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 © 2009 Published by Elsevier Inc. All rights reserved. Seminars in Thoracic and Cardiovascular Surgery1043-0679213Autumn 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.semthorcardiovascsurg.com/article/PIIS1043067909001221/abstract?rss=yesMasthead10.1053/S1043-0679(09)00122-1Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5iihttp://www.semthorcardiovascsurg.com/article/PIIS1043067909001245/abstract?rss=yesOfficers10.1053/S1043-0679(09)00124-5Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5iiiiiihttp://www.semthorcardiovascsurg.com/article/PIIS1043067909001257/abstract?rss=yesTable of Contents10.1053/S1043-0679(09)00125-7Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5ivvhttp://www.semthorcardiovascsurg.com/article/PIIS1043067909001269/abstract?rss=yesForthcoming/Previous Topics10.1053/S1043-0679(09)00126-9Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5vivihttp://www.semthorcardiovascsurg.com/article/PIIS1043067909001129/abstract?rss=yesCoronary artery disease (CAD) has been, and remains, the leading cause of death in the USA. Both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) represent important and well-established modalities for the mechanical revascularization for patients with obstructive CAD. Both CABG and PCI are among the most commonly performed procedures in North America and Europe. Sole CABG in combination with medical therapy and sole PCI in combination with medical therapy, have both been shown to relieve symptoms and, in certain circumstances, prolong life. Although sole CABG confers superior long-term survival in high-risk patients compared with multivessel PCI, its beneficial effects in low to intermediate risk patients are not as clear. The aspect of CABG with clear advantage is the left internal mammary artery (LIMA) to left anterior descending (LAD) artery graft. This graft has superior long-term patency and confers the survival benefit observed in CABG patients. Saphenous vein grafts (SVG) have significant limitations with high early failure rate (6.2%-30%, with an average of 20%). Sole multivessel PCI with drug eluting stents (DES) offers a less invasive revascularization modality with faster recovery and lower stroke rate compared with sole CABG. However, PCI does carry higher target vessel revascularization rate (TVR) compared with CABG, and importantly TVR is particularly high with PCI using DES in the LAD.Contemporary Issues in Coronary Bypass Surgery: IntroductionJohn G. Byrne10.1053/j.semtcvs.2009.09.001Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Contemporary Issues in Coronary Bypass Surgery - John G. Byrne, MD, Guest Editor195195http://www.semthorcardiovascsurg.com/article/PIIS1043067909000872/abstract?rss=yesDespite advances in percutaneous coronary intervention, coronary artery bypass grafting remains the most effective intervention for complex coronary artery disease in survival, freedom from reintervention, and cost-effectiveness. To ensure that patients have access to this “gold-standard” treatment, a multidisciplinary team approach, rather than an individual cardiologist acting as a “gatekeeper,” should be the standard of care when intervention is necessary, to ensure transparency, real patient choice, and genuine informed consent.Coronary Revascularization—2009: State of the ArtDavid P. Taggart10.1053/j.semtcvs.2009.08.003Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Contemporary Issues in Coronary Bypass Surgery - John G. Byrne, MD, Guest Editor196198http://www.semthorcardiovascsurg.com/article/PIIS1043067909000896/abstract?rss=yesRecent advances in medical therapy, percutaneous myocardial revascularization, and coronary artery bypass grafting have allowed patients to live longer without eliminating the underlying pathology of coronary artery disease. In this review the authors discuss surgical options, perioperative assessment, procedural details, and outcomes after repeated coronary artery bypass surgery and coronary endarterectomy, in patients with severe coronary artery disease that is not suited for further percutaneous coronary intervention. Furthermore, the authors also discuss the role of transmyocardial revascularization and protein/gene therapy in those extreme situations where complex coronary artery disease is no longer amenable to traditional surgical intervention.Surgical