摘要 :
Background and aim of the study Long-term laryngotracheal complications have not been described in adult patients undergoing cardiac surgery. The purpose of this study was to determine the incidence of and risk factors for laryngo...
展开
Background and aim of the study Long-term laryngotracheal complications have not been described in adult patients undergoing cardiac surgery. The purpose of this study was to determine the incidence of and risk factors for laryngotracheal complications following cardiac surgery. Methods A retrospective chart review of patients at high risk for laryngotracheal complications following cardiac surgery between 2006 and 2016 was performed. High-risk patients were reviewed to determine the presence of laryngotracheal complications including laryngotracheal stenosis, keyhole deformity, or vocal cord immobility. Logistic regression was used to identify predictors of long-term laryngotracheal complications. Results Of 11,417 patients who underwent cardiac surgery, 1099 were identified as at high risk. Of these, 24 (2.2%) developed laryngotracheal complications following their surgery and intensive care unit (ICU) stay. Laryngotracheal stenosis and keyhole deformity were present in 13 (1.2%) and 6 (0.5%) patients, respectively. Logistic regression demonstrated older age (age >= 70 odds ratio [OR] 0.31, 95% confidence interval [CI] 0.12-0.83) was protective, while readmission to ICU for ventilation (OR 3.11, 95% CI 1.17-8.25) and receiving a tracheostomy (OR 7.83, 95% CI 2.22-27.6) were associated with laryngotracheal complications. Conclusions The incidence of long-term laryngotracheal complications following cardiac surgery was 2.2%. Readmission to ICU for ventilation and having a tracheostomy performed were associated with laryngotracheal complications.
收起
摘要 :
Although laparoscopic surgery accounts for >2 million surgical procedures every year, the current preoperative risk scores and guidelines do not adequately assess the risks of laparoscopy. In general, laparoscopic procedures have ...
展开
Although laparoscopic surgery accounts for >2 million surgical procedures every year, the current preoperative risk scores and guidelines do not adequately assess the risks of laparoscopy. In general, laparoscopic procedures have a lower risk of morbidity and mortality compared with operations requiring a midline laparotomy. During laparoscopic surgery, carbon dioxide insufflation may produce significant hemodynamic and ventilatory consequences such as increased intraabdominal pressure and hypercarbia. Hemodynamic insults secondary to increased intraabdominal pressure include increased afterload and preload and decreased cardiac output, whereas ventilatory consequences include increased airway pressures, hypercarbia, and decreased pulmonary compliance. Hemodynamic effects are accentuated in patients with cardiovascular disease such as congestive heart failure, ischemic heart disease, valvular heart disease, pulmonary hypertension, and congenital heart disease. Prevention of cardiovascular complications may be accomplished through a sound understanding of the hemodynamic and physiological consequences of laparoscopic surgery as well as a defined operative plan generated by a multidisciplinary team involving the preoperative consultant, anesthesiologist, and surgeon.
收起
摘要 :
Background: It is precisely 100 years since the Nobel Prize for Physiology or Medicine was awarded to the French surgeon Alexis Carrel, the second and to date one of only rive surgeons to have received this most prestigious award....
展开
Background: It is precisely 100 years since the Nobel Prize for Physiology or Medicine was awarded to the French surgeon Alexis Carrel, the second and to date one of only rive surgeons to have received this most prestigious award. In spite of his outstanding contributions to the fields of cardiovascular and transplant surgery, the anniversary of his Nobel Prize award is likely to pass unnoticed and unacknowledged because of his outspoken and well-publicized beliefs and philosophies. Method: A review was carried out of the very many biographical papers of Carrel's work and publications. Results: Carrel's work did indeed form the basis of modern cardio-vascular and transplant surgery. Conclusion: In spite of deserving the Nobel prize for his scientific work, Carrel's views on eugenics were so abhorrent that he is unlikely to ever receive the accolades he deserves.
收起
摘要 :
Objective Radical resection for thoracic malignancies that invade the great vessels or heart structure is an uncommon, high-risk operation. To help surgeons determine therapeutic strategy, we reviewed the patient characteristics a...
展开
Objective Radical resection for thoracic malignancies that invade the great vessels or heart structure is an uncommon, high-risk operation. To help surgeons determine therapeutic strategy, we reviewed the patient characteristics and outcomes of combined thoracic and cardiovascular surgery for thoracic malignancies. Methods Surgical resections of lung cancer, mediastinal tumor and pulmonary artery sarcoma invading great vessels or heart structures were reviewed from the literature. Results Pneumonectomy was often performed for lung cancer invading the aorta, superior vena cava, and left atrium. Complete resection (R0), no mediastinal lymph node metastasis and without using cardiopulmonary bypass led to a good prognosis. Induction therapy was often performed for complete resection. Regarding mediastinal tumors, thymic epithelial tumors or germ cell tumors occasionally invaded the great vessels or heart structures. For these malignancies, multimodality therapy was often performed, and complete resection could be one of the prognostic factors. The resection of primary pulmonary artery sarcoma (PPAS) is also a combined thoracic and cardiovascular surgery. The primary treatment for PPAS is surgical resection; specifically, pulmonary endarterectomy and pneumonectomy, because PPAS has substantial resistance to chemotherapy or radiotherapy. The prognosis of PPAS is poor, but surgical resection has potential for long-term survival. Conclusion Although these surgeries are uncommon and invasive for the patients, selecting appropriate patients, aggressive multimodality therapy, and performing combined thoracic and cardiovascular surgery can contribute to a good outcome.
