The Experts below are selected from a list of 2430 Experts worldwide ranked by ideXlab platform
Bruce W Lytle - One of the best experts on this subject based on the ideXlab platform.
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does right thoracotomy increase the risk of mitral valve reoperation
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Lars G Svensson, Marc A Gillinov, Eugene H Blackstone, Penny L Houghtaling, Kyung Hwan Kim, Gosta B Pettersson, Nicholas G Smedira, Michael K Banbury, Bruce W LytleAbstract:Objective The study objective was to determine whether a right thoracotomy approach increases the risk of mitral valve reoperation. Methods Between January of 1993 and January of 2004, 2469 patients with mitral valve disease underwent 2570 reoperations (1508 replacements, 1062 repairs). The approach was median sternotomy in 2444 patients, right thoracotomy in 80 patients, and other in 46 patients. Multivariable logistic regression was used to identify factors associated with median sternotomy versus right thoracotomy, mitral valve repair versus replacement, hospital death, and stroke. Factors favoring median sternotomy ( P Results Hospital mortality was 6.7% (163/2444) for the median sternotomy approach and 6.3% (5/80) for the thoracotomy approach ( P = .9). Risk factors ( P P = .006). Mitral valve replacement (vs repair) was more common in those receiving a thoracotomy ( P Conclusions Compared with median sternotomy, right thoracotomy is associated with a higher occurrence of stroke and less frequent mitral valve repair. Specific strategies for conducting the operation should be used to reduce the risk of stroke when right thoracotomy is used for mitral valve reoperation. In most instances, repeat median sternotomy, with its better exposure and greater latitude for concomitant procedures, is preferred.
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does right thoracotomy increase the risk of mitral valve reoperation
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Lars G Svensson, Marc A Gillinov, Eugene H Blackstone, Penny L Houghtaling, Kyung Hwan Kim, Gosta B Pettersson, Nicholas G Smedira, Michael K Banbury, Bruce W LytleAbstract:Objective The study objective was to determine whether a right thoracotomy approach increases the risk of mitral valve reoperation. Methods Between January of 1993 and January of 2004, 2469 patients with mitral valve disease underwent 2570 reoperations (1508 replacements, 1062 repairs). The approach was median sternotomy in 2444 patients, right thoracotomy in 80 patients, and other in 46 patients. Multivariable logistic regression was used to identify factors associated with median sternotomy versus right thoracotomy, mitral valve repair versus replacement, hospital death, and stroke. Factors favoring median sternotomy (P Results Hospital mortality was 6.7% (163/2444) for the median sternotomy approach and 6.3% (5/80) for the thoracotomy approach (P = .9). Risk factors (P Conclusions Compared with median sternotomy, right thoracotomy is associated with a higher occurrence of stroke and less frequent mitral valve repair. Specific strategies for conducting the operation should be used to reduce the risk of stroke when right thoracotomy is used for mitral valve reoperation. In most instances, repeat median sternotomy, with its better exposure and greater latitude for concomitant procedures, is preferred.
Paolo Bagioni - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracic surgery in the treatment of pleural empyema
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Luciano Solaini, F. Prusciano, Paolo BagioniAbstract:The use of video-assisted thoracic surgery (VATS) in the treatment of pleural empyema has been proposed since the early 1990s, but among surgeons, its use varies considerably, and the results are discordant. This report aims to provide a retrospective assessment of the authors’ experience and the literature on VATS in an effort to ascertain rational criteria for the use of this technique. Over a period of 12 years, a total of 120 cases of pleural empyema were recorded. The patients were assessed with chest x-ray, computed tomography, ultrasound, and thoracentesis. On the basis of clearly defined clinical and radiographic parameters, 38 patients underwent VATS immediately, whereas the remaining 82 were treated initially by means of tube Thoracostomy. The latter was found to be sufficient for only 10 patients. Consequently, for the remaining 72 patients, it was decided to proceed also with VATS. The procedure was performed completely by VATS in 101 patients (91.8%), whereas in 9 patients (8.2%) it was necessary to convert to thoracotomy. The postoperative course was uneventful for 98 of the 110 patients (89%), whereas the remaining 12 patients experienced complications, including one case of persistent empyema (0.9%) treated by thoracotomy. The mean chest tube duration was 6 days (range, 3–25 days). The mean postoperative hospital stay was 7.1 days (range, 5–17 days). Of the 80 patients completing a 6-month follow-up evaluation, the results were considered good for 72, moderately good for 8, and less than satisfactory for 2 patients. In conclusion, the authors consider VATS to be the technique of first choice for the treatment of pleural empyema when the disease is advanced or tube Thoracostomy fails. It provides excellent results with a low level of invasiveness and considerably reduces the need for thoracotomy. These results can be achieved with good videothoracoscopic experience and the use of a very precise technique.
Jose Maria Matilla - One of the best experts on this subject based on the ideXlab platform.
