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Heart, Lung and Circulation S172007;16:S13–S29 ORAL PRESENTATIONS

EXPERIENCE WITH A MODIFIED MINIMISEDEXTRACORPOREAL CIRCULATION: A CAMPARISONWITH STANDARD CPB

A. Costantino , C. Gentili, P. Sordini, A. Alois, M.Staibano

Cardiac Surgery Unit, Ospedale San Filippo Neri, Roma, Italy

Introduction. The systemic inflammatory responsesyndrome is a well-known complication of cardiopul-monary bypass (CPB).1 A miniaturised closed CPB systemhas the theoretical advantage of minimising the bio-logical impact of extracorporeal circulation.2 Aim ofthis study is to compare the early outcome of twocohorts of patients operated on with an originally devel-oped CPB system (MECC System, Jostra, modified byus) and a traditional one, on the basis of clinicalend-points.

Methods. Two groups of isolated CABG patient (groupA standard CPB and group B MECC CPB, 100 patientseach) operated consecutively over the course of 20 monthswere compared for postoperative bleeding, need fortransfusions, time of ventilation, hospital and ICU stay,laboratory variations and PO inflammatory syndrome(defined as the occurrence of pleural/pericardial effusion,fever or both). Patient demographics were compara-ble for age (67.5 vs 68.8), EF (42.5% vs 40.8%), graft/pt(3.4 vs 3.5), CPB time (82 vs 78) and cross-clamp time(ndsipdg

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2. Fromes Y, Gaillard D, Ponzio O, Chauffert M, Gerhardt MF,Deleuze P, et al. Reduction of inflammatory response follow-ing coronary bypass grafting with total minimal extracorporealcirculation. Eur J Cardiothorac Surg 2002;22(4):527–33.

doi:10.1016/j.hlc.2007.02.016

ENDOBRONCHIAL CRYOTHERAPY FOR CARCIN-OID TUMOUR: AN ALTERNATIVE TO OPEN RESEC-TION

Philip Hayward 1, Julia Beeson 2, Omar Maiwand 2

1 Austin Hospital, Heidelberg, Victoria, Australia2 Harefield Hospital, London, United Kingdom

Introduction. Bronchial carcinoid tumours are treatedconventionally by surgical resection, with or withoutparenchymal sparing techniques. Local invasion limits therole of endobronchial therapies, which largely do not pen-etrate the bronchial wall. Outcomes after bronchoscopiccryotherapy, whose effect is, by contrast, transmural, wereassessed to determine its role as second line therapy.

Methods. Retrospective case note and database analy-sis of all bronchial carcinoid cases treated by cryotherapy.Serial applications of cryotherapy were delivered via a9.2 mm rigid bronchoscope under general anaesthesia.

Results. Seventeen patients received cryotherapy overan 11-year period with complete follow-up (median 63mpwar

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55 ± 15 vs 48 ± 15); all patients underwent primary coro-ary revascularisation without any selection. The mainifference between standard and MECC circuitry con-isted in the absence, for the latter, of any open air–bloodnterface; another major difference was the amount ofriming (1500 ml vs 500 ml) due to the absence of car-iotomy reservoir and the shorter lines in the MECCroup.Results. The hospital mortality was 3% for group A

nd 2% for group B; there was no incidence of majornfections in either group, nor major complications werebserved. The mean haematocrit of standard CPB groupas consistently lower than the MECC group, and transfu-

ions were also lower (0.03 ± 1.0 vs 0.7 ± 1.8); blood lossesf group A were almost double than group B on POay 1, as were ventilation time and ICU stay. Postoper-tive hospitalisation lasted an average two days less inroup B.Discussion. On the basis of these data we conclude

hat MECC system is a simple and safe alterna-ive to standard CPB, at least in CABG patients. Theesults of this series matches with OPCAB patients, andhis led us presently to consider MECC the alterna-ive of choice in cases of very ‘poor’ left ventricularunction, possibly extending indications in view ofhe easy switch to a medium term circulatory assis-ance.

eferences

1. Butler J, Rocker GM, Westaby S. Inflammatory response tocardiopulmonary bypass. Ann Thorac Surg 1993;55:552–9.

onths, range 4–138 months). Of these, two were treatedalliatively as they had had atypical carcinoid tumourith metastatic disease at presentation. Local control was

chieved successfully until death at 23 and 40 months,espectively.

Fifteen patients, of median age 51 years, underwentryotherapy with curative intent: six were unfit for thextent of surgical resection deemed appropriate, and nineere reluctant to undergo thoracotomy. All bar one of

hese tumours were of typical subtype.Nine of 15 patients had complete sustained tumour

emission, with median disease-free follow-up of 70onths. The remaining six patients derived incomplete

r transient tumour regression initially after cryotherapy;o proceeded to thoracotomy. No patient required a morextensive resection than would have been undertaken atresentation, and three required a lesser resection. One

ocal recurrence following lower lobectomy has been suc-essfully controlled to date by postoperative cryotherapy.

Bronchoscopic cryotherapy was well tolerated, witho adverse events and with trends at follow-up

o improved pulmonary function (pre- and post-reatment forced expiratory volumes in 1 s; p = 0.06)nd to improved performance scores (pre- and post-reatment World Health Organisation scores; p = 0.09) afterreatment.

