Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2010
Randomized Controlled TrialMyocardial injury is decreased by late remote ischaemic preconditioning and aggravated by tramadol in patients undergoing cardiac surgery: a randomised controlled trial.
The purpose of this study was to test, whether the late phase of remote ischaemic preconditioning (L-RIPC) improves myocardial protection in coronary artery bypass grafting (CABG) with cold-crystalloid cardioplegia and whether preoperative tramadol modifies myocardial ischaemia-reperfusion injury using the same group of patients in a single-blinded randomized controlled study. One hundred and one adult patients were randomly assigned to either the L-RIPC, control or tramadol group. L-RIPC consisted of three five-minute cycles of upper limb ischaemia and three five-minute pauses using blood pressure cuff inflation 18 hours prior to the operation. ⋯ Myocardial samples for inducible and endothelial nitric oxide synthases (iNOS, eNOS) estimation were drawn twice: before and after cannulation for cardiopulmonary bypass from the auricle of the right atrium. We found that L-RIPC can reduce injury beyond the myocardial protection provided by cold-crystalloid cardioplegia, and tramadol worsened myocardial injury after CABG. Expressions of iNOS were increased in the control (significantly) and L-RIPC groups and dampened in the tramadol group.
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Interact Cardiovasc Thorac Surg · Dec 2010
Case ReportsRupture of Kommerell diverticulum after total arch replacement.
A 62-year-old man was brought to the emergency room of our hospital because of chest pain. Computed tomography revealed a right aortic arch and an aberrant left subclavian artery with Kommerell diverticulum and acute aortic dissection (Stanford type A). Total arch replacement was performed emergently through a median full sternotomy. ⋯ The patient died because of the bleeding. Autopsy findings showed a communication between the esophagus and Kommerell diverticulum. Rupture of Kommerell diverticulum and perforation of the esophagus were indicated.
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Interact Cardiovasc Thorac Surg · Dec 2010
Comparative StudyCombined coronary artery bypass grafting and aortic valve replacement with minimal extracorporeal closed circuit circulation versus standard cardiopulmonary bypass.
Isolated aortic valve replacement (AVR) or coronary artery bypass grafting (CABG) using minimized extracorporeal circulation (MECC) has been shown to have less deleterious effects than standard cardiopulmonary bypass (CPB). In this prospective cohort study, we evaluated and compared clinical results of combined AVR with CABG using MECC. We prospectively collected preoperative, intraoperative, postoperative and follow-up data of 65 patients who underwent combined AVR with CABG using MECC and compared these with 135 patients undergoing combined AVR with CABG using standard CPB. ⋯ They had decreased blood products requirements (P=0.004) compared to patients in the standard CPB group. No differences were noted in pulmonary complications, neurological events or mortality. We present for the first time data showing that combined AVR with CABG using MECC is feasible and provides better clinical results compared to standard CPB with regard to blood products requirements, without compromising operative morbidity or mortality.
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Interact Cardiovasc Thorac Surg · Dec 2010
Quality-of-life in octogenarians one year after aortic valve replacement with or without coronary artery bypass surgery.
The increasing number of interventions for percutaneous aortic valve replacement (AVR) justify a renewed evaluation of one-year survival rates after open AVR with and without coronary artery bypass in octogenarians. Risk factors influencing mortality are compared, and the patients' quality-of-life (QoL) after one year is assessed. One hundred and fifty-four patients (102 females, 52 males) aged on average 82.9±2.5 years, who had undergone open bioprosthetic AVR with (n=80) and without (n=74) coronary artery bypass grafting (CABG) between January 2005 and December 2007 were reviewed retrospectively. ⋯ Assessment of QoL revealed a substantial improvement of physical fitness in all 126 patients. Surgery in the aortic valve without CABG is associated with a good outcome. The improvement in QoL after one year supports the decision to operate on patients older than 80 years of age.
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Interact Cardiovasc Thorac Surg · Dec 2010
Early diagnosis of lung cancer using a SAFE-3000 autofluorescence bronchoscopy.
The aim of the study was to evaluate the double modality working of a new autofluorescence videobronchoscope SAFE-3000 for the detection and localization of precancerous and malignant lesions. From April to May 2009, 168 patients underwent SAFE-3000 bronchoscopy using 'Twin Mode' and 'Multiple Image Xposition (MIX)' technologies. The study considers only 97 patients with morphological alterations (visual score 2 or 3) of mucosa; four bronchial biopsies (two for every modality) have been performed on every patient. ⋯ The specificity was 60% in both of these technologies. SAFE-3000 autofluorescence bronchoscopy allows an early diagnosis of preneoplastic or neoplastic lesions according to the careful analysis of the bronchial mucosa, due to the complementarity of two modalities 'Twin Mode' and 'MIX'. Based on the relationship between the bronchoscopic goal and the histological results the MIX method contributes more of the new endoscopic technique findings.