Therapy for Complex Coronary Artery DiseaseAndrew W. ElBardissi, Jorge M. Balaguer, John G. Byrne, Sary A. Aranki10.1053/j.semtcvs.2009.08.006Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Contemporary Issues in Coronary Bypass Surgery - John G. Byrne, MD, Guest Editor199206http://www.semthorcardiovascsurg.com/article/PIIS1043067909000914/abstract?rss=yesGraft patency strongly influences early and late outcomes after coronary artery bypass grafting (CABG) surgery. The current standard of care in CABG surgery does not require intraoperative imaging. Because coronary angiography is rarely available in the operating room (OR), other techniques have been developed to assess graft integrity intraoperatively. The 2 most commonly used are the transit time flow measurement (TTFM) and the intraoperative fluorescence imaging (IFI). The TTFM is a quantitative volume flow technique, whereas the IFI is based on the fluorescent properties of indocyanine green. TTFM cannot define the degree of graft stenosis nor discriminate between the influence of the graft conduit and the coronary arteriolar bed on the mean graft flow. IFI provides a “semiquantitative” assessment of the graft patency with images that provide some details about the quality of coronary anastomoses. Both methods are valuable in identifying only at the extremes, that is, either patent or occluded grafts, and can confirm very good grafts; however, neither method is sensitive or specific enough in identifying more subtle abnormalities. These abnormal grafts most likely have poor long-term patency and are predestined to fail. The hybrid suite has the capability of serving both as a complete surgical OR and as a catheterization laboratory. It allows for routine completion angiogram following CABG surgery and identifies abnormal grafts, providing the opportunity to revise them with percutaneous coronary intervention or surgery before leaving the OR.Intraoperative Grafts AssessmentMarzia Leacche, Jorge M. Balaguer, John G. Byrne10.1053/j.semtcvs.2009.08.007Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Contemporary Issues in Coronary Bypass Surgery - John G. Byrne, MD, Guest Editor207212http://www.semthorcardiovascsurg.com/article/PIIS1043067909001130/abstract?rss=yesIn an attempt to advance the surgical treatment of coronary artery disease, surgeons sought a way to offer the proven benefits of coronary revascularization and avoid the side effects of cardiopulmonary bypass by performing revascularization in the beating heart (off-pump coronary artery bypass). This review will describe the development and refinement of the technique, pitfalls to its widespread adoption, and an up-to-date assessment of current results.Off-Pump Coronary Artery Bypass: Techniques, Pitfalls, and ResultsSteven J. Hoff10.1053/j.semtcvs.2009.09.002Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Contemporary Issues in Coronary Bypass Surgery - John G. Byrne, MD, Guest Editor213223http://www.semthorcardiovascsurg.com/article/PIIS1043067909000902/abstract?rss=yesOff-pump coronary artery revascularization requires a unique skill set and a different conduct of operation compared with on-pump coronary artery bypass. Not only must the surgeon perform anastomoses on the beating heart, but he/she must understand the hemodynamic consequences of cardiac positioning and stabilization, the effects of regional ischemia on hemodynamic function, contractility, and arrhythmias, and the importance of anesthesia and grafting sequence given variants of anatomy and clinical conditions. Given these differences, the ability to teach off-pump coronary artery bypass to residents and surgeons places unique demands on the teaching surgeon. In this article, we review the available literature about the safety and efficacy of teaching off-pump coronary artery bypass to residents, discuss the fundamentals for training residents, and review the future of simulation and new training paradigms and the impact this will have on current training methods.Teaching Off-Pump Coronary Artery Bypass SurgeryMichael E. Halkos, John D. Puskas10.1053/j.semtcvs.2009.08.005Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Contemporary Issues in Coronary Bypass Surgery - John G. Byrne, MD, Guest Editor224228http://www.semthorcardiovascsurg.com/article/PIIS1043067909000884/abstract?rss=yesThe long-term benefits of a left