now available on a scale similar to many biological molecules and infectious agents, thereby opening the possibility of biological intervention on the molecular level. Several recent timely reports summarize nanoparticle properties and potential clinical applications in early-stage clinical trials. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085697 Tue, 02 Aug 2011 06:59:58 +0100 5085697 http://www.medworm.com/index.php?rid=5085696&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000190%2Fabstract%3Frss%3Dyes While adjuvant chemotherapy has been shown to modestly improve survival for patients with resected non-small cell lung cancer (NSCLC), the morbidities associated with administration of these drugs are substantial. The identification of molecular profiles that may predict a patient's need for adjuvant therapy may prove highly useful. In a recently published article, Zhu et al identify a 15-gene signature that serves as an independent prognostic marker for early-stage NSCLC, stratifying patients into low- and high-risk groups. Further, the authors found that the gene signature has predictive utility in determining the potential benefit of adjuvant chemotherapy. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085696 Tue, 02 Aug 2011 06:59:58 +0100 5085696 http://www.medworm.com/index.php?rid=5085695&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000529%2Fabstract%3Frss%3Dyes During the last year, the 3-year outcome data from the SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) trial in overall results, results for 3-vessel disease, and results for left main disease have provided important insights into contemporary results of coronary revascularization either by stenting or surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085695 Tue, 02 Aug 2011 06:59:58 +0100 5085695 http://www.medworm.com/index.php?rid=5085694&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000542%2Fabstract%3Frss%3Dyes Determining the optimal level of glycemic control in critical illness has proven difficult since the original Leuven study conclusions were published in 2001. Conflicting evidence, scientific methodologies, hospital cultures, and a-priori biases have challenged many clinical practice patterns. Specifically, the prioritization of patient safety has resulted in many practitioners changing from a glycemic control target of 80-110 mg/dL to a more liberal target of 140-180 mg/dL. However, a detailed examination of the evidence can provide a more population-specific glycemic control strategy. This position paper presents an approach for cardiac surgery patients in the intensive care unit (ICU) consistent with extant evidence and real-life variables. We argue that in the cardiac surgery ICU, glyc... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085694 Tue, 02 Aug 2011 06:59:58 +0100 5085694 http://www.medworm.com/index.php?rid=5085693&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000724%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085693 Tue, 02 Aug 2011 06:59:58 +0100 5085693 http://www.medworm.com/index.php?rid=5085692&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000700%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085692 Tue, 02 Aug 2011 06:59:58 +0100 5085692 http://www.medworm.com/index.php?rid=5085691&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000682%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=5085691 Tue, 02 Aug 2011 06:59:58 +0100 5085691 http://www.medworm.com/index.php?rid=4788778&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000207%2Fabstract%3Frss%3Dyes The postpneumonectomy patient with an indeterminate pulmonary nodule in the contralateral lung represents a formidable diagnostic and therapeutic challenge. The diagnosis of suspicious peripheral lung nodules is performed most commonly by computed tomography (CT)–guided transthoracic needle aspiration (TTNA). Depending on the size and location, the diagnostic accuracy of TTNA ranges from 65%-96%. The TTNA-associated risk of pneumothorax, particularly in patients with emphysema, is 21%-40%, depending on the number of needle passes and the experience of the operator. Many interventional radiologists consider a previous pneumonectomy as a contraindication to TTNA because of the significant risk of pneumothorax. In one published report, TTNA in postpeumonectomy patients was performed with a ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788778 Fri, 06 May 2011 06:43:43 +0100 4788778 http://www.medworm.com/index.php?rid=4788777&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000086%2Fabstract%3Frss%3Dyes The most common reconstruction after an esophagectomy is with a gastric pull-up. Essential for a good quality of life after esophagectomy, in addition to cure of the disease, is reestablishing the ability to aliment comfortably. The necessity of a pyloroplasty in patients having a gastric pull-up for esophageal replacement has been debated, but it has been our preference to use one, even with a thin, tabularized graft. Our standard pyloroplasty entails a full-thickness longitudinal incision through the pylorus with mucosal closure in the same direction as the incision and coverage with an omental patch. Potential disadvantages of a standard pyloroplasty are shortening of the graft and the risk of a leak, as well as long-term increased bile reflux. (Source: Seminars in Thoracic and Cardiova... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788777 Fri, 06 May 2011 06:43:43 +0100 4788777 http://www.medworm.com/index.php?rid=4788776&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000050%2Fabstract%3Frss%3Dyes A vagotomized, tubularized gastric conduit is the most commonly used conduit for reconstruction of the thoracic esophagus at esophagectomy. However, the gastric conduit is an imperfect esophageal replacement. The conduit has no receptive relaxation and has a reduced capacity compared with the native stomach. There is decreased antral motility, and gravity is the major determinant of conduit drainage. A pyloric drainage procedure, such as a pyloroplasty or pyloromyotomy, facilitates the emptying of the gastric conduit and may improve foregut function and quality of life after esophageal resection. Critics of this approach are concerned that a pyloroplasty may lead to excessive bile reflux and too rapid emptying of the stomach. At our institution, we have developed a minimally invasive Ivor ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788776 Fri, 06 May 2011 06:43:43 +0100 4788776 http://www.medworm.com/index.php?rid=4788775&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306791100013X%2Fabstract%3Frss%3Dyes Lung volume-reduction surgery is a proven palliative procedure for emphysema, and in patients with heterogeneous upper-lobe disease as well as low baseline exercise capacity, even mortality benefits can be realized. However, its application is limited by high postoperative morbidity and stringent selection criteria that effectively exclude many patients. This has been the impetus for the development of less-invasive approaches to lung volume reduction. A range of different bronchoscopic techniques, such as endobronchial blockers, airway bypass, endobronchial valves, thermal vapor ablation, biological sealants, and airway implants have been investigated. The underlying physiological mechanisms of the various endoscopic modalities differ and both homogeneous, as well as heterogeneous, emphys... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788775 Fri, 06 May 2011 06:43:43 +0100 4788775 http://www.medworm.com/index.php?rid=4788774&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000104%2Fabstract%3Frss%3Dyes Advanced endoscopic imaging techniques have made the early diagnosis of neoplastic lesions in Barrett's esophagus easier. A new chapter in minimal invasive cancer therapy has been opened. Endoscopic treatment of early neoplasia in Barrett's esophagus (high-grade intraepithelial neoplasia and mucosal adenocarcinoma) has become the method of choice in most countries. Long-term results for endoscopic treatment in a large group of patients are now available. These emerging data suggest that endoscopic therapy is safe and highly effective with long-term complete remission rates of more than 94%. All visible lesions should be treated by endoscopic resection for histologic confirmation of the neoplastic lesion rather than by ablative techniques. After successful endoscopic resection of all visibl... