Hybrid Totally Thoracoscopic Maze and Catheter Ablation for Persistent Atrial Fibrillation: Initial Experience.

Atrial fibrillation is now a pandemic in our ageing community. Although James L. Cox devised a surgical procedure with near-universal curative success in 1987, catheter-based interventions have flourished.

A donor PaO/FiO < 300 mm Hg does not determine graft function or survival after lung transplantation.

Background: A donor arterial PO/FiO (P/F ratio) of less than the 300 threshold would frequently result in either exclusion of the donor or placement of the lungs on ex vivo lung perfusion (EVLP). The aim was to investigate the veracity of the P/F ratio threshold of 300 for donor lung acceptability.

Methods: In 93 brain dead lung donors, arterial blood gases were drawn in the intensive care unit (ICU) just before procurement and each of the 4 donor pulmonary veins in the operating room (OR).

Anterior spinal artery syndrome after double valve replacement and coronary artery bypass surgery.

Spinal infarction is a rare and devastating complication of open-heart surgery, especially in the context of perioperative hemodynamic instability in patients requiring high dose of inotropes and vasoconstrictors. Our report highlights that spinal infarction can occur in such circumstances following a valve replacement surgery.

Lobar torsion following bilateral lung transplantation.

Torsion of lobes of the lung is a rare complication following lung transplantation. We present a case of counterclockwise torsion of the right lung allograft and review of nine additional cases in the literature of lobar torsion following lung transplantation. A high degree of suspicion is needed for early diagnosis with rapid surgical intervention to preserve lung viability.

4D CT and lung cancer surgical resectability: a technical innovation.

A 74-year-old man presents with a left upper lobe lung adenocarcinoma, which demonstrated a wide base intimately with the aortic arch. We utilised 4D CT technique with a wide field of view CT unit to preoperatively determine likely surgical resectability. We propose that 4D CT may be of use in further investigating lung cancer with likely invasion of adjacent structures.

Prophylaxis against atrial fibrillation after cardiac surgery: beneficial effect of perioperative metoprolol.

Introduction: Multiple agents have been investigated to prevent atrial fibrillation (AF) after cardiac surgery. Several studies have investigated the use of β-blockers such as metoprolol or amiodarone with promising results. We aimed to investigate perioperative pharmacologic prophylaxis against AF using metoprolol, and amiodarone in combination with metoprolol.

Lung T-cell responses to nontypeable Haemophilus influenzae in patients with chronic obstructive pulmonary disease.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by pulmonary inflammation that persists after the cessation of smoking. T cells have a major role in driving inflammation in patients with COPD and are activated by specific antigens to produce mediators, such as cytokines. The antigens that activate lung T cells have not been clearly defined.

Carbon dioxide insufflation in open-chamber cardiac surgery: a double-blind, randomized clinical trial of neurocognitive effects.

Objective: The aims of this study were first to analyze neurocognitive outcomes of patients after open-chamber cardiac surgery to determine whether carbon dioxide pericardial insufflation reduces incidence of neurocognitive decline (primary end point) as measured 6 weeks postoperatively and second to assess the utility of carbon dioxide insufflation in cardiac chamber deairing as assessed by transesophageal echocardiography.

Methods: A multicenter, prospective, double-blind, randomized, controlled trial compared neurocognitive outcomes in patients undergoing open-chamber (left-sided) cardiac surgery who were assigned carbon dioxide insufflation or placebo (control group) in addition to standardized mechanical deairing maneuvers.

Results: One hundred twenty-five patients underwent surgery and were randomly allocated.

Cadaveric lobar lung transplantation: technical aspects.

Background: The use of lobar transplantation and other size reduction techniques has allowed larger donor lungs to be utilized for smaller recipients who tend to have longer waiting times for transplantation. However, despite these advantages, the techniques have not been widely adopted. We outline the surgical and sizing issues associated with this technique.

KRAS mutation is associated with lung metastasis in patients with curatively resected colorectal cancer.

Purpose: Oncogene mutations contribute to colorectal cancer development. We searched for differences in oncogene mutation profiles between colorectal cancer metastases from different sites and evaluated these as markers for site of relapse.

Experimental Design: One hundred colorectal cancer metastases were screened for mutations in 19 oncogenes, and further 61 metastases and 87 matched primary cancers were analyzed for genes with identified mutations.

Pilot study of operative fixation of fractured ribs in patients with flail chest.

Background: Flail chest is a serious injury in trauma with a significant mortality rate, and long-term pain and disability. Traditionally, management has consisted of internal pneumatic splinting, leading to prolonged periods of mechanical ventilation, and its attendant complications. The aim of this study was to assess the safety of operative fixation of broken ribs in flail chest using absorbable prostheses.

Does prior percutaneous coronary intervention adversely affect early and mid-term survival after coronary artery surgery?

Objectives: To determine the association between previous percutaneous coronary intervention (PCI) and results after coronary artery bypass graft surgery (CABG).

Background: Increasing numbers of patients undergoing CABG have previously undergone PCI.

Methods: We analyzed consecutive first-time isolated CABG procedures within the Australasian Society of Cardiac and Thoracic Surgeons Database from June 2001 to May 2008.

What causes post-traumatic empyema?

