Minimized perfusion circuits (MPC) were found to reduce side effects of standard extracorporeal circulation (ECC). We evaluated the safety and efficacy of the ROCsafe MPC for aortic valve and aortic root surgery. One hundred and seventy patients were randomized for surgery using either MPC [n = 85, 30 female/55 male, mean age: 69.8 +/- 11.8 years; aortic valve replacement (AVR): n = 40; AVR + coronary artery bypass graft (CABG): n = 31; David operation: n = 3; aortic root replacement (ARR): n = 11] or ECC [n = 85, 29 female/56 male, mean age: 67.7 +/- 9.5 years; AVR: n = 39; AVR+CABG: n = 35, David operation: n = 2; ARR: n = 9]. Neurological status, length of ICU stay, C-reactive protein (CRP), blood count, transfusion requirements and bleeding volume were analyzed. The MPC system provided ultrasound-controlled de-airing. A small roller pump and a flexible reservoir were used for left ventricular venting. As a control, we used a standard ECC with cardiotomy suction and hard-shell reservoir. Cross-clamp time (MPC: 76.5 +/- 29.5; ECC: 79.0 +/- 34.0 min) and bypass time (MPC: 103.0 +/- 37.9; ECC: 106.9 +/- 44.9 min) were comparable between groups. Transfusion requirements (red blood cells: MPC: 1.5 +/- 1.5 vs. ECC: 2.2 +/- 2.1 units [p = 0.05], frozen plasma: MPC: 1.2 +/- 1.8 vs. ECC: 1.9 +/- 2.4 units [p = 0.03]), postoperative bleeding (MPC: 521 +/- 283 vs. ECC: 615 +/- 326 ml/24 h, p = 0.09) were lower using MPC. ICU stay was shorter with MPC (1.6 +/- 1.6 days) compared to ECC (2.4 +/- 2.8 days, p = 0.001). One stroke occurred in each group. The ROCsafe MPC provides safe circulatory support for a wide range of aortic valve surgeries. Transfusion requirements, postoperative bleeding and length of ICU stay were markedly reduced compared to standard extracorporeal perfusion.

Minimized perfusion circuits (MPCs) have been criticized for insufficient air elimination. The deairing capabilities of a new MPC, including an ultrasound controlled deairing unit, were compared to a standard extracorporeal circuit (ECC) in a laboratory setup. During blood flow of 4.0l/min, we injected 30-cc air over a period of 30 s into the venous line of both systems (n = 10 measurements/15-min intervals). Air was detected during the first 2 min post injection using a dual-channel ultrasound bubble counter. Venous air bubble measurements were made after the MPC bubble trap and the ECC hard-shell reservoir, respectively. Arterial air bubble data were obtained after the arterial filters (40 microm). Venous bubble count was significantly (P < 0.01) reduced in the MPC group (5-250 microm, 681 +/- 177; >40 microm, 288 +/- 92) compared with the ECC group (5-250 microm, 19 272 +/- 682; >40 microm, 7642 +/- 520). After the arterial filter, minimal numbers of air bubbles (5-250 microm, 172 +/- 59; >40 microm, 0) could be detected in the MPC group, but large amounts of air (5-250 microm, 16 194 +/- 1072; >40 microm, 3732 +/- 997) were measured in the ECC group. The air elimination of the modern MPC is superior to conventional ECC, which may result in a reduction of neurological complications.