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788774 Fri, 06 May 2011 06:43:43 +0100 4788774 http://www.medworm.com/index.php?rid=4788773&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000025%2Fabstract%3Frss%3Dyes Atrial fibrillation (AF) occurs commonly after noncardiac thoracic surgery, including lobectomy, pneumonectomy and esophagectomy. While not as extensively investigated as AF following cardiac surgery, some strategies for prophylaxis of AF after noncardiac thoracic surgery have been studied. Evidence from prospective, randomized controlled studies supports the use of beta-blockers, diltiazem, amiodarone or magnesium for prevention of AF after pulmonary resection. Limited evidence supports the efficacy of intravenous amiodarone for prevention of AF after esophagectomy. Further study is necessary to determine the safest and most effective methods of prophylaxis of AF after noncardiac thoracic surgery, and to identify patients most likely to benefit from AF prophylaxis. (Source: Seminars in Th... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788773 Fri, 06 May 2011 06:43:43 +0100 4788773 http://www.medworm.com/index.php?rid=4788772&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000098%2Fabstract%3Frss%3Dyes Natural orifice transluminal endoscopic surgery (NOTES) proposes the possibility of less-invasive, incisionless surgery. Initially conceived to replace abdominal procedures, more recently interest has focused on mediastinal and thoracic procedures as possible logical applications of transluminal approaches. A survey of the literature as well as the author's own experience is performed, examining experimental and increasingly human use of mediastinal and thoracoscopic flexible endoscopy. Issues regarding instrumentation, orientation, and best access are discussed. The literature describes both direct transesophageal access to the mediastinum and pleural cavities and submucosal flap access. Other techniques include transgastric, transvesicular, and percutaneous access via a neck incision. Ov... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788772 Fri, 06 May 2011 06:43:43 +0100 4788772 http://www.medworm.com/index.php?rid=4788771&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000141%2Fabstract%3Frss%3Dyes Brain protection in adult aortic surgery has been a very controversial issue among cardiothoracic surgeons for more than 40 years—almost since the inception of open heart surgery. Until today, 3 main strategies for cerebral protection of patients undergoing extensive aortic surgery have been developed and studied: (1) straight deep hypothermic circulatory arrest (DHCA), (2) retrograde cerebral perfusion (RCP), and (3) antegrade cerebral perfusion (ACP). Straight DHCA used to be the preferred and favored technique in the past; however, the recent trend among cardiothoracic surgeons is to avoid using straight DHCA and to apply additional perfusion adjuncts, such as RCP or ACP. In this article, we describe the advantages and disadvantages of each perfusion method on the basis of recent publ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788771 Fri, 06 May 2011 06:43:43 +0100 4788771 http://www.medworm.com/index.php?rid=4788770&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000128%2Fabstract%3Frss%3Dyes Understanding the risk of surgery in valvular disease is of interest because aging of the population renders decision making more difficult and the magnitude of risk will influence not only the decision to intervene but also the choice of intervention and its timing. To assist clinicians in assessing the risk of cardiac surgery, multivariate risk scores are increasingly used to estimate operative mortality. Overall, the currently available scores, mostly U.S. Society of Thoracic Surgeons score and European System for Cardiac operative Risk Evaluation, achieve acceptable discrimination but suboptimal calibration in estimating the operative mortality of heart valve surgery. The intrinsic limitations of scoring systems highlight the fact that risk scores should be integrated into clinical jud... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788770 Fri, 06 May 2011 06:43:43 +0100 4788770 http://www.medworm.com/index.php?rid=4788769&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000116%2Fabstract%3Frss%3Dyes Our understanding of calcific aortic stenosis has changed dramatically during the past 3 decades, with the concept of a “mechanical” disease of aging now replaced by the concept of an active disease process at the tissue level that may be amenable to medical therapy. The ability of echocardiography to provide early diagnosis and an accurate measurement of disease severity has increased our knowledge of the natural history of this disease process and allows us to follow individual patients over time, long before valve replacement is needed. We now recognize that even mild symptoms are an indication for valve replacement when severe obstruction is present. This review discusses the optimal approach to measurement of disease severity, the presymptomatic disease course, and the underlying ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788769 Fri, 06 May 2011 06:43:43 +0100 4788769 http://www.medworm.com/index.php?rid=4788768&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000037%2Fabstract%3Frss%3Dyes Preliminary results of the National Lung Screening Trial were recently announced. The significant implications of this trial for thoracic surgical practice are reviewed. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788768 Fri, 06 May 2011 06:43:43 +0100 4788768 http://www.medworm.com/index.php?rid=4788767&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000049%2Fabstract%3Frss%3Dyes The formalization of assessment of surgical outcomes across health care systems for complex procedures is a significant problem in the surgical literature. Low and colleagues present support for the use of the Accordion Severity Grading System as a tool to provide simple and comprehensive assessment of postoperative complications. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788767 Fri, 06 May 2011 06:43:43 +0100 4788767 http://www.medworm.com/index.php?rid=4788766&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000165%2Fabstract%3Frss%3Dyes MicroRNAs have recently emerged as important regulatory molecules of normal and abnormal cellular behavior. They are small (18-22 nucleotides) noncoding RNA that control translation by sequence complementarity of their “seed” sequence to the 3′ untranslated regions (UTR) of their target mRNAs, which are RNA species that code for proteins. Apart from their biological importance, these small molecules have received attention as biomarkers because of their remarkable stability in tissues and body fluids and the ease of their measurement. A recent article in Cancer Research by Voortman et al has failed to validate the hypothesis that tumor microRNA expression is associated with prognosis. In light of this significant finding, this article summarizes the current state of the art of microR... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788766 Fri, 06 May 2011 06:43:43 +0100 4788766 http://www.medworm.com/index.php?rid=4788765&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000062%2Fabstract%3Frss%3Dyes Improvements in technology, classic peer review, and even relentless determination of the individual practitioner have proven insufficient to eliminate adverse events in surgical patients. Preventing avoidable harm must focus on changing the operating room culture from one of separate—and well-meaning individuals—to a cohesive approach by surgeons, anesthesiologists, nurses, and associated or health staff. Neily and colleagues report the results of a comprehensive team training program implemented across 74 Veterans Health or facilities, which was associated with an 18% reduction in annual mortality (rate ratio = 0.82; P = 0.01). (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788765 Fri, 06 May 2011 06:43:43 +0100 4788765 http://www.medworm.com/index.php?rid=4788764&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000281%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788764 Fri, 06 May 2011 06:43:43 +0100 4788764 http://www.medworm.com/index.php?rid=4788763&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000268%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788763 Fri, 06 May 2011 06:43:43 +0100 4788763 http://www.medworm.com/index.php?rid=4788762&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067911000244%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4788762 Fri, 06 May 2011 06:43:43 +0100 4788762 http://www.medworm.com/index.php?rid=4294030&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001231%2Fabstract%3Frss%3Dyes Video assisted thoracoscopic (VATS) wedge resection of a small non-palpable and non-visible pulmonary nodule (PN) is a commonly encountered clinical challenge. A variety of techniques have been described to mark the pleural surface in the vicinity of a small PN and guide thoracoscopic resection: computerized tomography-guided percutaneous placement of wires, coils, or radio-opaque dye; intraoperative ultrasonography; and electromagnetic navigation bronchoscopy (ENB)-guided dye injection (). However, each of these techniques has practical limitations. We propose a technique that may circumvent the logistical problems of previously described approaches. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294030 Wed, 29 Dec 2010 05:31:20 +0100 4294030 http://www.medworm.com/index.php?rid=4294029&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001139%2Fabstract%3Frss%3Dyes We report a case of a 68-year-old woman with a basal postmyocardial infarction ventricular septal defect that recurred 4 months after initial surgical repair. Successful transcatheter closure using an Amplatzer Muscular VSD Occluder was facilitated by direct percutaneous left ventricular access. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294029 Wed, 29 Dec 2010 05:31:20 +0100 4294029 http://www.medworm.com/index.php?rid=4294028&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001218%2Fabstract%3Frss%3Dyes During the past 10 years, minimally invasive esophagectomy has emerged as a safe, reproducible, and durable technique for esophageal resection. Importantly, the minimally invasive approach yields low morbidity and mortality and equivalent oncological outcomes to open esophagectomy. Here, we will focus on the technical aspects of creating the intrathoracic esophagogastric anastomosis during minimally invasive Ivor Lewis esophagectomy. A detailed description of the operative steps preceding the creation of the anastomosis and the benefits of the Ivor Lewis approach can be found elsewhere. In summary, after the creation of a narrow gastric conduit and a pyloroplasty, we then proceed to video-assisted thoracoscopic anastomosis. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294028 Wed, 29 Dec 2010 05:31:20 +0100 4294028 http://www.medworm.com/index.php?rid=4294027&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306791000122X%2Fabstract%3Frss%3Dyes Minimally invasive Ivor Lewis esophagogastrectomy is one of the most complex minimally invasive operations. A major technical limitation in the performance of this operation is the difficulty in construction of a thoracoscopic, intrathoracic, esophagogastric anastomosis. Many techniques for thoracoscopic construction of an intrathoracic esophagogastric anastomosis have been described. However, the circular stapled technique is the preferred approach by our group. Our original technique consists of thoracoscopic division of the proximal esophagus at the level of the azygous vein, or higher, with the use of the ultrasonic shear. A 25-mm anvil is placed transthoracically into the open esophageal stump and secured with a pursestring suture. The 25-mm circular stapler is then placed transthorac... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294027 Wed, 29 Dec 2010 05:31:20 +0100 4294027 http://www.medworm.com/index.php?rid=4294026&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001176%2Fabstract%3Frss%3Dyes Off-pump coronary artery bypass surgery (OPCAB) provides an alternative method of surgical revascularization by allowing coronary anastomoses to be constructed without the use of cardiopulmonary bypass and without manipulation of the aorta. The presence of a calcified aorta is one of the strongest indications for OPCAB because both distal and proximal anastomoses can be performed without cannulation or clamping of the aorta. In patients with left ventricular dysfunction, OPCAB techniques allow for revascularization without the need for global myocardial ischemia associated with cardioplegic arrest. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294026 Wed, 29 Dec 2010 05:31:20 +0100 4294026 http://www.medworm.com/index.php?rid=4294025&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001243%2Fabstract%3Frss%3Dyes Experience reported in the literature increasingly supports the notion that segmentectomy is comparable with lobectomy for small tumors (≤2 cm), provided that the lesion is located centrally and affords a 2-cm parenchymal surgical margin. In a recent retrospective study that compared video-assisted thoracic surgery (VATS) lobectomy to VATS segmentectomy, the authors concluded that segmentectomy yields excellent oncological results with comparable morbidity, mortality, locoregional recurrence, and 3-year survival. Moreover, patients in both surgical groups were discharged after similar length hospital stays although patients undergoing VATS segmentectomy had worse pulmonary function before surgery. Perceived difficulties with new applications of minimally invasive surgeries disappear as e... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294025 Wed, 29 Dec 2010 05:31:20 +0100 4294025 http://www.medworm.com/index.php?rid=4294024&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001206%2Fabstract%3Frss%3Dyes Transcervical extended mediastinal lymphadenectomy (TEMLA), introduced by our team in 2004, is a new technique for the preoperative staging of non-small cell lung cancer (NSCLC). The aim of TEMLA is to maximally accurately stage and possibly to improve late results of treatment of NSCLC. Operative techniques include a collar incision in the neck, elevation of the sternal manubrium with a special retractor, bilateral visualization of the laryngeal recurrent and vagus nerves, and dissection of all mediastinal nodal stations except for the pulmonary ligaments nodes (station 9, according to the Mountain-Dresler map). Generally, the mediastinal pleura are not violated, and no drain is left in the mediastinum. In this article, some important steps the facilitating safe and straightforward perfor... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294024 Wed, 29 Dec 2010 05:31:20 +0100 4294024 http://www.medworm.com/index.php?rid=4294023&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001164%2Fabstract%3Frss%3Dyes Patients in the cardiothoracic surgical intensive care unit are generally critically ill and undergoing a systemic inflammatory response to cardiopulmonary bypass, ischemia/reperfusion, and hypothermia. This presents several metabolic challenges: hyperglycemia in need of intensive insulin therapy, catabolism, and uncertain gastrointestinal tract function in need of nutritional strategies. Currently, there are controversies surrounding the standard use of intensive insulin therapy and appropriate glycemic targets as well as the use of early enteral nutrition ± parenteral nutrition. In this review, an approach for intensive metabolic support in the cardiothoracic surgical intensive care unit is presented incorporating the most recent clinical evidence. This approach advocates an IIT blood g... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294023 Wed, 29 Dec 2010 05:31:20 +0100 4294023 http://www.medworm.com/index.php?rid=4294022&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001152%2Fabstract%3Frss%3Dyes Cardiac surgery presents a life-saving and life-enhancing opportunity to hundreds of thousands of patients each year in the United States. However, many patients face significant challenges during the postoperative period, including pain, anxiety, and tension. Mounting evidence demonstrates that such challenges can impair immune function and slow wound healing, in addition to causing suffering for the patient. Finding new approaches to mitigate these challenges is necessary if patients are to experience the full benefits of surgery. Massage therapy is a therapy that has significant evidence to support its role in meeting these needs. This paper looks at the data surrounding the use of massage therapy in cardiac surgery patients, with a special focus on the experience at Mayo Clinic. (Sourc... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294022 Wed, 29 Dec 2010 05:31:20 +0100 4294022 http://www.medworm.com/index.php?rid=4294021&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001140%2Fabstract%3Frss%3Dyes Mitral regurgitation (MR), currently the most frequent valvular heart disease, is mostly degenerative, linked to aging and of increasing prevalence. Indications of mitral surgery, the only current approved treatment of MR, are disputed. Coherent cumulative evidence obtained worldwide show that early surgery in asymptomatic patients is the preferred approach. Waiting for symptoms or left ventricular dysfunction is a failed strategy in that these characteristics are insensitive markers of risk, are often unrecognized in a timely manner and, even after successful surgery, are associated with poor outcome. Furthermore, in patients with severe organic MR, surgery is almost unavoidable and early mitral repair before the appearance of symptoms or overt LV dysfunction may restore life expectancy a... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294021 Wed, 29 Dec 2010 05:31:20 +0100 4294021 http://www.medworm.com/index.php?rid=4294020&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306791000119X%2Fabstract%3Frss%3Dyes Echocardiography is the primary noninvasive tool for evaluating the structure and function of cardiac valves and has become an essential diagnostic test in pre-, intra-, and postoperative management. Standard echocardiogram reports include several measurements and findings important to most cardiovascular and cardiothoracic surgeons. These measurements are derived from multiple standard imaging techniques, such as M-mode, 2-dimensional (2D), spectral Doppler and color Doppler which are employed in transthoracic (TTE) and transesophageal (TEE) echocardiography. As an ensemble, these techniques provide a comprehensive assessment of primary valve pathology and its secondary effects. In this review, we describe the use of these techniques in the imaging of the mitral, aortic, tricuspid and pul... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294020 Wed, 29 Dec 2010 05:31:20 +0100 4294020 http://www.medworm.com/index.php?rid=4294019&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001188%2Fabstract%3Frss%3Dyes The translation of proteins within the cell has been increasingly implicated in multiple malignancies as an important regulatory checkpoint. Although evidence continues to mount regarding the role of translation in cancer, questions persist as to how translation is activated and the overall significance in thoracic malignancies. Two recent articles are reviewed here that explore the role of enhanced translation in tumorigenesis and prognosis. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294019 Wed, 29 Dec 2010 05:31:20 +0100 4294019 http://www.medworm.com/index.php?rid=4294018&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001255%2Fabstract%3Frss%3Dyes Identifying novel drugs for treatment of lung cancer remains of utmost importance, and, in recent years, targeted therapies have been acknowledged as particularly attractive. Metformin, a commonly prescribed oral hypoglycemic agent, has known effects on the mammalian target of rapamycin pathway, ultimately resulting in downstream inhibition of cellular growth and proliferation. In a recent article (Memmott RM, Mercado JR, Maier CR, et al: Metformin prevents tobacco carcinogen-induced lung tumorigenesis. Cancer Prev Res (Phila) 3:1066-1076, 2010), Memmott et al assessed the utility of metformin in an in vivo model of tobacco carcinogen-induced lung cancer. The authors show that tumor burden is decreased in animals administered metformin, suggesting that this drug may have promising potentia... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294018 Wed, 29 Dec 2010 05:31:20 +0100 4294018 http://www.medworm.com/index.php?rid=4294017&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000882%2Fabstract%3Frss%3Dyes Despite many recent advances in treatment, the prognosis of lung cancer patients remains poor, with 5-year survival rates ≤15%. The treatment of nonsmall cell lung cancer (NSCLC) can include surgery, radiation, and chemotherapy, depending on the stage at the time of diagnosis. These treatments as well as the disease itself can be extremely burdensome. In a systematic review of the literature, lung cancer patients were found to report on average 14 symptoms throughout the trajectory of illness. Newly diagnosed patients most commonly reported fatigue, dyspnea, pain, and cough, in addition to anxiety and depression. Similarly, the incidence of chronic postthoracotomy pain in patients with early-stage lung cancer ranges from 26% to 67%. Although the prevalence of postthoracotomy pain decreas... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294017 Wed, 29 Dec 2010 05:31:20 +0100 4294017 http://www.medworm.com/index.php?rid=4294016&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000870%2Fabstract%3Frss%3Dyes As with other high-risk surgical procedures demonstrated to have a wide variance in perioperative survival among centers, there appears to be a relationship between operation volume and patient survival following lung transplantation. Two recent studies evaluated this relationship using the United Network for Organ Sharing transplant registry and are highlighted in this article. While increasing lung transplantation volume is associated with improved early and longer-term patient survival, the impact of this relationship may be no greater than other patient and donor risk factors, and may be a surrogate for other as yet unidentified center-specific processes of care. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294016 Wed, 29 Dec 2010 05:31:20 +0100 4294016 http://www.medworm.com/index.php?rid=4294015&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001346%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294015 Wed, 29 Dec 2010 05:31:20 +0100 4294015 http://www.medworm.com/index.php?rid=4294014&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001334%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294014 Wed, 29 Dec 2010 05:31:20 +0100 4294014 http://www.medworm.com/index.php?rid=4294013&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910001322%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4294013 Wed, 29 Dec 2010 05:31:20 +0100 4294013 http://www.medworm.com/index.php?rid=4179038&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306791000078X%2Fabstract%3Frss%3Dyes We report a case in which a patient developed right coronary artery occlusion because of tricuspid valve repair and review management options. An 83-year-old gentleman with a past medical history of mitral valve prolapse developed Class III symptoms of congestive heart failure in addition to atrial fibrillation and pulmonary hypertension. Transthoracic echocardiogram revealed preserved ventricular function and severe mitral regurgitation secondary to annular dilation with minimally restricted leaflet motion. In addition, moderate tricuspid regurgitation was evident secondary to annular dilation. Preoperative cardiac angiography revealed nonobstructive coronary artery disease and a right dominant system. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179038 Thu, 18 Nov 2010 21:21:47 +0100 4179038 http://www.medworm.com/index.php?rid=4179037&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000869%2Fabstract%3Frss%3Dyes The laparoscopic Heller myotomy combined with a Dorr fundoplication has become the operative standard of care for the treatment of achalasia. One challenge has been the lack of effective techniques for performing a bloodless dissection of the esophageal muscle layer to ensure entry into the correct plane. During the past few years, I have developed a technique, whereby the entire myotomy operation is performed with the LigaSure device (Covidien, Mansfield, MA) alone. It turns out that this type of instrument is ideally suited to finding the correct plane. Appropriately used, it eliminates the bleeding that can obscure the field of vision and obviates the need to coagulate near the thin mucosa. The fact that the coagulation occurs away from the mucosa protects it. (Source: Seminars in Thora... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179037 Thu, 18 Nov 2010 21:21:47 +0100 4179037 http://www.medworm.com/index.php?rid=4179036&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000778%2Fabstract%3Frss%3Dyes Heller's 1914 report describes a transabdominal double (anterior and posterior) vertical extramucosal esophagomyotomy in a 49-year-old man with a 30-year history of swallowing difficulties. At the time, Heller tucked some omentum into this anterior myotomy with a stitch to maintain separation of the divided muscle. The operation was a success initially; 8 years later, the patient was still improved but was eating slowly. In 1918, De Bruïne Groeneveldt described a single anterior myotomy, and Zaaijer is credited with having popularized the single myotomy modification throughout most of continental Europe. Acceptance of myotomy for treating achalasia in Britain and North America did not come until reports became available on the late complications of cardioplasties. To this day, the surgica... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179036 Thu, 18 Nov 2010 21:21:47 +0100 4179036 http://www.medworm.com/index.php?rid=4179035&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000791%2Fabstract%3Frss%3Dyes We describe our systematic approach to repair of Barlow valves. This approach can be applied to all Barlow valves, and we have achieved a 100% valve repair rate by its consistent application. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179035 Thu, 18 Nov 2010 21:21:47 +0100 4179035 http://www.medworm.com/index.php?rid=4179034&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000808%2Fabstract%3Frss%3Dyes Mitral valve (MV) leaflet billowing, prolapse, and excessive tissue are hallmarks of Barlow syndrome. Successful MV repair can be a challenge in these oftentimes young and otherwise healthy patients. We herein present details on our stepwise approach to MV repair for Barlow syndrome including: (1) surgical approach; (2) MV exposure; (3) assessment of MV pathology; (4) repair of leaflet prolapse; (5) choice and sizing of annuloplasty ring; and (6) fine-tuning and troubleshooting. Our repair strategy involves extensive use of Gore-Tex neochordae using the so-called “loop technique.” We have used this operative strategy via a right mini-thoracotomy in 436 patients with bileaflet prolapse and 144 patients with Barlow syndrome. Our successful MV repair rate is 95% in patients with Barlow sy... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179034 Thu, 18 Nov 2010 21:21:47 +0100 4179034 http://www.medworm.com/index.php?rid=4179033&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000663%2Fabstract%3Frss%3Dyes Severe, diffuse tracheobronchomalacia (TBM) is an underrecognized cause of dyspnea, recurrent respiratory infections, cough, secretion retention, and even respiratory insufficiency. Patients often have comorbidities, such as asthma or chronic obstructive pulmonary disease, and inappropriate treatment for these conditions may precede eventual recognition of TBM by months or years. Most of these patients have an acquired form of TBM in which the etiology in unknown. Diagnosis of TBM is made by airway computed tomography scan and flexible bronchoscopy with forced expiration. The prevailing definition of TBM as a 50% reduction in cross-sectional area is nonspecific, with a high proportion of healthy volunteers meeting this threshold. The clinically significant threshold is complete or near-com... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179033 Thu, 18 Nov 2010 21:21:47 +0100 4179033 http://www.medworm.com/index.php?rid=4179032&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000705%2Fabstract%3Frss%3Dyes The principle treatment for high-grade dysplasia and superficial esophageal cancer is considered esophagectomy. However, novel technologies and innovations in technique have enabled esophageal preservation by endoscopic management in select patients. The concepts and evidence pertaining to esophageal preservation in early stage malignancy are reviewed in detail. A treatment algorithm based upon the current evidence surrounding esophageal preservation is presented. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179032 Thu, 18 Nov 2010 21:21:47 +0100 4179032 http://www.medworm.com/index.php?rid=4179031&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000742%2Fabstract%3Frss%3Dyes The relevance of endobronchial ultrasonography (EBUS) to thoracic surgeons is 2-fold: first, EBUS is an accurate and versatile diagnostic tool; second, EBUS is of importance to our specialty.The diagnostic performance of endobronchial ultrasonography (EBUS) is similar to that of mediastinoscopy, except for a lower negative predictive value for EBUS. Consequently, EBUS does not replace mediastinoscopy, but instead EBUS and mediastinoscopy are complementary. A thoracic surgeon proficient in EBUS has the ability to decide which tool or combination of tools to use to optimize patient care. The relevance of EBUS can be described in evolutionary terms: proficiency in EBUS exemplifies a new trait that can enhance our adaptability to the current environment. An indirect measure of the acquisition ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179031 Thu, 18 Nov 2010 21:21:47 +0100 4179031 http://www.medworm.com/index.php?rid=4179030&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000821%2Fabstract%3Frss%3Dyes Transcatheter aortic valve implantation (TAVI) is a new modality that may change the therapeutic landscape in the management of aortic valve stenosis. Despite the excellent results of surgical aortic valve replacement, TAVI has the potential to revolutionize the treatment of elderly and high-risk patients with aortic stenosis. It therefore constitutes a new reality that cardiac surgeons have to acknowledge. As TAVI indications and techniques become better defined, the importance of a team approach to the implementation and performance of TAVI is becoming increasingly evident. The surgeon has a crucial role to play in the introduction, development, and sustainability of TAVI at any institution. In this article, we discuss the procedural technique involved in TAVI, as well as the cardiologis... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179030 Thu, 18 Nov 2010 21:21:47 +0100 4179030 http://www.medworm.com/index.php?rid=4179029&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306791000081X%2Fabstract%3Frss%3Dyes Vasoplegic syndrome (VS) is a recognized and relatively common complication of cardiopulmonary bypass (CPB), appearing with an incidence ranging between 5% and 25%. It is characterized by significant hypotension, high or normal cardiac outputs and low systemic vascular resistance (SVR), and increased requirements for fluids and vasopressors during or after CPB. Patients developing VS are at increased risk for death and other major complications following cardiac surgery. This review will focus on the pathophysiology and contemporary strategies of treating VS encountered after CPB. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179029 Thu, 18 Nov 2010 21:21:47 +0100 4179029 http://www.medworm.com/index.php?rid=4179028&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000833%2Fabstract%3Frss%3Dyes Heart failure is a chronic progressive disorder in which frequent and recurrent hospitalizations are associated with high mortality and morbidity. The incidence and the prevalence of this disease will increase with the increase in the number of the aging population of the United States. Understanding the molecular pathology and pathophysiology of this disease will uncover novel targets and therapies that can restore the function or attenuate the damage of malfunctioning cardiomyocytes by gene therapy that becomes an interesting and a promising field for the treatment of heart failure as well as other diseases in the future. Of equal importance are developing vectors and delivery methods that can efficiently transduce most of the cardiomyocytes that can offer a long-term expression and that... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179028 Thu, 18 Nov 2010 21:21:47 +0100 4179028 http://www.medworm.com/index.php?rid=4179027&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000845%2Fabstract%3Frss%3Dyes Despite increasing evidence suggesting harmful effects of blood transfusions, physician practices are slow to change. A systematic approach is required to successfully minimize the need for red cell transfusions in the perioperative cardiac surgical patient. This involves preoperative, intraoperative, and postoperative strategies to minimize blood loss and maximize blood conservation. In addition it requires physician education regarding the potential deleterious effects of blood and the more recent evidence that restrictive transfusion strategies are safe and possibly beneficial to postoperative surgical outcomes. In this article, we review the data with respect to blood transfusions in cardiac surgery patients as well as management strategies to minimize the need for blood transfusions i... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179027 Thu, 18 Nov 2010 21:21:47 +0100 4179027 http://www.medworm.com/index.php?rid=4179026&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000717%2Fabstract%3Frss%3Dyes The sequencing of the human genome has lead to an even greater understanding of the genetic basis of numerous diseases. During the past several years, genetic approaches to a number of solid organ malignancies, including non-small cell lung cancer, have lead us to an increased understanding of the disrupted genetic pathways involved in tumor initiation and progression. Two recent articles are reviewed that highlight the broad potential for successful targeted therapy in thoracic malignancies. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179026 Thu, 18 Nov 2010 21:21:47 +0100 4179026 http://www.medworm.com/index.php?rid=4179025&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000699%2Fabstract%3Frss%3Dyes When we chose to become physicians, we accepted a fundamental responsibility—to help others in need, regardless of race or socioeconomic status. Although most physicians are willing to care for patients from any racial, social, or economic background, the results (ie, patient outcomes) often fall short of our altruistic intentions. There is a growing body of evidence that racial and socioeconomic disparities permeate cancer treatment and adversely affect patient outcomes. To begin to gain a better understanding of the basis of these disparities, Yang et al used an administrative dataset from Florida to examine the potential contribution of race and socioeconomic status to the observed disparities in lung cancer treatment and survival. (Source: Seminars in Thoracic and Cardiovascular Surg... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179025 Thu, 18 Nov 2010 21:21:47 +0100 4179025 http://www.medworm.com/index.php?rid=4179024&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000675%2Fabstract%3Frss%3Dyes The video-assisted thoracoscopic surgical (VATS) approach to lobectomy for non-small cell lung cancer (NSCLC) may do more for the patient than just provide an improved perioperative experience, for example, less morbidity, improved pain, quicker return to daily life. Accumulating evidence suggests that it may in and of itself provide a superior oncological outcome. The elucidation of the mechanism of both the perioperative response and the long-term effects will undoubtedly lay the groundwork for future investigations into surgical immunomodulatory therapy. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179024 Thu, 18 Nov 2010 21:21:47 +0100 4179024 http://www.medworm.com/index.php?rid=4179023&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000687%2Fabstract%3Frss%3Dyes The enhancement of professionalism in surgery and medicine is an important goal for all healthcare providers, both at the individual level of the physician and at the large-scale level of the healthcare system. Recently, much has been written about the challenges in implementing the concept of professionalism within healthcare delivery. The dilemma of ensuring a uniform commitment to professional behavior from all physicians has gained particular attention. In a unique approach, Lucey and Souba advocate for addressing the problem of lapses in professionalism as a form of medical error. This perspective may provide a fresh outlook on the problem. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179023 Thu, 18 Nov 2010 21:21:47 +0100 4179023 http://www.medworm.com/index.php?rid=4179022&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000754%2Fabstract%3Frss%3Dyes Although age is an extensively documented independent risk factor for mortality, morbidity and decreased quality of life after cardiac surgery, it has also been demonstrated that excellent outcomes can be obtained after cardiac surgery in very elderly patients. The disparity between chronological and biological age that underlies these findings forms the focus of this review, which examines recent studies aiming to refine pre-operative risk stratification tools by using assessments of frailty and functional status. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179022 Thu, 18 Nov 2010 21:21:47 +0100 4179022 http://www.medworm.com/index.php?rid=4179021&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000766%2Fabstract%3Frss%3Dyes With the widespread use of continuous-flow ventricular assist devices (VADs), the role of pulsatile VADs remain in question. In acute cardiogenic shock, pulsatile VADs maximize perfusion pressure, restore end organ perfusion, and maximally unload the pulmonary circulation and right heart. In addition, pulsatile left VADs allow for easy conversion to biventricular support using one platform, in the case of acute right ventricular failure. Pulsatile VADs still have a major role in the treatment of acute cardiogenic shock. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179021 Thu, 18 Nov 2010 21:21:47 +0100 4179021 http://www.medworm.com/index.php?rid=4179020&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000857%2Fabstract%3Frss%3Dyes We are pleased and very excited to unveil our entirely new design for Seminars in Cardiovascular and Thoracic Surgery in this issue. The entire format of the journal has been redesigned in an effort to make the Journal more relevant to our diversified readership. As opposed to having Guest Editors and a series of invited papers on a specific topic in thoracic or cardiac surgery, we will now have 4 new sections in each issue, beginning with News and Views, where experts will provide up-to-date succinct commentaries about topics that have been recently presented at meetings or in the literature. Our State of the Art section will now comprise authoritative reviews by world leaders on a variety of topics relevant to practicing cardiovascular and thoracic surgeons written by surgeons, medical p... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179020 Thu, 18 Nov 2010 21:21:47 +0100 4179020 http://www.medworm.com/index.php?rid=4179019&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000924%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179019 Thu, 18 Nov 2010 21:21:47 +0100 4179019 http://www.medworm.com/index.php?rid=4179018&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000912%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179018 Thu, 18 Nov 2010 21:21:47 +0100 4179018 http://www.medworm.com/index.php?rid=4179017&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000900%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=4179017 Thu, 18 Nov 2010 21:21:47 +0100 4179017 http://www.medworm.com/index.php?rid=3924565&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000365%2Fabstract%3Frss%3Dyes In this study, we evaluated the outcomes of different tricuspid repairs regarding durability and analyzed the risk factors for repair failure. We also presented our current approach to surgical management of functional tricuspid regurgitation on the basis of recent studies and our experience treating patients with heart failure. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924565 Thu, 02 Sep 2010 09:36:47 +0100 3924565 http://www.medworm.com/index.php?rid=3924564&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000353%2Fabstract%3Frss%3Dyes Functional or secondary tricuspid regurgitation commonly is found in the setting of left-sided heart disease and, when severe, is associated with substantially poorer functional outcomes and survival if untreated. The traditional view that functional tricuspid regurgitation generally resolves with surgical correction of the primary lesions is no longer held. Data showing late development of severe tricuspid regurgitation in patients with mild regurgitation at time of mitral valve surgery have heralded a new era of aggressive intervention on the tricuspid valve. Tricuspid ring annuloplasty can be performed with minimal incremental morbidity and negligible additional mortality. Therefore, in addition to patients with severe regurgitation, annuloplasty is now also recommended for patients wit... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924564 Thu, 02 Sep 2010 09:36:47 +0100 3924564 http://www.medworm.com/index.php?rid=3924563&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000341%2Fabstract%3Frss%3Dyes Functional tricuspid regurgitation (TR) primarily arises from asymmetric dilation of the tricuspid annulus in the setting of right ventricular dysfunction and enlargement in response to left-sided myocardial and valvular abnormalities. Even if TR is not severe at the time of mitral valve surgery, TR can worsen and even appear late after successful mitral valve surgery, which portends a poor prognosis. Despite data demonstrating inferior outcomes in the presence of residual TR, surgical repair for functional TR remains underused. However, “benign neglect” of TR, especially in the presence of tricuspid annular dilation, is unacceptable. Surgical repair should consist of placement of a rigid or semirigid annular ring, which has been shown to provide superior durability compared with sutur... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924563 Thu, 02 Sep 2010 09:36:47 +0100 3924563 http://www.medworm.com/index.php?rid=3924562&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000389%2Fabstract%3Frss%3Dyes Functional tricuspid regurgitation is a complex valvular lesion. Its optimal management remains controversial in the current era as the result of uncertainties regarding accurate diagnosis, surgical indication, the appropriate surgical procedure, and the late results of surgical treatment. It is no longer regarded a benign problem and does not resolve spontaneously after correction of left-sided heart valve lesions as once believed. It carries a significant morbidity and has an adverse impact on survival. Current techniques to repair functional tricuspid regurgitation are associated with a significant degree of residual or recurrent regurgitation mainly because of failure to address all the components of this challenging entity. This review article highlights emerging concepts and advances... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924562 Thu, 02 Sep 2010 09:36:47 +0100 3924562 http://www.medworm.com/index.php?rid=3924561&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000377%2Fabstract%3Frss%3Dyes Functional tricuspid regurgitation (TR) is a common etiology of TR. Functional TR results from geometrical distortion of the normal spatial relationships of the tricuspid leaflets, annulus, chords, papillary muscles, and right ventricular (RV) walls. Functional TR results most commonly from left-sided heart disease, including mitral valve abnormalities and cardiomyopathy and RV dysfunction secondary to pulmonary disease (Cor pulmonale). The tricuspid annulus, which has a normal bimodal or saddle shape, becomes larger, flatter, and more circular with the development of functional TR. RV dilation can lead to papillary muscle displacement and tethering of the tricuspid leaflets, resulting in incomplete coaptation and development of functional TR. (Source: Seminars in Thoracic and Cardiovascul... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924561 Thu, 02 Sep 2010 09:36:47 +0100 3924561 http://www.medworm.com/index.php?rid=3924560&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000390%2Fabstract%3Frss%3Dyes In this review we summarize the data on epidemiology and natural history of functional tricuspid valve regurgitation as it applies to surgery for mitral valve disease. Tricuspid regurgitation in the context of mitral valve disease is frequent and is associated with substantial reduction in survival and quality of life. In many patients, the correction of left-sided cardiac lesions does not lead to resolution of tricuspid regurgitation. Significant tricuspid regurgitation after mitral valve surgery portends a poor prognosis, a course that is often not altered by subsequent surgical therapy. Although a liberal approach to tricuspid annuloplasty is widely practiced, the evidence that this approach alters the natural history of functional tricuspid regurgitation is not yet available, so it is ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924560 Thu, 02 Sep 2010 09:36:47 +0100 3924560 http://www.medworm.com/index.php?rid=3924559&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000419%2Fabstract%3Frss%3Dyes Functional or secondary tricuspid regurgitation typically refers to tricuspid regurgitation occurring secondary to left-sided heart disease, or pulmonary hypertensive disease, in the absence of organic lesions of the tricuspid valve. Until recently, “surgical abstention” has been the norm in dealing with functional tricuspid regurgitation, with the assumption that tricuspid regurgitation should resolve once the primary cause (typically mitral stenosis or regurgitation) is eliminated. This historical conservative approach to tricuspid regurgitation continues to tailor surgical practice to the present day, and tricuspid valve annuloplasty remains an infrequent operation in most surgical practices. Increasingly, however, there are reports in the literature supporting a more aggressive rol... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924559 Thu, 02 Sep 2010 09:36:47 +0100 3924559 http://www.medworm.com/index.php?rid=3924558&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000274%2Fabstract%3Frss%3Dyes This article reviews the history of SRS as applied to lung tumors, summarizes the currently available data on efficacy and toxicity, and describes some of the current controversial aspects of this treatment. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924558 Thu, 02 Sep 2010 09:36:47 +0100 3924558 http://www.medworm.com/index.php?rid=3924557&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000420%2Fabstract%3Frss%3Dyes Lung cancer is the most common cause of cancer-related mortality in the United States. Surgical resection with a lobectomy is the standard treatment for stage I non-small cell lung cancer. With an aging population, however, there are a significant number of patients who have other comorbidities that preclude surgical resection. Image-guided radiofrequency ablation is a new emerging modality of treatment which may be applicable in this high-risk group of patients. In this article, we review the principles of radiofrequency ablation, the common devices in use, the results of ablate and resect studies, future directions, and the results of treatment for stage I non-small cell lung neoplasm. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924557 Thu, 02 Sep 2010 09:36:47 +0100 3924557 http://www.medworm.com/index.php?rid=3924556&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306791000033X%2Fabstract%3Frss%3Dyes The treatment of patients with early-stage non-small cell lung cancer and cardiopulmonary dysfunction has rapidly evolved during the past decade. Although fractionated radiotherapy has been the most frequently used alternative treatment, additional approaches, including limited resection with or without brachytherapy, stereotactic body radiotherapy, and radiofrequency ablation are increasingly used and have now been studied prospectively. This review will focus on the potential current role of fractionated radiotherapy for high-risk patients with particular consideration of altered fractionation schemes and recent advances in treatment related technology. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924556 Thu, 02 Sep 2010 09:36:47 +0100 3924556 http://www.medworm.com/index.php?rid=3924555&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000328%2Fabstract%3Frss%3Dyes Surgical resection remains the favored option of treatment for stage I lung cancer patients. Co-existing obstructive lung disease can reduce lung function and increase the risk of surgery. Severe emphysema may preclude resection of lung cancer due to concerns about low values of postoperative lung function. However, many patients will experience stable or improved lung function simply by resecting hyper-expanded and relatively functionless lung. This so-called “lung volume reduction effect” may occur after standard resection or after rare instances of formal lung volume reduction surgery concurrent with pulmonary resection of the tumor. This review explores these possibilities and informs the readers of pioneering work in this area. (Source: Seminars in Thoracic and Cardiovascular Surg... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924555 Thu, 02 Sep 2010 09:36:47 +0100 3924555 http://www.medworm.com/index.php?rid=3924554&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000304%2Fabstract%3Frss%3Dyes Lobar resection is currently the standard approach for the treatment of stage I non-small cell lung cancer. Sublobar resection is generally considered a compromise, reserved for high-risk patients because of greater rates of local recurrence compared with lobar resection. Adjuvant radiation therapy may decrease these increased local recurrence rates, but because of respiratory motion and difficulties in identifying the staple line, radiation delivery can be challenging with an external beam approach. Adjuvant intraoperative brachytherapy with the use of low-dose rate iodine-125 seeds placed alongside the surgical staple has been used with success in several centers. A randomized multicenter North American study has also recently completed accrual, but the results of this are not yet availa... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924554 Thu, 02 Sep 2010 09:36:47 +0100 3924554 http://www.medworm.com/index.php?rid=3924553&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000316%2Fabstract%3Frss%3Dyes The use of sublobar resection techniques (anatomic segmentectomy; extended wedge) in the treatment of early-stage non-small cell lung cancer has been associated with increased local recurrence rates compared with lobectomy. Recent data, however, have suggested that sublobar resection of smaller tumors (especially those ≤2 cm) can be performed with no significant difference in local recurrence or long-term survival. These findings have particular relevance in elderly patients and in those patients who may be at high risk for lobectomy because of underlying medical comorbidities. Careful patient selection on the basis of individualized assessment of specific patient and tumor characteristics will aid in selecting the optimal approach. For larger tumors, or when adequate surgical margins ar... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924553 Thu, 02 Sep 2010 09:36:47 +0100 3924553 http://www.medworm.com/index.php?rid=3924552&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000298%2Fabstract%3Frss%3Dyes Lobectomy via video-assisted thoracoscopic surgery (VATS) has a lower rate of morbidity and is less immunosuppressive than open lobectomy. Compared with open lobectomy, VATS lobectomy appears to have equivalent oncological results. We review the literature on perioperative outcomes, biological impact, and oncological results. Most published reports to date—although retrospective—suggest significant perioperative advantages to VATS lobectomy over open lobectomy. Data on acute phase reactants and cellular immunity show that VATS lobectomy causes less of an inflammatory response and is less immunosuppressive than open lobectomy. Mid- to long-term oncological results of patients with early-stage non-small cell lung cancer (NSCLC) appear to be equivalent for VATS and open lobectomy. Clinica... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924552 Thu, 02 Sep 2010 09:36:47 +0100 3924552 http://www.medworm.com/index.php?rid=3924551&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000286%2Fabstract%3Frss%3Dyes Risk assessment for pulmonary resection must include a preliminary cardiac evaluation. Patients deemed at prohibitive cardiac risk should be evaluated and treated as per American Heart Association/American Society of Cardiology guidelines. Those with low cardiac risk or with optimized treatment can proceed with pulmonary assessment. A systematic measurement of lung carbon monoxide diffusing capacity is recommended. In addition, predicted postoperative forced expiratory volume in 1 second should not be used alone for patient selection because it is not an accurate predictor of complications, particularly in patients with chronic obstructive pulmonary disease. The use of exercise testing should be emphasized. Low-technology tests, such as stair climbing, can be used whenever a formal cardiop... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924551 Thu, 02 Sep 2010 09:36:47 +0100 3924551 http://www.medworm.com/index.php?rid=3924550&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000407%2Fabstract%3Frss%3Dyes This issue of Seminars in Thoracic and Cardiovascular Surgery includes a series of articles which highlight newer technologies and advances in the treatment of stage I non-small cell lung cancer (NSCLC) with a focus on the high-risk patient. Thoracic surgery is rapidly evolving, and it is critical that surgeons are apprised of new technological advances, as well as some of the controversies surrounding them. Here, the management of early-stage NSCLC, including risk assessment for pulmonary resection, newer techniques and concepts for lung resection in high-risk patients, and emerging new technologies, is featured. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924550 Thu, 02 Sep 2010 09:36:47 +0100 3924550 http://www.medworm.com/index.php?rid=3924549&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000481%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924549 Thu, 02 Sep 2010 09:36:47 +0100 3924549 http://www.medworm.com/index.php?rid=3924548&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306791000047X%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924548 Thu, 02 Sep 2010 09:36:47 +0100 3924548 http://www.medworm.com/index.php?rid=3924547&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000456%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3924547 Thu, 02 Sep 2010 09:36:47 +0100 3924547 http://www.medworm.com/index.php?rid=3354134&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001397%2Fabstract%3Frss%3Dyes This article reviews the current treatment of blunt thoracic aortic injury and the use of thoracic aortic stent grafting for this patient population. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354134 Thu, 11 Mar 2010 18:09:36 +0100 3354134 http://www.medworm.com/index.php?rid=3354133&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306790900149X%2Fabstract%3Frss%3Dyes DeBakey type I aortic dissections pose significant challenges in operative and long-term management of the arch and distal thoracic aorta. Concerns regarding management of complex tears extending to the arch and descending thoracic aorta, malperfusion syndromes, and late aortic dilatation have provided an impetus to explore aortic repairs that involve stent-graft placement into the descending thoracic aorta in combination with conventional hemi-arch or total arch repairs. Early results with these techniques are promising but further study is warranted. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354133 Thu, 11 Mar 2010 18:09:36 +0100 3354133 http://www.medworm.com/index.php?rid=3354132&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001440%2Fabstract%3Frss%3Dyes Type III aortic dissection is associated with high morbidity and mortality. There is a shifting paradigm in the treatment of complicated and uncomplicated acute type III aortic dissection toward earlier endovascular repair. In this review, the authors present the current perspective on the endovascular management of acute complicated and uncomplicated type III aortic dissection. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354132 Thu, 11 Mar 2010 18:09:36 +0100 3354132 http://www.medworm.com/index.php?rid=3354131&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001415%2Fabstract%3Frss%3Dyes Endoleaks and endotension remain the primary limitation of endovascular aortic repair with stent-grafts. Consequently, all endovascular surgeons performing thoracic or abdominal endovascular aortic repairs require a comprehensive knowledge and understanding of how to survey and manage endoleaks. The derivation of the current endoleak classification scheme, the clinical impact of endoleaks, the diagnostic tools relevant to endoleak detection, an endoleak surveillance protocol, and the strategies in use for their management are outlined in this review. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354131 Thu, 11 Mar 2010 18:09:36 +0100 3354131 http://www.medworm.com/index.php?rid=3354130&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001464%2Fabstract%3Frss%3Dyes Thoracoabdominal aortic aneurysms (TAAA) remain a formidable surgical challenge, with conventional open repair associated with significant rates of mortality and morbidity. Furthermore, many of these patients are elderly with significant comorbidities and may not be candidates for repair. Consequently, the availability of a “hybrid” option, including open visceral debranching with concomitant endovascular aneurysm exclusion, may have advantages in these high-risk patients, including the potential to offer therapy to those ineligible for conventional repair. Our technique for hybrid TAAA repair is performed by means of midline laparotomy. A commercially manufactured custom multibranched Dacron graft is used to sequentially bypass, in extranatomic manner, the left renal artery, superior ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354130 Thu, 11 Mar 2010 18:09:36 +0100 3354130 http://www.medworm.com/index.php?rid=3354129&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001439%2Fabstract%3Frss%3Dyes Surgical management of aortic arch aneurysms remains a clinical challenge associated with significant perioperative morbidity and mortality. For the increasingly aging population with significant comorbidities, innovative hybrid aortic arch reconstructive techniques using thoracic endograft technology have been developed in an attempt to improve surgical outcome. With these hybrid arch reconstructive techniques, surgeons have extended the indications and provided an alternative surgical option to patients previously considered prohibitively high risk for conventional open repair of aortic arch aneurysms. Multiple techniques have been described in the literature. In this section, we will present: (1) the current results of hybrid aortic arch repair and (2) a new classification based on the ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354129 Thu, 11 Mar 2010 18:09:36 +0100 3354129 http://www.medworm.com/index.php?rid=3354128&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001488%2Fabstract%3Frss%3Dyes Descending thoracic aortic aneurysmal disease is associated with poor 5-year survival rates as low as 10%-15% if untreated. This is probable because of a combination of the aneurysmal disease, comorbidities, and in many patients advanced age. In the search for better outcomes and newer techniques, the endovascular approach for the treatment of these aneurysms has developed over the last 20 years. Many advances in the materials and techniques have been made since the first reports of abdominal and thoracic aortic endovascular repair in the early 1990s. Currently, clinical trials have proven that several different commercially available endovascular grafts can be deployed safely, with early results equal to or better than conventional open repairs. Most of the data reported have been on earl... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354128 Thu, 11 Mar 2010 18:09:36 +0100 3354128 http://www.medworm.com/index.php?rid=3354127&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001506%2Fabstract%3Frss%3Dyes Since US Food and Drug Administration approval in 2005 for the treatment of descending thoracic aortic aneurysms, thoracic endovascular aortic repair (TEVAR) has revolutionized the field of thoracic aortic surgery. Although no randomized studies exist to this point, accumulating clinical experience from around the world has confirmed the feasibility and the safety of this new treatment paradigm, with results comparable to conventional open repair. Furthermore, TEVAR provides patients previously considered prohibitively high risk for conventional repair an alternative surgical option. With its widespread acceptance in the treatment of aneurysmal disease, innovative investigators have further expanded the indications of use with off-label application of TEVAR in various other thoracic aortic... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354127 Thu, 11 Mar 2010 18:09:36 +0100 3354127