The Annals of thoracic surgery
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Randomized Controlled Trial Clinical Trial
Glucose-insulin-potassium solutions improve outcomes in diabetics who have coronary artery operations.
This study was undertaken to determine whether glucose-insulin-potassium (GIK) would improve myocardial performance and limit morbidity after coronary artery bypass grafting in diabetic patients. ⋯ Substrate enhancement with GIK in diabetic patients improved myocardial performance and resulted in faster recovery after coronary artery bypass grafting.
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Comparative Study
Predictive accuracy study: comparing a statistical model to clinicians' estimates of outcomes after coronary bypass surgery.
The purpose of this study was to compare clinicians' prior probability estimates of operative mortality (OM) and prolonged intensive care unit stay (ICU) length of stay greater than 48 hours after coronary artery bypass graft surgery (CABG) with estimates derived from statistical models alone. ⋯ Clinicians trusted their own empiric estimates rather than a predictive rule and overestimated the probability of OM and ICU stay greater than 48 hours.
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We examined the effect on outcome of mild hypothermia (< 36 degrees C) upon intensive care unit (ICU) admission on patient outcome after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). ⋯ BCT of less than 36 degrees C, upon ICU admission, has a significant association with adverse outcome after CABG with CPB. M An __ Tl QA_7_t-0
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Valvuloplasty has significant advantages over valve replacement for mitral regurgitation, but the presence of severe calcification of the mitral valve apparatus has been thought to preclude successful valve reconstruction in general. The purpose of this report is to assess the results of valvuloplasty in patients with severe mitral regurgitation having extensive calcification extending from the mitral annulus to underlying myocardium and parts of the papillary muscles. ⋯ Valvuloplasty can be safely and successfully carried out in patients suffering from regurgitation associated with severe calcification of the mitral apparatus. With encouraging beneficial midterm results, we suggest patients with calcified valves should not be excluded from mitral repair.
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Comparative Study
Epidural versus subdural spinal cord cooling: cerebrospinal fluid temperature and pressure changes.
Regional spinal cord cooling can increase the tolerable duration for spinal cord ischemia resulting from aortic clamping. We compared the efficacy of epidural and subdural cooling and the effect of the resulting cerebrospinal fluid-pressure (CSF) increases on spinal cord motor neuron function. ⋯ Subdural and epidural infusion cooling produce localized spinal cord hypothermia in pigs. The concurrent pressure increases, however, are uniformly distributed and can result in tc-MEP evidence of ischemia.