Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2017
Caveolin 2: a facultative marker of unfavourable prognosis in long-term patency rate of internal thoracic artery grafts used in coronary artery bypass grafting. Preliminary report.
Intimal hyperplasia leading to graft failure in patients undergoing coronary artery bypass grafting (CABG) is related to vascular smooth muscle cells (SMCs) proliferation. SMCs respond to a variety of mediators, the most important of which is platelet-derived growth factor (PDGF). The platelet-derived growth factor-induced cellular response has been shown to be mediated by caveolins. The aim of this study was to analyze CAV1-3 expression in internal thoracic artery (ITA) grafts used in CABG and correlate their expression with graft occlusion. ⋯ CAV2 expression in SMCs of the tunica media in autologous ITA transplants might indicate the risk of graft failure.
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Interact Cardiovasc Thorac Surg · May 2017
Perioperative outcomes of off-pump minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries under direct vision†.
We previously introduced techniques to harvest and use the right internal thoracic artery in minimally invasive coronary artery bypass grafting (CABG) via a single left thoracotomy for revascularization with bilateral internal thoracic arteries (BITA). We report our short-term outcomes of patients who underwent minimally invasive CABG using BITA and a single internal thoracic artery (SITA). ⋯ BITA can be safely harvested in a reproducible manner under direct vision via a small left thoracotomy. The potential advantages of minimally invasive CABG using BITA, although yet to be established, include a long-term survival benefit conferred by BITA grafts and elimination of the risk of sternal wound infection, in addition to the established advantages of minimally invasive coronary artery surgery. This approach has the potential for further optimization with hybrid revascularization strategies.
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Interact Cardiovasc Thorac Surg · Apr 2017
Early and long-term cognitive outcome after conventional cardiac valve surgery.
Adverse cognitive outcome is well recognized after coronary artery bypass grafting (CABG) while little is known about the extent and duration of decline after cardiac valve surgery. We investigated changes in cognitive function following conventional cardiac valve surgery over up to 4 years. ⋯ The course of cognitive performance after valve surgery and CABG was similar with early postoperative decline followed by subsequent recovery. Although silent small brain infarcts were present in about half of all patients, they did not impact cognitive performance neither at early nor during long-term follow-up.
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Interact Cardiovasc Thorac Surg · Apr 2017
Lung ultrasound profile after cardiopulmonary bypass in paediatric cardiac surgery: first experience in a simple cohort.
To explore the association between lung ultrasound (LUS) and clinical variables in children undergoing cardiopulmonary bypass (CPB). ⋯ In a small cohort of children undergoing CPB, the LUS profile on POD1 was associated with CPB time, aortic cross-clamp time and mechanical ventilation duration.
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Interact Cardiovasc Thorac Surg · Apr 2017
Uniportal thoracoscopic decortication for pleural empyema and the role of ultrasonographic preoperative staging.
The surgical approach to chronic pleural empyema is still controversial. Video-assisted thoracic surgery (VATS) debridement and decortication has shown favourable outcomes, while the uniportal VATS (U-VATS) approach is still anecdotal. We report our experience with ultrasonographic (US) preoperative staging followed by U-VATS decortication for pleural empyema. ⋯ Uniportal thoracoscopic decortication for pleural empyema is a safe and effective approach for selected patients based on a combination of clinical and imaging staging. US patterns well corresponded with intraoperative pleural findings and showed a prognostic value.