internal mammary artery bypass graft to the left anterior descending artery (LAD) have been well described. As the patient population with multivessel coronary artery disease has grown older with greater comorbidities, less invasive approaches to revascularization have been explored. The use of drug-eluting stents has minimized the morbidity of revascularization but has failed to match the durability of coronary artery bypass grafting (CABG). Hybrid coronary revascularization (HCR) is the planned use of minimally invasive surgical techniques for left internal mammary artery-LAD grafting and the use of percutaneous coronary interventions (PCI) for non-LAD target revascularization. The optimal timing and order of revascularization in HCR remains unclear. Novel operating suites with surgical and fluoroscopic capabilities have begun to support the performance of simultaneous minimally invasive CABG and PCI. The role of HCR compared to both PCI and conventional CABG awaits the results of ongoing randomized clinical trials.Current State of Integrated “Hybrid” Coronary RevascularizationJoseph John DeRose10.1053/j.semtcvs.2009.08.004Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Contemporary Issues in Coronary Bypass Surgery - John G. Byrne, MD, Guest Editor229236http://www.semthorcardiovascsurg.com/article/PIIS1043067909000926/abstract?rss=yesOver the past 8 years, new techniques and perhaps more significantly new technology have expanded the possibilities for minimally invasive coronary artery bypass grafting. In this section, we review 3 important and potentially enabling technologies: (1) robotics, (2) anastomotic connectors, and (3) the expanding role of imaging in the context of combined operating room/catheterization laboratories (hybrid suites).Enabling Technology for Minimally Invasive Coronary Artery Bypass GraftingThomas Vassiliades10.1053/j.semtcvs.2009.08.008Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Contemporary Issues in Coronary Bypass Surgery - John G. Byrne, MD, Guest Editor237244http://www.semthorcardiovascsurg.com/article/PIIS1043067909000938/abstract?rss=yesThis edition of Seminars in Thoracic and Cardiovascular Surgery is devoted to airway surgery. Dr. Sharma is a dedicated chest radiologist with many years of experience in radiologic evaluation of chest diseases. Although in the past plain radiographs and tomography were used for the evaluation of the airway, computed tomography has assumed a primary role. The primacy of computed tomographic evaluation of the trachea is emphasized and numerous characteristic images are displayed.Airway Surgery: Evaluation, Surgery and Treatment: IntroductionCameron D. Wright10.1053/j.semtcvs.2009.08.009Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Airway Surgery: Evaluation, Surgery and Treatment - Cameron D. Wright, MD, Guest Editor245245http://www.semthorcardiovascsurg.com/article/PIIS104306790900080X/abstract?rss=yesMultidetector computed tomography (CT) allows for an accurate, noninvasive means of evaluating tracheal anatomy and pathology. The integration of information obtained from axial images, multiplanar reformats and 3-D rendering enables precise anatomical localization of tracheal pathology, provides detailed information on surrounding structures, aids in surgical planning, and allows for assessment of posttreatment response. Although bronchoscopy remains the gold standard in the diagnosis of tracheal pathology, the proper utilization of radiologic imaging can allow for improved patient care.Radiologic Evaluation of the TracheaSeth Kligerman, Amita Sharma10.1053/j.semtcvs.2009.06.012Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Airway Surgery: Evaluation, Surgery and Treatment - Cameron D. Wright, MD, Guest Editor246254http://www.semthorcardiovascsurg.com/article/PIIS1043067909000458/abstract?rss=yesFlexible and rigid bronchoscopy are the thoracic surgeon's stethoscope. These tools are vital to evaluating, diagnosing, and treating a tracheobronchial pathologic condition. Airway dilation, used appropriately and selectively, is an effective method of treating various tracheal pathologic conditions.Bronchoscopic Evaluation of the Trachea and Dilation of the TracheaMoishe Liberman10.1053/j.semtcvs.2009.06.003Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Airway Surgery: Evaluation, Surgery and Treatment - Cameron D. Wright, MD, Guest