Seminars in Thoracic and Cardiovascular Surgery RSS feed: Current Issue. Seminars in Thoracic and Cardiovascular Surgery is devoted to keeping the practicing surgeon current. Each issue includes two topics, one on cardiac surgery and one on general thoracic surgery. Each topic is explored in approximately five articles that present detailed descriptions and sound evaluations of developments in diagnosis and treatment, new techniques, and scientific and technologic advances. 2009 Topics , Volume 21 January Imaging advances for surgery of the thoracic aorta Therapeutic options for the treatment of advanced lung cancer April Ethical, legal, and health policy challenges in contemporary cardiothoracic surgery July Contemporary management of mesothelioma October Endovascular options for cardiac surgeons Current status of tracheal surgery http://www.semthorcardiovascsurg.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Seminars in Thoracic and Cardiovascular Surgery1043-0679234Winter 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.semthorcardiovascsurg.com/article/PIIS1043067912000214/abstract?rss=yesMasthead10.1053/S1043-0679(12)00021-4Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0IFCIFChttp://www.semthorcardiovascsurg.com/article/PIIS1043067912000226/abstract?rss=yesOfficers10.1053/S1043-0679(12)00022-6Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0iihttp://www.semthorcardiovascsurg.com/article/PIIS1043067912000238/abstract?rss=yesTable of Contents10.1053/S1043-0679(12)00023-8Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0iiiiihttp://www.semthorcardiovascsurg.com/article/PIIS1043067912000068/abstract?rss=yesInfection within the pleural space has posed a management dilemma for physicians since the time of Hippocrates. Despite advances in medical treatment for pneumonia, the incidence of both complicated parapneumonic effusion and empyema is increasing in both the United States and the United Kingdom. The impact of the problem is significant; with up to one-third of patients progressing to surgical decortication and drainage and overall mortality ranging from 10%-20%. Complete drainage of the infection is the key management principle. Systemic antibiotic therapy and drainage of the pleural space via tube thoracostomy constitute first-line management, with surgical drainage reserved for those with complicated effusions, development of a pleural “peel or rind,” or uncontrolled pleural sepsis.Intrapleural Therapy in Empyema Thoracis: A Contemporary Solution to an Age-Old Problem?David D. Odell, Jonathan D'Cunha10.1053/j.semtcvs.2012.01.004Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0News and Views257258http://www.semthorcardiovascsurg.com/article/PIIS1043067911001481/abstract?rss=yes An intriguing paper was recently published that describes c-kit–positive human lung stem cells that self-renew and differentiate into multiple lineages. While these findings are potentially therapeutically exciting, several questions remain to be answered. We review the paper and the issues that have arisen. Human Lung Stem Cells: Has the Future Arrived?Jennifer M. Hanna, Mark W. Onaitis10.1053/j.semtcvs.2011.10.009Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0News and Views259260http://www.semthorcardiovascsurg.com/article/PIIS1043067912000044/abstract?rss=yes The cancer risk in patients with Barrett's esophagus is important because it determines screening, surveillance, and treatment considerations. Previously, the risk of progression to esophageal adenocarcinoma in patients with Barrett's esophagus was thought to be approximately 1%. Recently, 2 very large population-based studies have significantly reduced this risk estimate of cancer. Paradoxically, esophageal adenocarcinoma continues to rise exponentially in the United States. Screening and surveillance programs based on endoscopic, histopathological, and molecular criteria need to be improved to identify a high-risk population of progressors. Barrett's Esophagus and Cancer Risk: A More Realistic EstimateShanmugarajah Rajendra, Prateek Sharma10.1053/j.semtcvs.2012.01.003Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0News and Views261262http://www.semthorcardiovascsurg.com/article/PIIS1043067912000032/abstract?rss=yes In a recent report, authors describe their findings from the Exhale Airway Stents for Emphysema (EASE) trial. In this study, investigators follow patients with emphysema and severe hyperinflation after a novel bronchoscopic lung-volume reduction procedure utilizing paclitaxel-eluting stents. Despite the merits of this randomized, sham-controlled, multi-institutional study, the authors were unable to demonstrate any sustainable benefit for the treatment group upon follow-up. Nonetheless, important lessons can be learned from this trial, which has set a foundation for future investigations. Airway Stenting for Emphysema: Back to the Drawing BoardMara B. Antonoff, Jonathan D'Cunha10.1053/j.semtcvs.2012.01.002Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0News and Views263265http://www.semthorcardiovascsurg.com/article/PIIS104306791100178X/abstract?rss=yesSince commercialization of transcatheter aortic valves in 2007, there have been an estimated >40,000 valves implanted in patients in 42 countries outside of the United States. Despite this extensive experience, there has been only one randomized controlled trial completed and a second one that is currently underway. The completed