Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jan 2012
Randomized Controlled Trial Comparative StudyAdenosine in cold blood cardioplegia--a placebo-controlled study.
OBJECTIVE Adenosine as an additive in blood cardioplegia is cardioprotective in animal studies, but its clinical role in myocardial protection remains controversial. The aim of this study was to investigate whether the addition of adenosine in continuous cold blood cardioplegia would enhance myocardial protection. METHODS In a prospective double-blind study comparing adenosine 400 μmol l(-1) to placebo in continuous cold blood cardioplegia, 80 patients undergoing isolated aortic valve replacement were randomized into four groups: antegrade cardioplegia with adenosine (n = 19), antegrade cardioplegia with placebo (n = 21), retrograde cardioplegia with adenosine (n = 21) and retrograde cardioplegia with placebo (n = 19). ⋯ When compared with the antegrade groups, the retrograde groups showed higher myocardial oxygen uptake (17.3 ± 11.4 versus 2.5 ± 3.6 ml l(-1) at 60 min of aortic occlusion, P < 0.001) and lactate accumulation (43.1 ± 20.7 versus 36.3 ± 23.0 µmol g(-1) at 60 min of aortic occlusion, P = 0.052) in the myocardium during aortic occlusion, and lower postoperative left ventricular stroke work index (27.2 ± 8.4 versus 30.1 ± 7.9 g m m(-2), P = 0.034). CONCLUSIONS Adenosine 400 μmol l(-1) in cold blood cardioplegia showed no cardioprotective effects on the parameters studied. Myocardial ischaemia was more pronounced in patients receiving retrograde cardioplegia.
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Interact Cardiovasc Thorac Surg · Jan 2012
Multicenter Study Comparative StudyOutcome of pulmonary embolectomy for acute pulmonary thromboembolism: analysis of 32 patients from a multicentre registry in Japan.
Massive pulmonary embolism is relatively rare but a potentially life-threatening condition. The purpose of this study was to analyse the outcome of pulmonary embolectomy in registered data from the Japanese Society of Pulmonary Embolism Research (JaSPER). ⋯ Pulmonary embolectomy is an effective therapeutic option for patients with massive or submassive pulmonary embolism. Prompt triage of patients with haemodynamic instability is important.
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Interact Cardiovasc Thorac Surg · Jan 2012
ReviewWhat is the optimal timing for surgery in infective endocarditis with cerebrovascular complications?
Neurologic dysfunction complicates the course of 10-40% of left-side infective endocarditis (IE). In right-sided IE, instead, when systemic emboli occur, paradoxical embolism should be considered. The spectrum of neurologic events includes embolic cerebrovascular complication (CVC), intracranial haemorrhage, ruptured mycotic aneurysm, transient ischaemic attack (TIA), meningitis, encephalopathy and brain abscess. ⋯ Surgery for prosthetic valve endocarditis (PVE) follows the general principles outlined for native valve IE. Every patient should have a repeated head CT scan immediately before the operation to rule out a preoperative haemorrhagic transformation of a brain infarction. The presence of a haematoma warrants neurosurgical consultation and consideration of cerebral angiography to rule out a mycotic aneurysm.
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Interact Cardiovasc Thorac Surg · Jan 2012
ReviewThe role of myocardial ischaemic preconditioning during beating heart surgery: biological aspect and clinical outcome.
Short periods of ischaemia consecutive to reperfusion periods before a sustained ischaemic condition, the so-called ischaemic preconditioning (IP), aim to protect myocardial cells against prolonged ischaemia. IP appears as a considerable endogenous cardioprotective mechanism decreasing the infarct size after total occlusion in either experimental models or humans. Angina periods before an acute coronary syndrome limit the myocardial infarction being protective for the myocardium. Our report aims to review the international bibliography of the IP during off-pump coronary artery bypass grafting.
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Interact Cardiovasc Thorac Surg · Jan 2012
Comparative StudyPredicting risk of intensive care unit admission after resection for non-small cell lung cancer: a validation study.
A model for predicting the risk of emergency, unplanned intensive care unit (ICU) admission after lung resection for lung cancer has been reported. However, it has not been validated outside of the derivation cohort, and the aim of our study was to undertake external validation at our institution. We reviewed a series of consecutive patients who underwent major lung resection for non-small cell lung cancer over a 6-year period. ⋯ The mortality rate among these patients was 17%. The area under the ROC curve was 0.66 (95% CI 0.53-0.79). The Brunelli scoring system had moderate discriminating ability to predict the risk of ICU admission after lung resection in our institution.