The Annals of thoracic surgery
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Meta Analysis Comparative Study
Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials.
Off-pump coronary artery bypass (OPCAB) challenges the conventional on-pump coronary artery bypass grafting (CABG) as the standard of surgical therapy for coronary disease. The aim of this study is to assess the differences in clinical outcomes between CABG and OPCAB by meta-analysis of data published in randomized trials. ⋯ Cumulative analysis of the few prospective randomized studies currently available found a potential clinical benefit of OPCAB, indicating that the avoidance of extracorporeal circulation might result in improved clinical outcomes. Further evidence, however, from large randomized trials is needed to assess potential advantages of OPCAB in terms of early outcomes.
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Junctional ectopic tachycardia (JET) is a life-threatening arrhythmia producing severe hemodynamic dysfunction, which may complicate the postoperative course of surgery for congenital heart disease. Strict care and a fast and effective antiarrhythmic strategy are essential, because mortality largely depends on the duration of the arrhythmia. ⋯ Flecainide can exert a fast antiarrhythmic effect on postoperative JET, and its infusion can be modulated to maintain the concentration within the therapeutic range, thus avoiding toxicity. We propose further consideration of flecainide for treatment of JET in neonates without myocardial ischemia.
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Transaortic repair of the tear was previously proposed as a compromise alternative to total arch replacement for acute type A aortic dissection with an arch tear. However, there are no data about long-term prognosis and radiologic findings after this procedure. ⋯ Transaortic repair of the arch tear with replacement of the ascending aorta can be an option in selected patients who have a small intimal tear in the aortic arch. This option would be more viable for less experienced surgeons who would hesitate to replace the total arch.
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A 52-year-old male with a history of repair of aortic coarctation by prosthetic tube graft replacement 35-years ago developed anterior spinal artery syndrome caused by acute functional occlusion of the aorta at the repair site where pseudoaneurysm formation was observed. The patient was rescued by an emergency axillofemoral bypass, and residual hypertension in upper limbs was improved by elective ascending aorta-descending aorta bypass grafting.