trial, the Partner Trial, was a randomized trial of the Edwards Lifesciences Sapien Valve, a bovine pericardial tissue valve mounted in a balloon deployable stainless steel stent.Partner IA: What It Means for SurgeonsMichael Mack10.1053/j.semtcvs.2011.12.009Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0News and Views266267http://www.semthorcardiovascsurg.com/article/PIIS1043067911001730/abstract?rss=yes The burgeoning field of catheter-based, percutaneous valve intervention takes an interdisciplinary approach to mitral valve regurgitation with the goal of maximizing clinical outcomes and minimizing procedure-associated morbidity. This exciting field continues to push the boundaries of technological innovation as it expands the armamentarium available to treat valvular disease. Around the world teams are working to create a catheter-based approach that is practical and durable. Several technologies are in various stages of development and clinical application. Percutaneous Treatment of Mitral Regurgitation: Current Status and Future DirectionsLori K. Soni, Michael Argenziano10.1053/j.semtcvs.2011.12.004Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0News and Views268270http://www.semthorcardiovascsurg.com/article/PIIS1043067911001729/abstract?rss=yesThe landscape of cardiac surgery is continually and rapidly transformed by a high rate of innovation. Today, cardiac surgery represents a surgical specialty with a significant number of actively enrolling clinical trials, which are driven in part by the prevalence of cardiovascular disease, the culture of those who treat it, and the need to provide an evidence base for innovative procedures and devices. Clinical trials, however, represent a significant investment in resources and, for surgical trials in particular, are fraught with challenges in design, execution, and analysis. In this perspective, we briefly highlight some of these challenges, drawing examples from trials that span the spectrum of early phase to confirmatory to comparative effectiveness trials.Innovative Clinical Trial Design in Cardiac SurgeryAlexander Iribarne, Annetine C. Gelijns, Michael A. Acker, Deborah D. Ascheim10.1053/j.semtcvs.2011.12.003Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0News and Views271273http://www.semthorcardiovascsurg.com/article/PIIS1043067911001717/abstract?rss=yes The options for treating heart disease have greatly expanded during the course of the last 2 1/2 decades with the advent of hybrid technology. The hybrid option for treating cardiac disease implies using the technology of both interventional cardiology and cardiac surgery to treat cardiac disease. This rapidly developing technology has given rise to new and creative techniques to treat cardiac disease involving coronary artery disease, coronary artery disease and cardiac valve disease, and atrial fibrillation. It has also led to the establishment of new procedural suites called hybrid operating rooms that facilitate the integration of technologies of interventional cardiology catheterization laboratories with those of cardiac surgery operating rooms. The development of hybrid options for treating cardiac disease has also greatly augmented teamwork and collaboration between interventional cardiologists and cardiac surgeons. Hybrid Options for Treating Cardiac DiseaseRamanan Umakanthan, Marzia Leacche, David X. Zhao, Anna H. Gallion, Prabodh C. Mishra, John G. Byrne10.1053/j.semtcvs.2011.12.002Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0State of the Art274280http://www.semthorcardiovascsurg.com/article/PIIS1043067912000020/abstract?rss=yes The elucidation of the molecular alterations in non-small cell lung cancer (NSCLC) and the development of molecularly targeted agents have permanently shifted NSCLC therapy to a personalized approach. In the metastatic setting, the addition of the anti–vascular endothelial growth factor monoclonal antibody, bevacizumab, to chemotherapy improves overall survival. The oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors, gefitinib and erlotinib, prolong progression-free survival in patients selected for the presence of an EGFR activating mutation. The monoclonal antibody to EGFR, cetuximab, improves survival in patients with metastatic NSCLC, and the inhibitor of the echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) fusion protein, crizotinib, has resulted in an unprecedented overall survival advantage in patients harboring the EML4-ALK translocation. In the adjuvant setting, gefitinib has not been shown to improve patient survival outcomes; however, there are several ongoing clinical trials in the adjuvant setting evaluating the role of erlotinib, bevacizumab, and the MAGE-A3 and MUC1 vaccines. The realm of personalized lung cancer therapy also includes the study of chemotherapy selected on the basis of the pharmacogenetic profile of a patient's tumor. Several ongoing clinical trials in both the metastatic and adjuvant settings are studying the excision repair cross-complementing group 1 (ERCC1) protein, the ribonucleotide reductase subunit 1 (RRM1) protein, thymidylate synthase, and BRCA1 as predictors of chemotherapy response. This review will outline the current state of the art of personalized NSCLC therapy. Personalized Therapy for Non-Small Cell Lung Cancer: Which Drug for Which Patient?Liza C. Villaruz, Mark A. Socinski10.1053/j.semtcvs.2012.01.001Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0State