收起
摘要 :
Background: Tracheal stenosis in combination with vascular and/or cardiac anomalies is a life-threatening condition in infants and children presenting with severe symptoms of airway obstruction. The optimal surgical treatment of t...
展开
Background: Tracheal stenosis in combination with vascular and/or cardiac anomalies is a life-threatening condition in infants and children presenting with severe symptoms of airway obstruction. The optimal surgical treatment of these cases remains controversial. Objectives: We present here a group of infants and children with combined tracheal malformations and vascular and/or cardiac anomalies. More than 30% of the stenotic trachea was resected in a subgroup of the patients. A reconstruction with end-to-end anastomosis was achieved on the basis of extensive mobilization of the whole tracheobronchial tree and use of CPB. Methods; The clinical outcome in 37 children with a median age of 8 (1 - 72) months was analyzed retrospectively. The patients presented with severe airway obstruction in combination with congenital heart defects and/or vascular anomalies. Cardiac catheterization, bronchoscopy and thoracic computer tomography were performedprior to operation. The operations were performed under CPB and consisted of tracheal resection with end-to-end anastomosis or external stabilization. Associated intracardiac and vascular anomalies were repaired simultaneously. Results: All but 1 patient survived and had a straightforward recovery. The patients were ex-tubated under bronchoscopic control with a median intubation time after airway repair of 12.2 days. The average follow-up was 8.4 years (1-14 years) and the surviving patients did not show signs of restenosis clinically. A segment longer than 30% of the tracheal length was resected and reconstructed with end-to-end anastomosis in 57% of the patients (12 of 21 patients). Conclusions: Our experience demonstrates that resection of tracheal stenosis and end-to-end anastomosis can be achieved successfully even in cases with stenosis of more than 30% of the total tracheal length. The use of CBP allowed extensive mobilization of the tracheobronchial tree and resection with end-to-end tension-free anas-tomotic reconstruction.
收起
摘要 :
Subclavian Steal Syndrome (SSS) is a rare vascular syndrome caused due to proximal occlusion or stenosis of subclavian or innominate artery. It is usually asymptomatic but occasionally may present with vertebro‐basilar insufficie...
展开
Subclavian Steal Syndrome (SSS) is a rare vascular syndrome caused due to proximal occlusion or stenosis of subclavian or innominate artery. It is usually asymptomatic but occasionally may present with vertebro‐basilar insufficiency and/or upper limb ischemia. Atherosclerosis is the most common cause.
收起
摘要 :
Minimal-invasive mitral valve surgery after breast augmentation is an ongoing interdisciplinary challenge. Notably, the perioperative explantation of the breast implant, as reported in most cases, is of questionable benefit. We he...
展开
Minimal-invasive mitral valve surgery after breast augmentation is an ongoing interdisciplinary challenge. Notably, the perioperative explantation of the breast implant, as reported in most cases, is of questionable benefit. We herein report on successful minimal-invasive mitral valve repair after subpectoral breast augmentation with perioperative preservation of the breast implant in situ.
收起
摘要 :
Primary cardiac angiosarcoma is a rare tumor that may present with features mimicking venous thromboembolic disease, making the diagnosis particularly challenging. Without a high index of suspicion, the majority of cases will rema...
展开
Primary cardiac angiosarcoma is a rare tumor that may present with features mimicking venous thromboembolic disease, making the diagnosis particularly challenging. Without a high index of suspicion, the majority of cases will remain undetected until the disease is advanced. As a result, the outlook for most patients remains dismal even with aggressive multimodality treatment. We report a case of angiosarcoma masquerading as recurrent pulmonary embolism successfully treated by radical surgery and adjuvant cytotoxic chemotherapy.
收起
摘要 :
Introduction: By analyzing epidemiological trends in cardiovascular disease (CVD), key stakeholders can make informed decisions on the future of disease burden and treatment. Accordingly, the cardiovascular perfusion community wou...
展开
Introduction: By analyzing epidemiological trends in cardiovascular disease (CVD), key stakeholders can make informed decisions on the future of disease burden and treatment. Accordingly, the cardiovascular perfusion community would benefit from data that would help predict future professional resource utilization.
收起
原文获取