• Journal of Chest Surgery
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• v.46 no.4
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• pp.249-255
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• 2013

Background: The continuous suture (CS) technique has several advantages as a method for simple, fast, and secure aortic valve replacement (AVR). We used a simple CS technique without the use of a pledget for AVR and evaluated the surgical outcomes. Materials and Methods: Between October 2007 and 2012, 123 patients with aortic valve disease underwent AVR alone (n=28) or with other concomitant cardiac procedures (n=95), such as mitral, tricuspid, or aortic surgery. The patients were divided into two groups: the interrupted suture (IS) group (n=47), in which the conventional IS technique was used, and the CS group (n=76), in which the simple CS technique was used. Results: There were two hospital deaths (1.6%), which were not related to the suture technique. There were no significant differences in cardiopulmonary bypass time or aortic cross-clamp time between the two groups for AVR alone or AVR with concomitant cardiac procedures. In the IS group, two patients had prosthetic endocarditis and one patient experienced significant perivalvular leak. These patients underwent reoperations. In the CS group, there were no complications related to the surgery. Postoperatively, the two groups had similar aortic valve gradients. Conclusion: The simple CS method is useful and secure for AVR in patients with aortic valve disease, and it may minimize surgical complications, as neither pledgets nor braided sutures are used.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.61-68
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• 2022

Background: While the coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of health care, its impact on cardiac surgical practice and outcomes is yet to be determined. We compared the outcomes of our cardiac surgical practice from the past year during the pandemic to those in a similar pre-pandemic period. Methods: Retrospective data were collected from 307 patients who were involved in all adult cardiac surgical procedures performed between March 2020 and February 2021, which was considered the pandemic period, at Amrita Institute of Medical Sciences, India. These were compared with data from the 1-year period between March 2019 and February 2020. During that earlier period, 491 patients underwent surgery, and the surgical outcomes were assessed. Outpatient visit data were also collected to evaluate the effect of COVID-19 on outpatient follow-up visits. Results: A 37% decrease in surgical case volume was observed during the study period. No difference was found in operative mortality between the 2 time periods (3.3% vs. 2.6%, p=0.383). Overall postoperative complications were less frequent during this period, at 23% compared to 38% the previous year (p<0.001). Conclusion: The COVID-19 pandemic caused a dramatic decrease in surgical volume and outpatient medical follow-up. However, the pandemic and its attendant social restrictions did not yield a significant change in the surgical outcomes of our patients. Hence, it is reasonable to continue cardiac surgical care during global health crises, and this can be done with good results.

• Journal of Trauma and Injury
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• v.32 no.1
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• pp.8-16
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• 2019

Purpose: The Essential Surgical Procedures in Trauma (ESPIT) course was developed as a model to teach necessary surgical procedures to trauma physicians. Its goals are to improve knowledge, self-confidence, and technical competence. Methods: The ESPIT course consisted of five lectures and a porcine lab operative experience. The ESPIT course has been run seven times between February 2014 and April 2016. ESPIT participants completed a questionnaire to assess self-efficacy regarding essential surgical procedures in trauma before and immediately after taking the ESPIT course. Sixty-three participants who completed both pre- and post-course questionnaires on self-efficacy were enrolled in this study. Results: The overall post-ESPIT mean self-efficacy score was higher than the pre-ESPIT mean self-efficacy score ($8.3{\pm}1.30$ and $4.5{\pm}2.13$, respectively) (p<0.001). Self-efficacy was significantly improved after the ESPIT course in general surgeons (p<0.001), thoracic and cardiovascular surgeons (p<0.001), emergency medicine doctors, and others (neurosurgeons, orthopedic surgeons) (p<0.001). The differences in self-efficacy score according to career stage (<1 year, 1-3 years, 3-5 years, and >5 years) were also statistically significant (p<0.001). Conclusions: The data of the ESPIT participants indicated that they felt that the ESPIT course improved their self-efficacy with regard to essential surgical procedures in trauma. The ESPIT course may be an effective strategy for teaching surgical procedures, thus promoting better management of traumatic injuries.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.55-60
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• 2022

Background: Robot-assisted repair of atrial septal defect (ASD) can be performed under either beating-heart or non-beating-heart conditions. However, the risk of cerebral air embolism (i.e., stroke) is a concern in the beating-heart approach. This study aimed to compare the outcomes of beating- and non-beating-heart approaches in robot-assisted ASD repair. Methods: From 2010 to 2019, a total of 45 patients (mean age, 43.4±14.6 years; range, 19-79 years) underwent ASD repair using the da Vinci robotic surgical system. Twenty-seven of these cases were performed on a beating heart (beating-heart group, n=27) and the other cases were performed on an arrested or fibrillating heart (non-beating-heart group, n=18). Cardiopulmonary bypass (CPB) was achieved via cannulation of the femoral vessels and the right internal jugular vein in all patients. Results: Complete ASD closure was verified using intraoperative transesophageal echocardiography in all patients. Conversion to open surgery was not performed in any cases, and there were no major complications. All patients recovered from anesthesia without any immediate postoperative neurologic symptoms. In a subgroup analysis of isolated ASD patch repair (beating-heart group: n=22 vs. non-beating-heart group: n=5), the operation time and CPB time were shorter in the beating-heart group (234±38 vs. 253±29 minutes, p=0.133 and 113±28 vs. 143±29 minutes, p=0.034, respectively). Conclusion: Robot-assisted ASD repair can be safely performed with the beating-heart approach. No additional risk in terms of cerebral embolism was found in the beating-heart group.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.293-296
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• 1995