Editor255262http://www.semthorcardiovascsurg.com/article/PIIS1043067909000860/abstract?rss=yesCentral airway obstruction is a complex problem that requires a careful multidisciplinary evaluation. The central airways can be obstructed by intrinsic exophytic tumor, by extrinsic mass compression or by dynamic collapse. Both benign and malignant processes can obstruct the airway lumen. This article reviews the core principles and techniques available to the interventionalist managing central airway obstruction.Endoscopic Management of Central Airway ObstructionJed A. Gorden, Armin Ernst10.1053/j.semtcvs.2009.08.002Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Airway Surgery: Evaluation, Surgery and Treatment - Cameron D. Wright, MD, Guest Editor263273http://www.semthorcardiovascsurg.com/article/PIIS1043067909000446/abstract?rss=yesCongenital tracheal surgery is uncommon and few centers have enough experience to make meaningful conclusions about treatment. Short-segment congenital tracheal stenosis is treated by tracheal resection, whereas long-segment stenosis is treated by slide tracheoplasty. Tracheomalacia is treated most commonly by aortopexy if due to simple vascular compression, division of an offending vascular ring if due to a compressing or encircling ring, or by careful observation if not associated with vascular compression.Treatment of Congenital Tracheal StenosisCameron D. Wright10.1053/j.semtcvs.2009.06.002Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Airway Surgery: Evaluation, Surgery and Treatment - Cameron D. Wright, MD, Guest Editor274277http://www.semthorcardiovascsurg.com/article/PIIS1043067909000689/abstract?rss=yesIdiopathic laryngotracheal stenosis is a very rare condition characterized by an inflammatory cicatricial stenosis at the level of the cricoid cartilage and proximal trachea. Treatment options range from conservative short-term solutions to definitive surgical resection and reconstruction.Treatment of Idiopathic Laryngotracheal StenosisMoishe Liberman, Douglas J. Mathisen10.1053/j.semtcvs.2009.06.004Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Airway Surgery: Evaluation, Surgery and Treatment - Cameron D. Wright, MD, Guest Editor278283http://www.semthorcardiovascsurg.com/article/PIIS1043067909000859/abstract?rss=yesPostintubation tracheal stenosis is caused by either cuff-induced ischemic damage to the trachea, stomal injury from a tracheostomy, or a combination of the two. Patients who present with stridor or unexplained dyspnea after a period of mechanical ventilation should be investigated for postintubation tracheal stenosis. Most patients with such an injury are candidates for tracheal resection and reconstruction. The length of the anticipated resection is the most important determinant of resectability. Tracheal resection is now a standardized operation with predictable, reliable, good results. The principles of operative repair include precise bronchoscopic assessment, complete tracheal mobilization, dissection close to the trachea to avoid recurrent nerve injury, and precise anastomotic technique.Postintubation Tracheal StenosisJohn C. Wain10.1053/j.semtcvs.2009.08.001Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Airway Surgery: Evaluation, Surgery and Treatment - Cameron D. Wright, MD, Guest Editor284289http://www.semthorcardiovascsurg.com/article/PIIS1043067909000434/abstract?rss=yesThe evidence for the treatment of tracheal tumors rests on a small number of single-institution series, national surveys, and epidemiologic studies. From this evidence, the following observations have been made: tracheal tumors are rare and must be identified among a much larger number of metastatic malignant tracheal lesions; most tracheal tumors are malignant; most tracheal tumors in selected series are resectable; and survival after resection exceeds survival after nonoperative treatment, even if resection margins are close. A discussion of evaluation and treatment of these tumors in this review proceeds along a systematic series of questions.Treatment of Tracheal TumorsHenning A. Gaissert, Jimmie Honings, Manjusha Gokhale10.1053/j.semtcvs.2009.06.001Seminars in Thoracic and Cardiovascular Surgery 21, 3 (2009)Seminars in Thoracic and Cardiovascular Surgery213S1043-0679(09)X0005-5Airway Surgery: Evaluation, Surgery and Treatment - Cameron D. Wright, MD, Guest Editor290295