The Annals of thoracic surgery
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We explored the possibility of anastomosing the left anterior internal mammary artery (LIMA) to the left anterior descending artery in a beating heart via a left anterior small thoracotomy. ⋯ Left internal mammary artery-to-left anterior descending artery anastomosis performed on a beating heart via a left anterior small thoracotomy is a safe procedure. In selected patients the operation has good early and midterm results.
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A previous coronary artery bypass grafting (CABG) procedure may complicate subsequent aortic valve replacement (AVR). However, the operative risks and long-term outcome of patients who undergo these two procedures remain poorly defined. ⋯ Previous CABG poses added technical challenges at the time of reoperation for AVR. The operation can be performed safely, with the expectation of satisfactory long-term survival.
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Comparative Study
Critical importance of the first 10 minutes of lung graft reperfusion after hypothermic storage.
We have shown previously that lung graft function can be improved by achieving reperfusion with stepwise increments of perfusion pressure over 60 minutes. This study aimed to establish whether similar benefit could be achieved with a shorter, simpler protocol and different storage conditions. ⋯ An initial 10-minute period of 50%-pressure reperfusion improves the function of stored rat lung grafts, whereas 5 minutes is insufficient.
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Use of deep hypothermic circulatory arrest (DHCA) in infant cardiac surgery is associated with reduced cerebral perfusion and metabolism during the recovery period. We investigated the impairment of nitric oxide production as a possible cause. ⋯ Tonal production of nitric oxide is impaired in the brain after DHCA and is partly responsible for the circulatory and metabolic changes observed. Stimulation of nitric oxide production (L-arginine) significantly improved recovery of cerebral blood flow and cerebral oxygen metabolism after DHCA.
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The known complications of heterograft bioprostheses and homograft valves have renewed the interest in the use of autologous material. A new technique to construct a tissue prosthesis for aortic valve replacement using the patient's pericardium harvested at the time of operation was developed. The glutaraldehyde-tanned pericardium is mounted on a stent requiring no suturing. Intraoperative testing assures adequate valve function. ⋯ These results demonstrate that an autologous tissue cardiac valve can be manufactured in the operating room without significant additional operating time. Intraoperative testing minimizes the risk of primary failure with aortic insufficiency. Short-term results are encouraging with good hemodynamic performance of the valve and no signs of degeneration. However, long-term durability needs to be demonstrated.