Seminars in Thoracic and Cardiovascular Surgery最新文献

The bronchial sleeve represents a pivotal advancement in thoracic surgery, allowing for oncological radicality while preserving respiratory function. We present 29 cases of telescopic monofilament continuous suture bronchial sleeves out of a total of 43 bronchial sleeve resections performed by us. There were no mortalities, no bronchial positive margins, no local recurrences, and only one anastomotic fistula requiring pneumonectomy with open window thoracostomy, which closed after a few months (Fig. 2). The telescopic intussusception technique avoids the significant problem of caliber discrepancy, and this type of suture consolidates with the physiological increases in airway pressure due to Valsalva maneuver or coughing, because the internal "endobronchial" pressure generated is applied radially on the smaller caliber bronchus, pushing it and causing it to adhere to the larger caliber external bronchus.

Ventricular assist device (VAD) technologies have advanced in recent years from large, pulsatile devices to smaller continuous flow (CF) pumps. As such, their design has allowed surgeons to pioneer less invasive methods of implantation with alternative configurations to treat a larger number of patients with varied types of cardiomyopathies who are often sick with high-risk clinical scenarios. In recent years, these patients appear to have a higher degree of vascular disease and have had multiple prior cardiac surgeries. In this review, we highlight both standard as well as alternative VAD configurations including additional inflow and outflow cannulation techniques along with considerations for biventricular support for both durable biventricular VADs and as a total artificial heart configuration.

Lung transplantation for cancer is controversial. The hesitancy has largely been driven by historical outcomes. However, early-stage lung cancer does not significantly affect the outcome of lung transplant for other end-stage lung diseases. We have also made more donor lungs available and hence can consider transplanting patients where the only curative option is to resect both lungs. With careful patient selection, experienced transplant centers can achieve acceptable long-term lung transplant results in patients with cancer as compared to those with other end-stage lung diseases. Additionally, there are two ongoing trials investigating the role of lung transplant for lung cancer and aim to expand access to lung transplants for cancer patients and potentially change medical opinion. If more than one type of patient can benefit from transplant, is it ethical to only allocate donor allografts to patients with chronic lung disease simply because that is what we have always done? Is one disease process more deserving of treatment than another?

Biventricular heart failure remains a challenging issue in patients with end-stage cardiomyopathy requiring mechanical circulatory support options. Also, the Achilles heel of durable left ventricular assist devices (LVADs) remains right ventricular failure that significantly impacts morbidity and mortality. With recent changes in the heart transplant allocation system, there has been major shifts in practice patterns in the use of extracorporeal membranous oxygenation (ECMO), temporary VADs, and durable VADs in the treatment of biventricular failure and strategies for bridge to heart transplantation. Direct comparisons between devices are often difficult to make as there is a learning curve both at the provider level and institution level for each of these devices and strategies. The field continues to rapidly evolve, and the application of artificial intelligence may further hasten this growth.