Jose Ramón Cano

Incidence, management and clinical outcomes of patients with airway complications following lung transplantation

OBJECTIVE Airway complications (AC) remain a significant contributing factor of morbidity after lung transplantation (LT). The aim of this study was to identify risk factors for AC, and to review the outcomes after endoscopic and surgical treatment. METHODS From 1993 to 2006, 255 patients underwent LT. Seven retransplants and 34 patients not surviving beyond 7 days were excluded. The remaining patients were: 124 double LT (DLT), 85 single LT (SLT), 3 lobar LT and 2 liver-DLT, comprising 343 bronchial anastomoses at risk. Donor lungs were flushed with either modified Eurocollins or Perfadex. Bronchial anastomoses were telescoped when needed. Donor and recipient variables were recorded and analyzed by univariate and multivariate tests to identify risk factors for AC, and to assess differences between both complicated and non-complicated groups. RESULTS Among 343 bronchial anastomoses, 31 presented AC (9%) in 27 patients (12.6%): 22 stenoses, 5 dehiscences, and 4 malacias, at 2.6+/-1.7 months post-transplant. Indications were 7 emphysema, 3 Alpha-1-antitrypsin deficiency, 12 cystic fibrosis (p=0.007), 4 pulmonary fibrosis, and 1 bronchiectasis. AC were observed in 4 SLT and 23 DLT (p=0.005). Incidence of AC did not differ between telescoped and non-telescoped anastomoses. By univariate analysis, AC were more frequent in grafts preserved with modified Eurocollins (p=0.033), CMV infection/disease (p=0.027) and airway colonizations post-transplant (p=0.021). Other donor and recipient variables did not differ between groups. By multivariate analysis, intubation longer than 72 h, DLT, and airway colonizations post-transplant remained independently associated with AC. Survival did not differ between groups. Most patients were successfully treated with endoscopic procedures; three required reoperation (lobectomy, pneumonectomy, retransplantation). AC related mortality was 1%. CONCLUSIONS The incidence of AC after LT is 12.6% with a related mortality of 1%, irrespective of the technique of bronchial anastomosis performed. DLT, airway colonizations, and prolonged intubation post-transplant are associated with AC. Either endoscopic procedures or surgical therapy resolve these complications in most cases.

New minimally invasive technique for correction of pectus carinatum

We describe a new video-assisted operative technique for correction of pectus carinatum (PC) using a modified Nuss procedure. A new design of the steel bar was developed, so that it could be introduced and placed in a suitable position through very small skin incisions. Substantial modifications were introduced in the bar length and shape aimed at facilitating insertion and subsequent removal when required. All the surgical manoeuvres took place under direct vision using a 30° thoracoscope. Single unilateral fixation of the bar in a subpectoral pocket provided satisfactory stabilisation without the need for lateral stabilisers. Adequate correction of the deformity was achieved with minor postoperative scars. Our results support the view that minimally invasive surgical repair should be preferred over open surgery for correction of pectus carinatum in young adults and children.

New technique for pulmonary artery reconstruction

Bronchial and vascular reconstructive procedures are a technically feasible alternative to pneumonectomy in lung cancer and have the advantage of preserving lung parenchyma function. Sleeve resection and prosthetic reconstruction of the pulmonary artery (PA) have progressively gained acceptance as an alternative to pneumonectomy in lung cancer surgery. To spare the lung parenchyma, angioplastic procedures involving removal of a portion of the arterial wall or a circumferential resection with arterial reconstruction have been used. Several techniques of pulmonary arterioplasty have been documented, such as patch reconstruction, end-to-end anastomosis, synthetic prosthesis, biological prosthesis, prosthetic or pericardial conduit. We present the first case reported in the literature of PA reconstruction with a pulmonary vein graft.

Minimally-invasive resection of a scapular osteochondroma.

Osteochondroma of the scapula is a rare benign tumour that produces pain and mechanical dysfunction of the joint when settled on the ventral surface of the scapula. Surgical resection is the treatment of choice in symptomatic cases. Conventional open excision has been the traditional treatment of choice, while published cases involving a minimally-invasive approach are rare and restricted to descriptions of video-assisted procedures. We present a case of video-assisted surgical resection of a large osteochondroma from the ventral surface of the scapula in a young male patient with the snapping scapula syndrome. The technique and the postoperatory outcome are described.

Tumor de células dendríticas foliculares en mediastino anterior

fallo hepático, realizar un trasplante de hı́gado urgente. El cual ha sido descrito como una opción para estos pacientes ante el riesgo de graves complicaciones. Sin embargo, la posibilidad de un trasplante genera un número importante de interrogantes en relación con su tratamiento. Se proponen diferentes tratamientos en la literatura, que dependerán de la experiencia y los medios del equipo tratante.

Videothoracoscopic repair of pectus excavatum with sternal transection for adult patients with nonelastic deformity

Minimally invasive repair techniques for pectus excavatum (PE) are thought to be contraindicated in patients with a rigid chest wall and to result in incomplete correction and more severe and prolonged postoperative pain for adult or late adolescent patients with a relatively malleable thorax. In these cases, additional procedures, such as osteotomy or insertion of a second bar, are required to achieve adequate correction. A new minimally invasive repair technique for PE successfully applied to patients with symmetric and rigid deformity is presented. This technique is a modification of the Nuss procedure, based on bilateral videothoracoscopic guidance and sternal transection, where the corrective bar has been modified in size and shape. Inasmuch as the involved bar is shorter and less bent than that in the original Nuss procedure, it can be inserted through minimal periareolar or submammary skin incisions with optimal cosmetic results. Sternal transection facilitates the elevation of the sternum, which results in highly satisfactory correction of the deformity and reduces the tension and pressure of the bar against the rib cage, thus potentially reducing postoperative pain.

Reconstruction of the anterior chest wall with a 3-dimensionally printed biodynamic prosthesis

Abstract Chest wall reconstructions, mainly secondary to surgical treatment of oncologic disease or trauma, still represent a challenge for chest surgeons. No consensus exists on the materials or prostheses to be used. Thus, a wide variety of methods and materials are available for chest wall reconstruction and the choice generally depends on the location and size of the defect to be covered. Up to this day, most prostheses provide the chest wall with the necessary hardness and stability to protect inner organs; however, they restrict normal respiratory movements because of their rigidity. Moreover, there is the problem of finding good anchor points, since it is the patient who has to adapt to the prosthesis and exact adjustment is usually not possible. Designing personalized prostheses with three-dimensional technology may be a solution to this problem. Up to our knowledge, here we present the first case of complete reconstruction of the anterior chest wall with a patient-tailored flexible prosthesis designed with 3D technology, which did not restrict respiratory movements and allowed for normal respiratory function.

Transcervical bedside brachiocephalic trunk clamping as a technique to reduce exsanguination from injuries to the upper right torso

From the Department of Thoracic Surgery, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Sept 17, 2015; revisions received Dec 7, 2015; accepted for publication Dec 8, 2015; available ahead of print Jan 16, 2016. Address for reprints: David Perez, MD, PhD, Department of Thoracic Surgery, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas, Spain (E-mail: dperalo@live.com). J Thorac Cardiovasc Surg 2016;151:1424-5 0022-5223/

Thoracoscopic Approach for Surgical Repair of Pectus Carinatum

36.00 Copyright 2016 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2015.12.008

Triton tumor of the left sympathetic nerve

Surgery for correction of Pectus Carinatum according to our technique is a fully endoscopic procedure that involved placement of major part of the pectus bar within the thorax with only the medial segment is positioned to compress the sternum and correct the deformity.