Klappenerhaltende Operationstechniken bei der akuten AortendissektionZusammenfassung. Grundlagen: Klappenerhaltende Verfahren bei Patienten mit akuter Dissektion der Aorta ascendens sind bei makroskopisch intakten Taschenklappen möglich. Die Reinterventionsrate an der Aortenwurzel 10 Jahre nach suprakommisuralem Ersatz beträgt bis zu 20 %.Methodik: Durchsicht der Literatur. Ergebnisse: Im Falle einer ausgeprägten Dissektion der Wurzel, annuloaortaler Ektasie oder bei bestehender Bindegewebserkrankung wie dem Marfan-Syndrom erscheint eine radikalere Taktik ratsam. Unter den verfügba-ren Verfahren zeigte sich, dass die Remodeling-Technik besser geeignet ist die Flexibilität und daher die Physiologie der Aortenwurzel zu erhalten. Der vorteilhafte Einfluss dieser erhaltenen Physiologie auf die Lebenserwartung der rekonstruierten Klappe bleibt allerdings unbestä-tigt. Andererseits besteht durch die radikalere Entfernung von erkranktem Gewebe an der Aortenwurzel sowie durch die zusätzliche Stabilisierung des Annulus bei der Reimplantations-Technik eine niedrige proximale Reinterventionsrate.Schlussfolgerungen: Diese Ergebnisse sowie die bessere Hämostase bei dem vulnerablen dissezierten Gewebe, machen die Reimplantationstechnik in unsere Meinung zum besten klappenerhaltenden Verfahren.Schlüsselwörter: Aortendissektion, Klappenerhaltende Operationstechniken, Aortenklappe.Summary. Background: Valve-sparing procedures in AADA are feasible whenever valve cusps appear macroscopically intact. Secondary root interventions amount to 20 % at 10 years following root repair with supracommissural replacement.Methods: Review of literature.Results: In case of extensive root dissection, annuloaortic ectasia or presence of a connective tissue disorder like Marfan's syndrome, a more aggressive approach appears advisable. Although the remodeling technique has been proven to preserve more of the flexibility and thus physiology of the aortic root, the impact of this advantage on the durability of valve repair is still missing. On the contrary, as the reimplantation technique is more radical in terms of exclusion of all diseased tissue and adds complete stabilization of the aortic annulus the need for proximal reoperations has been low.Conclusions: These results, and the better hemostasis in these friable dissected tissues, make the reimplantation technique in our opinion the best suited valve sparing technique.

Objective: Early detection by CT screening and the minimally invasive thoracic surgery for lung cancer has been growing rapidly where total 5,410 cases of video-assisted thoracoscopic lobectomy (33.8%) were performed in the year 2003 in Japan. Today, technically, systematic node dissection can be done by VATS. We performed 202 VATS lobectomies including 20 segmentectomies with systematic node dissection or lymph node sampling for clinical stage 1 non-small cell lung cancer. The technical feasibility of video-assisted thoracoscopic lobectomy with systematic node dissection is demonstrated and long-term survivals is also recorded. Methods: A double-lumen endobronchial tube is inserted while the patient is placed in lateral decubitus position and single lung ventilation is instituted. Three skin incision of 1.5 cm for trocars is made, followed by a wedge biopsy of the tumor. Aditional 6 -7 cm utility thoracotomy and lobectomy is performed as in the standard procedures. Having done a lobectomy with hilar lymph node dissection using stapler or self-produced instruments, mediastinal node dissection is performed as in an open thoracotomy. Results: No mortality or major morbidity were recorded. The procedure was completed within an average of 249 minutes including wedge biopsy, frozen section diagnosis, sentinel node navigation study, etc. with an average 127g of hemorrhage. Median hospital stay was 10 days. Long-term outcomes were 88.1% of clinical stage 1a, 77.9% of clinical stage 1b, 91.4% of pathological stage 1a and 77.5% of pathological stage 1b. Conclusions: As the fundamental benefit behind this approach remains controversial, systematic node dissection can be done safely and sufficiently by VATS. In terms of long-term survival, video-assisted thoracoscopic surgery has a similar or better result compared to a standard thoracotomy.Objective: Videothoracoscopy is becoming the approach of choice for the removal of neurogenic mediastinal tumors. Tumors extending into the spinal canal (dumbbell-type) require a combined neurosurgical approach. The aim of the study was to evaluate the feasibility of videothoracoscopic resection of benign neurogenic tumors (BNT) of the posterior mediastinum including dumbbell-type tumors through a retrospective review of our experience. Methods: Between January 1993 and November 2005, 30 patients underwent resection of a BNT of the posterior mediastinum at our Institution. Twenty-five tumors developed in the costovertebral sulcus and five were dumbbell-type. Preoperative assessment included chest CT scan, nuclear magnetic resonance for dumbbell-type tumors and spinal angiography in case the tumor was located near the site of the Adamkiewicz artery. Results: Mean tumor size was 5.6Ϯ1.4 cm (range 4 -11). Videothoracoscopic resection was possible in 26 patients, of whom five were dumbbelltype tumors requiring a combined neurosurgical approach. Reasons for conversion to thoracotomy were pleural adhesions in one case and bleeding in three. Mean operative time was 215Ϯ42 minutes (range 180 -28...