Background: Empyema post chest trauma is a morbid condition requiring operative intervention (thoracotomy and decortication). It is hypothesized that patients who have a complicated initial pleural drainage procedure are at increased risk of developing an empyema.

Methods: All patients who underwent operative decortication for post-traumatic empyema over a 24 month period (July 2003 to June 2005) were included in the study.

Contemporary results show repeat coronary artery bypass grafting remains a risk factor for operative mortality.

Background: Reoperative coronary artery bypass grafting (redo CABG) shows improving outcomes, but with varying degrees of improvement. We assessed contemporary outcomes after redo CABG to determine if redo status is still a risk factor for early postoperative complications and midterm survival.

Methods: Isolated CABG procedures (June 1, 2001 to May 31, 2008) within the Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database were included.

Epicardial high-intensity focused ultrasound cardiac ablation for surgical treatment of atrial fibrillation.

Background: The available alternatives to an effective but technically complex Cox maze procedure for surgical treatment of atrial fibrillation include ablation using radiofrequency, microwave, laser, cryotherapy or ultrasound energy sources. The purpose of this study was to evaluate the safety and efficacy profile of high-intensity focused ultrasound cardiac ablation for the surgical treatment of atrial fibrillation.

Methods: 14 patients underwent epicardial high-intensity focused ultrasound treatment for atrial fibrillation using the Epicor cardiac ablation system between August 2006 and August 2007.

Is informed consent in cardiac surgery and percutaneous coronary intervention achievable?

Background: Medical and legal published work regularly discusses informed consent and patient autonomy before medical interventions. Recent discussions have suggested that Cardiothoracic surgeons' risk adjusted mortality data should be published to facilitate the informed consent process. However, as to which aspects of medicine, procedures and the associated risks patients understand is unknown.

A reinforced sternal wiring technique for transverse thoracosternotomy closure in bilateral lung transplantation: from biomechanical test to clinical application.

Objectives: A high incidence of failure of transverse thoracosternotomy closure, involving the loops of wire cutting through the sternum, remains a significant morbidity after bilateral lung transplantation. We postulated that placing peristernal wires inside the usual longitudinal wires could prevent the longitudinal wires from cutting through the sternum. The aims of this study were to investigate the biomechanical and clinical efficacy of the proposed reinforced sternal closure technique.

Fast-track cardiac surgery: application in an Australian setting.

In response to the current state of healthcare in Australia, our unit has employed a fast-track policy for low-risk cardiac surgery patients since January 2000. This study was designed to examine the safety and efficacy of this policy. From July 2001 to June 2004, 342 (23%) of 1,488 patients undergoing cardiac surgery were identified preoperatively as suitable for fast-track recovery.

Experience with unipolar radiofrequency ablation for atrial fibrillation.

Background: The cut and sew Cox maze procedure for atrial fibrillation (AF), although effective, is not widely used because of technical complexity, prolonged duration and significant risk of postoperative bleeding. This study reviews our experience with the unipolar radiofrequency ablation (RFA) procedure, which was used to create a modified maze to treat AF.

Methods: A retrospective review of 31 patients undergoing consecutive cardiac surgery who had concomitant RFA for AF over a 16-month period was carried out.

Urgent and emergency coronary artery bypass grafting for acute coronary syndromes.

Background: Urgent and emergency coronary artery bypass grafting may be associated with significant mortality and morbidity. We report our recent experience with this group of patients.

Methods: A retrospective analysis of 441 patients undergoing urgent and emergency surgery over a 3-year period was carried out.

Techniques of reconstruction for inadequate donor left atrial cuff in lung transplantation.

Background: An inadequate donor left atrial (LA) cuff due to an anatomical abnormality of the pulmonary vasculature or technical errors at the time of procurement can exclude the lungs from transplant. This study aims to describe the incidence, efficacy, and various techniques of LA cuff reconstruction in lung transplantation.

Methods: A total of 637 pulmonary venous anastomosis in 405 consecutive lung transplants from January 1995 to July 2005 were reviewed.

The outcome of cardiac surgery in dialysis-dependent patients.

Background: Patients on dialysis for end-stage renal failure (ESRF) are undergoing cardiac surgery with increasing frequency. Furthermore, ESRF is known to be an important risk factor for complications of cardiac operations performed with cardiopulmonary bypass.

Aims: To evaluate the outcome of dialysis-dependent patients undergoing cardiac surgery at one institution.

Coenzyme Q10 therapy before cardiac surgery improves mitochondrial function and in vitro contractility of myocardial tissue.

Objectives: Previous clinical trials suggest that coenzyme Q(10) might afford myocardial protection during cardiac surgery. We sought to measure the effect of coenzyme Q(10) therapy on coenzyme Q(10) levels in serum, atrial trabeculae, and mitochondria; to assess the effect of coenzyme Q(10) on mitochondrial function; to test the effect of coenzyme Q(10) in protecting cardiac myocardium against a standard hypoxia-reoxygentation stress in vitro; and to determine whether coenzyme Q(10) therapy improves recovery of the heart after cardiac surgery.

Methods: Patients undergoing elective cardiac surgery were randomized to receive oral coenzyme Q(10) (300 mg/d) or placebo for 2 weeks preoperatively.