of the Art281290http://www.semthorcardiovascsurg.com/article/PIIS1043067911001705/abstract?rss=yes Local therapy alone (surgery or radiation) leads to poor overall survival in patients with stage III non-small cell lung cancer because most of these patients die of distant metastases. During the past 20 years, studies have focused on developing effective chemotherapy regimens that can be combined with local therapies (surgery and/or radiation). The role of surgery has been evaluated, and the selection criteria for resection have been defined. Current Surgical Therapy for Stage IIIA (N2) Non-Small Cell Lung CancerJane Yanagawa, Valerie W. Rusch10.1053/j.semtcvs.2011.12.001Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0State of the Art291296http://www.semthorcardiovascsurg.com/article/PIIS1043067912000056/abstract?rss=yes The role of chest physiotherapy in limiting postoperative pulmonary complications and in the recovery of pulmonary function and exercise capacity after lung surgery is still unclear because of the lack of conclusive, well-designed clinical trials. In this article the available literature on these topics is reviewed, and the effects of respiratory physiotherapy, instituted preoperatively or administered after surgery to patients undergoing lung resection, are commented on. The authors conclude that chest physiotherapy improves preoperative exercise capacity; this is a parameter highly predictive of postoperative pulmonary complications. Also physiotherapy administered during the immediate period after lung resection probably decreases frequency of pulmonary complications. Finally, further investigation is required for a better understanding of the effects of long-term chest physiotherapy after hospital discharge in lung resection patients. Chest Physiotherapy in Lung Resection Patients: State of the ArtGonzalo Varela, Nuria M. Novoa, Paula Agostini, Esther Ballesteros10.1053/j.semtcvs.2011.11.001Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0State of the Art297306http://www.semthorcardiovascsurg.com/article/PIIS1043067912000147/abstract?rss=yes Biomimesis has become the objective of the reconstructive strategies after chest wall resections for primary or secondary tumors. Biomimesis is pursued by respecting the anatomy, preserving function, selecting adequate reconstructive materials, and integrating multidisciplinary efforts for complex reconstructions. Elements of novelty in the clinical practice are represented by the introduction of the principles of video-assisted thoracic surgery to resect chest wall tumors and the increasingly frequent resort to either new materials or revised concepts of time-honored ones for chest wall reconstruction. Experimental investigation seems to outline interesting perspectives for materials destined to reconstruction after either partial or full-thickness resections for recurrent chest wall tumors. Chest Wall Resection and Reconstruction According to the Principles of BiomimesisGaetano Rocco10.1053/j.semtcvs.2012.01.011Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0State of the Art307313http://www.semthorcardiovascsurg.com/article/PIIS1043067911001766/abstract?rss=yesIncreased complexity of patients referred for cardiac surgery has led surgeons to develop new methods of myocardial protection. Together with improvements in anesthesia management and postoperative care, outcomes have improved over the years. Continuous retrograde warm blood cardioplegia, simultaneous antegrade/retrograde cardioplegia, and more recently, beating heart surgery, are examples of new strategies aimed at minimizing post–cardiopulmonary bypass (CPB)–induced myocardial ischemia and ischemia-reperfusion injury. Cardioplegia, although valuable, is not an indispensable component of myocardial protection. Coronary perfusion, rather than cardioplegia, is of primary importance in protection of the heart against ischemic injury.Myocardial Preservation: Beating Heart TechniquesFrancisco Igor B. Macedo, Yilliam Rodriguez, Tomas A. Salerno10.1053/j.semtcvs.2011.12.007Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0Techniques My Way314317http://www.semthorcardiovascsurg.com/article/PIIS1043067911001778/abstract?rss=yes Reperfusion injury after reestablishing coronary flow by releasing the aortic cross clamp after cardiac surgery with cardioplegic arrest causes myocardial damage and even death. Attenuation of this reperfusion response by controlling the biochemical and physical environment can avoid morbidity and mortality. Use of a warm reperfusate with addition of drugs that are known to decrease reperfusion injury with manipulation of coronary vascular resistance and the physical parameters of the reperfusion environment helps the heart to reestablish coronary perfusion while decreasing the harm produced by the period of ischemia that occurs during cardiac surgery with intermittent cardioplegic arrest. Myocardial Preservation: Controlled ReperfusionPrasanna Simha Mohan Rao, Parimala Prasanna Simha10.1053/j.semtcvs.2011.12.008Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0Techniques My Way318321http://www.semthorcardiovascsurg.com/article/PIIS1043067912000135/abstract?rss=yesThoracic malignancies have the potential to invade the superior vena cava (SVC) and innominate veins (IV). In the past, major vascular invasion was considered an operative contraindication; however, published data show that SVC and IV resection