Discussion. While surgical resection remains the goldtandard therapy, the sustained and complete remissionn over half of these cases, and absence of detrimentalffects from treatment or delay in incomplete respon-ers, confirms bronchoscopic cryotherapy as the bestlternative modality for those unfit or unwilling to

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S18 Heart, Lung and CirculationORAL PRESENTATIONS 2007;16:S13–S29

undergo surgical resection for endobronchial carcinoidtumour.

doi:10.1016/j.hlc.2007.02.017

VATS LOBECTOMY: PUTTING AUSTRALIA ON THEMAP

Naveed Z. Alam , Gavin M. Wright

Peter MacCallum Cancer Centre and St. Vincent’s Hospital Mel-bourne, Melbourne, Australia

Introduction. Minimally invasive techniques for lobec-tomy were first published in the early nineties, yet thisprocedure is still only performed in a few specialist centresaround the world. To date, no centres in Australasia havepublished their experience with this operation, despiterandomised trials and large published international seriesconfirming its safety and efficacy in trained hands.

Methods. The results from a prospectively maintaineddatabase are presented. Patients with suspected or provenlung cancers were selected for VATS lobectomy if they hadtumours less than 5 cm in diameter, were clinically stageI (T1 or 2, N0, M0) and met standard cardiopulmonaryrequirements for the planned lung resection. Patients withother suitable benign or malignant indications for surgerywere also selected for VATS lobectomy. Data on conversionrates to thoracotomy, mortality, complications, length of

CLINICAL OUTCOMES IN MYASTHENIA GRAVISAFTER VIDEO-ASSISTED THORACOSCOPIC (VATS)THYMECTOMY

C. Keating 1, Y. Kong 1, V. Tay 1, S. Knight 2, C.P. Clarke 2,G.M. Wright 1

1 St Vincent’s, Melbourne, Australia2 Austin Hospitals, Melbourne, Australia

Introduction. Thymectomy is an important treatmentin myasthenia gravis (MG) in combination with medi-cal therapy. A minimally invasive VATS approach hasbecome a well-accepted technique with similar efficacyand decreased morbidity and inpatient stay, comparedto open thymectomy via sternotomy. This procedure hasbeen offered in Australia for the past seven years and wereview the clinical outcomes of this population.

Methods. Fifty-five consecutive patients with MGundergoing a VATS thymectomy at the above hospi-tals between 1999 and 2006 were analysed. Patients withand without thymoma were included. Clinical outcomeswere assessed using the Myasthenia Gravis Foundation ofAmerica (MGFA) post-intervention status classification.Data were collected from medical records and supple-mented with telephone interviews. Six patients were lostto follow-up.

Results. Forty-nine patients (14 males and 35 females)were followed up, median review time 23 months. The

stay (LOS) and long-term survival were collected.Results. Between March 2001 and August 2006, 64 VATS

anatomic lung resections were performed by the authors attwo hospital campuses, including three segmentectomiesand two bi-lobectomies. Fifty-one of these were performedin the most recent 12-month period. Median follow-upis 6.4 months (range 1–65 months). Final diagnoses werenon-small cell lung cancer (NSCLC) in 47 patients, metas-tases in eight, carcinoid in three, lymphoma in one andbenign causes in five. The rate of conversion to thora-cotomy was 6.3% (4/64) all of which were for bleeding.The mortality rate was 3.2% (2/62; one haemorrhage, onelingular infarction/sepsis/ARDS). Ten patients had non-fatal complications (16%). The median LOS was seven days(3–43 days).

For the 47 patients with NSCLC, the Kaplan-Meier 1-,2-, 3-, 4- and 5-year survival was 85%. Final pathologicalstage in these patients was IA (17), IB (22), IIA (2), IIB (2)and III (4).

Discussion. VATS lobectomy can be safely performedwith long-term survival, morbidity and mortality compa-rable to an open procedure in a specialist centre.

doi:10.1016/j.hlc.2007.02.018

average age was 43 years. Preoperative MGFA classifica-tion was: class I: 4 (8%); class IIa: 16 (33%); class IIb: 3 (6%);class IIIa: 3 (6%); class IIIb: 15 (31%); class IVa: 2 (4%); classIVb: 5 (10%); class V: 1 (2%). Histopathology yielded 10(20%) normal thymus glands, 26 (53%) with thymic hyper-plasia, 12 (25%) thymomas and 1 (2.0%) non-thymomamalignancy.

Two patients (4.1%) subsequently died but not in theimmediate postoperative period (10 and 12 months). Therewas one conversion to sternotomy and two unplannedICU admissions requiring ventilation (<6 h each). A totalof 40 patients (82%) had improved symptoms – 19 (44%)of which were asymptomatic at follow-up, six patients(12%) had unchanged symptoms and one patient (2%)experienced worsened symptoms. Overall this correlateswith an average decrease in symptom class of 1.7 for allpatients undergoing this procedure. For all patients withmore than six months follow-up (n = 35), 19 (54%) wereasymptomatic. Using strict MGFA criteria (minimum 12months of follow-up), 3 of 27 patients (11%) had clini-cally stable remission, requiring no medications. Eightfurther patients (30%) had pharmacological remission.Only 12 patients (44%) reported ongoing symptoms after12 months.

Discussion. VATS thymectomy has become an acceptedtreatment for MG in Australia in patients with or withoutthymoma. The procedure is well tolerated and medium-term follow-up demonstrates excellent clinical improve-ment despite a higher than expected thymoma incidencein this patient group. Using the MGFA post-interventionstatus classification for comparison to international stud-