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International Society For Minimally Invasive Cardiothoracic Surgery

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Simultaneous Cardio And Thoracic Surgery Options And Limitations
Adam Rzechonek, Sr.1, Ireneusz Szwedo2, Maksymilian Piórkowski3, Piotr Blasiak4, Grzegorz Wąż3, Pawel Kwinecki3, Grzegorz Pniewski5, Hanna Lisowka6, Mariusz Mieczyriski3, Arkadiusz Chmiel7, Ryszard Stanisławski2, Romuald Cichoń2.
1B. Medical University Wroclaw, Department of Thoracic Surgery (Wroclaw,3Interventional Drug Delivery Systems and Strategies, Wroclaw, Poland, 2Medinet Lower Silesian Center for Heart Diseases, Wroclaw, Poland, 3Medinet Lower Silesian Center for Heart Diseases, Zabrze, Poland, 4Medical University Wroclaw, Department of Thoracic Surgery (Wroclaw,3Interventional Drug Delivery Systems and Strategies, Wroclaw, Poland, 54Lower Silesian Centre of Lung Diseases, Department of Thoracic Surgery Pathology, Wroclaw, Poland, 6Lower Silesian Centre of Lung Diseases, Department of Thoracic Surgery, Zabrze, Poland, 7Medicus Specialist Hospital – Lubin, Lubin, Poland.

Goal:
The aim of the study was to determine the benefits and limitations of simultaneous cardio and thoracic surgery (OKT).
Material and methods:
11 patients were presented: 10 men and 1 woman, average age 65, 6 years (+/- 4, 8), median 71. All patients were previously diagnosed due to critical coronary or circulatory failure requiring cardiac surgery intervention. Suspected lung lesions were detected by chest radiographs. First, heart surgery was performed, followed by biopsy or pulmonary pathology resection.
Results:
In 7 patients (64% on average), coronary artery bypass surgery was performed, in 3 patients resection of the ingrown tumor, in 1 patient pericardial fenestration. Radical thoracic surgery accounted for 55% of the remaining cases (45%) in diagnostic procedures.
Nine patients were diagnosed (82%).
The need to extend access beyond sternotomy occurred in 2 cases.
Postoperative complications occurred in 3 cases (27%).
Conclusions:
1. Preliminary results indicate the practical usefulness of OKTs that provide diagnostic and survival opportunities in patients with cardiac contraindications for thoracosurgical interventions.
2. OKT treatments reduce the time, overall cost and invasiveness of procedures.
3. Longitudinal sternotomy does not provide:
a) Radical resection of mediastinal lymph nodes of groups 7, 8, 9, 4 and 2
b) Access to pulmonary lesions in posterior segments 2, 6, 8, 9 and 10. In this case, VATS is an effective supplement.
4. Cross-cutting of the sternum allows resection with full lymphadenectomy.
5. Associating longitudinal stenotomy with additional intercostal incision may result in impaired healing of the surgical wound.


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