Between September, 1987 and March, 1994, 11 patients were treated for the pulmonary aspergilloma.The mean age was 59.6 years. Hemoptysis was the most common chief compliants[100% .Postoperative pathology showed bronchiectasis and tuberculosis were most common underlying diseases.Operative procedures were wedge resection in one patient, segmentectomy in 2, lobectomy in 7. One patient treated conservative.In 3 patients, the postoperative air leakage persisted longer than after other pulmonary resectional surgery.There was no postoperative death. The surgical resection is strongly recommended when the patient develops hemoptysis.

• Journal of Chest Surgery
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• v.29 no.7
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• pp.792-797
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• 1996

Empyema with bronchopleural fistula is a serious complication after resectional surgery of the lung. Several methods in treating empyema with bronchopleural fistula have been developed, but the results were not always satisfactory. Recently, successful results have been reported with the surgical treatments using tissue flap (the omentum and f or the chest wall muscles) to close the bronchopleural fistula in patients with thoracic empyema. We have performed surgical procedures to treat bronchopleural fistula using omentum in 1 patient an chest wall muscles in 3 patients. Their postoperative courses were uneventful.

• Journal of Chest Surgery
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• v.46 no.3
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• pp.202-207
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• 2013

Background: The role of totally implantable central venous port (TICVP) system is increasing. Implantation performed by radiologist with ultrasound-guided access of vein and fluoroscope-guided positioning of catheter is widely accepted nowadays. In this article, we summarized our experience of TICVP system by surgeon and present the success and complication rate of this surgical method. Materials and Methods: Between March 2009 and December 2010, 245 ports were implanted in 242 patients by surgeon. These procedures were performed with one small skin incision and subcutaneous puncture of subclavian vein. Patient's profiles, indications of port system, early and delayed complications, and implanted period were evaluated. Results: There were 82 men and 160 women with mean age of 55.74. Port system was implanted on right chest in 203, and left chest in 42 patients. There was no intraoperative complication. Early complications occurred in 11 patients (4.49%) including malposition of catheter tip in 6, malfunction of catheter in 3, and port site infection in 2. Late complication occurred in 12 patients (4.90%). Conclusion: Surgical insertion of TICVP system with percutaneous subclavian venous access is safe procedures with lower complications. Careful insertion of system and skilled management would decrease complication incidence.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.526-530
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• 1988

Acquired communicated fistula between the esophagus and respiratory system are infrequent and they are caused by carcinoma, trauma, infection and traction. This report reviews the feature of acquired esophagobronchial fistula[that developed spontaneously]. Patient is 34 year old man with excellent result by surgical intervention. The surgical procedures consist of division and repair of the fistula. Clinically and radiologically, the patient is free from coughing after drinking, substernal distress, esophagorespiratory fistula, and esophageal stricture after surgical treatment.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.264-267
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• 2008

The da Vinci telemanipulator system (Intuitive Surgical, Sunnyvale, CA USA) is the most advanced robotic surgical system and has been increasingly used for cardiac surgical procedures. We report out first clinical experience of use of the da Vinci telemanipulator system for endoscopic harvesting of the bilateral thoracic artery andmulti-vessel small thoracotomy off pump CABG for 3-vessel disease. The da Vinci telemanipulator system has been previously utilized primarily for mitral valve surgery.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.463-469
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• 1991

Post-anastomotic leakage and stenoses remain major complications and are still responsible for many mortalities after esophageal reconstructive procedures. If the hand-suture is used, anastomotic leaks developed frequently than stenoses. But post-anastomotic leakages are more critical than post-anastomotic stenoses. If the stapler is used, anastomotic stenoses will develop frequently and not critical than anastomotic leakages. The stapler suture method is easier and quicker than the hand suture method in the esophageal anastomotic procedures. But the disadvantages of the stapler suture method is that there is not reachable site with anastomotic stapler the thoracic inlet region and the cost is expensive. We have treated 44 cases of the surgical complications after esophageal reconstructive procedure with conservative and surgical treatment for 10 years from January, 1980 to December, 1989. The anastomotic site stenoses were 8 cases in the hand-suture methods and 4 cases in the stapler-suture methods. The anastomotic leaks were 8 cases in hand-suture methods and 5 cases in stapler-suture methods. There were one death in the surgical repair of four post-operative anastomotic stenoses and two deaths in the surgical repair of three post-operative anastomotic leakages. Ever though we consider that there is more anastomotic leakage than stenoses after the hand-suture methods in esophageal reconstructive procedures. the cost with long stay in the intensive care unit to treat anastomotic leakage after the hand-suture, would be more expensive than-the cost of the treatment of the anastomotic stenoses after auto-suture.