and reconstruction might be accomplished through a variety of approaches and techniques with acceptable operative morbidity and mortality and might lead to improved long-term oncological outcomes in carefully selected patients.Introduction: Superior Vena Cava and Innominate Vein Reconstruction in Thoracic MalignanciesRafael S. Andrade10.1053/j.semtcvs.2012.02.001Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0Techniques My Way322322http://www.semthorcardiovascsurg.com/article/PIIS1043067912000123/abstract?rss=yes Benign or malignant disease processes involving the superior vena cava can be resected and reconstructed with excellent perioperative results and sustained durability. Superior Vena Cava and Innominate Vein Reconstruction in Thoracic Malignancies: Single-Vein ReconstructionIkenna C. Okereke, Kenneth A. Kesler10.1053/j.semtcvs.2012.01.010Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0Techniques My Way323325http://www.semthorcardiovascsurg.com/article/PIIS1043067912000111/abstract?rss=yesExtensive major venous resection and reconstruction with prosthetic vascular conduits are feasible with very good short- and long-term results. Okereke et al described the use of an externally stented polytetrafluoroethylene (PTFE) conduit for bypass of the superior vena cava (SVC) with 90% patency at a mean of 24 months. Sekine et al expanded on the traditional method of reconstruction by using direct independent grafts between the left and right innominate veins (IV) and the right atrium. We describe our technique for independent reconstruction of the left and right innominate venous systems by using ringed PTFE prosthetic vascular grafts.Superior Vena Cava and Innominate Vein Reconstruction in Thoracic Malignancies: Double-Vein ReconstructionDavid D. Odell, Kenneth Liao10.1053/j.semtcvs.2012.01.009Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0Techniques My Way326329http://www.semthorcardiovascsurg.com/article/PIIS1043067912000172/abstract?rss=yesRecent technical advances in the domains of anesthesia, cardiovascular and thoracic surgery, and synthetic materials manufacturing coupled with more oncological extended tumor indications have unlocked the door to the surgical treatment of pulmonary, mediastinal, or other rare tumors involving intrathoracic vessels. In 1987, Dartevelle et al first described a consecutive and large series of patients with mediastinal or lung malignancies and superior vena cava (SVC) involvement treated with SVC resection by using polytetrafluoroethylene tubular grafts for reconstruction. Open surgery requires a high level of technical expertise and vigilant attention to patient selection and perioperative management to minimize complications, which are reported even in highly specialized centers. During the past decade, operative mortality for these procedures has ranged between 0% and 7.7%, with long-term patency rates of about 70%-100%. However, proper patient selection is critical for clinical success. We will outline the role of surgery for selected patients with locally advanced but completely resectable non-small cell lung cancers (NSCLC) or mediastinal tumors (MT) involving invading the SVC and/or the innominate vein (IV).Superior Vena Cava and Innominate Vein Reconstruction in Thoracic Malignancies: Cryopreserved Graft ReconstructionMassimo Jaus, Paolo Macchiarini10.1053/j.semtcvs.2012.02.002Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0Techniques My Way330335http://www.semthorcardiovascsurg.com/article/PIIS1043067912000159/abstract?rss=yesLarge size discrepancy between donor and recipient airway in lung transplantation presents a technical challenge. Most commonly, this mismatch presents as a smaller donor airway, particularly when matching donor size to recipient whose chest cavity has been shrunken by fibrotic lung disease but whose airway remains unaffected. Size mismatch can be accommodated to a degree by using beveled anastomoses and telescoping techniques, but extreme size mismatch, by using these strategies, predisposes to airway complications such as stenosis and dehiscence. We describe a simple anastomotic technique to manage the small donor airway.Managing Extreme Airway Size Mismatch in Lung Transplantation: The “Upper Lobectomy” TechniqueSiva Raja, Sudish C. Murthy, Gosta B. Pettersson, David P. Mason10.1053/j.semtcvs.2012.01.012Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0Innovations and Challenges336338http://www.semthorcardiovascsurg.com/article/PIIS1043067911001808/abstract?rss=yes Mitral valve replacement surgery after previous aortic valve surgery can be extremely challenging. The presence of heavy calcification and scarring in the aortic and/or mitral annulus can make suture placement nearly impossible. Although novel techniques have been described, even these alternatives might not be feasible. We present a case of nonanatomical mitral valve replacement in the pulmonary venous confluence as a salvage operation. This can provide adequate hemodynamics and survival until a subsequent care plan can be established. Nonanatomical Mitral Valve Replacement in the Pulmonary Venous Confluence for Heavily Calcified Aortic or Mitral AnnulusBrian E. Kogon, Maan Jokhadar, Anurag Sahu, Micheal McConnell, Wendy Book10.1053/j.semtcvs.2011.12.011Seminars in Thoracic and Cardiovascular Surgery 23, 4 (2011)Seminars in Thoracic and Cardiovascular Surgery234S1043-0679(11)X0006-0Innovations and Challenges339341