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open window Thoracostomy and thoracomyoplasty to manage chronic pleural empyema
The Annals of Thoracic Surgery, 1998Co-Authors: Mariano Garciayuste, Guillermo Ramos, J L Duque, Felix Heras, Manuel Castanedo, Luis J Cerezal, Jose Maria MatillaAbstract:Abstract Background . The purpose of this study is to report our 15-year experience treating chronic empyemas after pulmonary resection and tuberculosis. Methods . Open-window Thoracostomy and thoracomyoplasty were used to treat 40 patients with chronic pleural empyema characterized by residual empyematic cavity, bronchopleural fistula, and persistent pleural infections that were secondary to tuberculosis (n = 22) or pulmonary resection (n = 18). Between 2 and 7 months after Thoracostomy, thoracomyoplasty was performed to eliminate a persistent pleural cavity. In 2 patients with postpulmonary resection empyema and a large bronchopleural fistula, intrathoracic transposition of the latissimus dorsi flap and open-window Thoracostomy were performed simultaneously to close the fistula. Results . The pleural space was eliminated per primam intentionem in 21 of 22 patients with tuberculosis and in 14 of 18 with a postpulmonary resection empyema. Another myoplasty was performed in an additional 3 patients to eliminate the pleural space. During open-window Thoracostomy, the latissimus dorsi muscle was preserved with minimal injury to the anterior serratus muscle. One patient died postoperatively. Conclusions . Successful treatment of chronic pleural empyema requires adequate timing of surgical procedures. Our two-procedure technique is relatively simple and safe.
Lars G Svensson - One of the best experts on this subject based on the ideXlab platform.
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does right thoracotomy increase the risk of mitral valve reoperation
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Lars G Svensson, Marc A Gillinov, Eugene H Blackstone, Penny L Houghtaling, Kyung Hwan Kim, Gosta B Pettersson, Nicholas G Smedira, Michael K Banbury, Bruce W LytleAbstract:Objective The study objective was to determine whether a right thoracotomy approach increases the risk of mitral valve reoperation. Methods Between January of 1993 and January of 2004, 2469 patients with mitral valve disease underwent 2570 reoperations (1508 replacements, 1062 repairs). The approach was median sternotomy in 2444 patients, right thoracotomy in 80 patients, and other in 46 patients. Multivariable logistic regression was used to identify factors associated with median sternotomy versus right thoracotomy, mitral valve repair versus replacement, hospital death, and stroke. Factors favoring median sternotomy ( P Results Hospital mortality was 6.7% (163/2444) for the median sternotomy approach and 6.3% (5/80) for the thoracotomy approach ( P = .9). Risk factors ( P P = .006). Mitral valve replacement (vs repair) was more common in those receiving a thoracotomy ( P Conclusions Compared with median sternotomy, right thoracotomy is associated with a higher occurrence of stroke and less frequent mitral valve repair. Specific strategies for conducting the operation should be used to reduce the risk of stroke when right thoracotomy is used for mitral valve reoperation. In most instances, repeat median sternotomy, with its better exposure and greater latitude for concomitant procedures, is preferred.
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does right thoracotomy increase the risk of mitral valve reoperation
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Lars G Svensson, Marc A Gillinov, Eugene H Blackstone, Penny L Houghtaling, Kyung Hwan Kim, Gosta B Pettersson, Nicholas G Smedira, Michael K Banbury, Bruce W LytleAbstract:Objective The study objective was to determine whether a right thoracotomy approach increases the risk of mitral valve reoperation. Methods Between January of 1993 and January of 2004, 2469 patients with mitral valve disease underwent 2570 reoperations (1508 replacements, 1062 repairs). The approach was median sternotomy in 2444 patients, right thoracotomy in 80 patients, and other in 46 patients. Multivariable logistic regression was used to identify factors associated with median sternotomy versus right thoracotomy, mitral valve repair versus replacement, hospital death, and stroke. Factors favoring median sternotomy (P Results Hospital mortality was 6.7% (163/2444) for the median sternotomy approach and 6.3% (5/80) for the thoracotomy approach (P = .9). Risk factors (P Conclusions Compared with median sternotomy, right thoracotomy is associated with a higher occurrence of stroke and less frequent mitral valve repair. Specific strategies for conducting the operation should be used to reduce the risk of stroke when right thoracotomy is used for mitral valve reoperation. In most instances, repeat median sternotomy, with its better exposure and greater latitude for concomitant procedures, is preferred.
Gaetano Rocco - One of the best experts on this subject based on the ideXlab platform.
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amplatzer device and vacuum assisted closure therapy to treat a thoracic empyema with bronchopleural fistula
The Annals of Thoracic Surgery, 2011Co-Authors: Eliseo Passera, Giovanni Guanella, Alberto Meroni, G Chiesa, A Rizzi, Gaetano RoccoAbstract:We present a case of lower bilobectomy complicated by a large bronchopleural fistula and empyema 1 month after primary surgery. The patient was immediately treated with an open window Thoracostomy. After surgical debridement, an Amplatzer Septal Occluder device (AGA Medical Corp, Plymouth, MN) was positioned to close the fistula. Thereafter, the Thoracostomy rapidly and spontaneously closed with vacuum-assisted closure therapy.
