The Annals of thoracic surgery
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Comparative Study
Airway stenting for malignant and benign tracheobronchial stenosis.
Patients with benign and malignant central airway obstruction suffer from disabling dyspnea, obstructive pneumonia, and impending suffocation. Therapeutic bronchoscopy provides immediate and gratifying palliation. Airway stenting is the principal modality used to manage intrinsic tracheobronchial pathology and extrinsic airway compression. This report provides the details of the indications, techniques, and results of airway stenting in our practice. ⋯ Airway stenting provides prompt and durable palliation in unresectable patients with central airway obstruction. Frequently multiple stents and multiple procedures will be necessary to maintain a satisfactory airway.
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous ultrafiltration attenuates the pulmonary injury that follows open heart surgery with cardiopulmonary bypass.
Pulmonary injury after cardiac surgery is one of the complications of cardiopulmonary bypass. We evaluated the ultrafiltration technique in preventing and relieving the pulmonary injury that can follow open heart surgery with cardiopulmonary bypass (CPB). ⋯ The combined use of balanced ultrafiltration and modified ultrafiltration can effectively concentrate the blood, modify the increase of some harmful inflammatory mediators, attenuate the lung edema and inflammatory pulmonary injury, and mitigate the impairment of pulmonary function.
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Randomized Controlled Trial Comparative Study Clinical Trial
Myocardial and lung injury after cardiopulmonary bypass: role of interleukin (IL)-10.
Proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, and IL-8 play a key role in the inflammatory cascade after cardiopulmonary bypass (CPB) and may induce cardiac and lung dysfunction. Antiinflammatory cytokines such as IL-10 may also significantly limit these complications. Corticosteroid administration before CPB increases blood IL-10 levels and prevents proinflammatory cytokine release. This study examined the association of increased release of IL-10, stimulated by steroid pretreatment, with reduced myocardial and lung injury after CPB. ⋯ This study confirms that corticosteroids abolish proinflammatory cytokines release and increase blood IL-10 levels after CPB. Our findings demonstrate a greater release of IL-10 induced by steroid pretreatment, and better heart and lung protection after CPB.
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The effect of preoperative aspirin use until the day of operation on mortality rate and bleeding risks in patients who had on-pump coronary artery bypass operation has been well documented. However, the effect of aspirin use in patients undergoing off-pump coronary artery bypass operation (OPCAB) with regard to postoperative blood loss and morbidity has not been studied. We aimed to determine the effects of continuing aspirin therapy preoperatively. ⋯ Preoperative aspirin did not increase bleeding-related complications, mortality rate, or other morbidities in patients who had off-pump coronary artery operation.
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Composite valve graft replacement is currently the treatment of choice for a wide variety of lesions of the aortic root and the ascending aorta. In this study we report our experience with aortic root replacement using a composite graft. ⋯ Composite valve graft replacement can be performed with low hospital mortality and morbidity. The button technique offers some advantages and should be used whenever possible. In case of acute aortic dissection root replacement is usually not necessary. Marfan patients should be treated with early root replacement before dissection occurs.