The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Apr 2018
Is More than One Hour of Selective Antegrade Cerebral Perfusion in Moderate-to-Mild Systemic Hypothermic Circulatory Arrest for Surgery of Acute Type A Aortic Dissection Safe?
Surgery for acute type A aortic dissection (AAD) remains a surgical challenge with considerable risk of morbidity and mortality. Antegrade cerebral perfusion (ACP) has been popularized, offering a more physiologic method of brain perfusion during complex aortic arch repair, often necessary in setting of AAD. The safe limits of this approach under moderate-to-mild systemic hypothermic circulatory arrest (≥ 28°C) are yet to be defined. Thus, the current study investigates our clinical results after surgical treatment for AAD in patients with a selective ACP and systemic circulatory arrest time of ≥ 60 minutes in moderate-to-mild hypothermia (≥ 28°C). ⋯ Our preliminary data suggest that selective ACP during moderate-to-mild systemic hypothermic circulatory arrest (≥ 28°C) can safely be applied for more than 1 hour even in the setting of AAD.
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Thorac Cardiovasc Surg · Apr 2018
Case ReportsNo Clamp Complete Parachute Technique for Ascending Aorta Anastomosis in Hybrid Aortic Arch Debranching Surgery.
The proper proximal landing zone is a key element for success of endografting in thoracic aortic pathology. If coverage of innominate artery is unavoidable for safe proximal landing, arch debranching surgery is necessary to recruit supra-aortic blood flow before endografting. However, calcified or adhesive ascending aorta makes it difficult to clamp ascending aorta for anastomosis in the first step of arch debranching surgery. We present a novel "no clamp complete parachute technique" to complete this challenging anastomosis.
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Thorac Cardiovasc Surg · Mar 2018
Randomized Controlled TrialLocal Anesthetics delivered through Pleural Drainages improve Pain and Lung Function after Cardiac Surgery.
Pleural tubes after coronary artery bypass graft (CABG) surgery usually cause pain resulting interalia in an impact of postoperative breathing. Therefore, the influence of intrapleural lidocaine application through special double-lumen chest tubes with respect to pain relief and lung function was investigated and compared with placebo. ⋯ Intrapleural application of lidocaine is a safe and feasible method to reduce drainage-related pain and improving lung function after CABG.
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Thorac Cardiovasc Surg · Jan 2018
Overexpression of MicroRNA-106b-5p Attenuates Kidney Injuries after Deep Hypothermic Circulatory Arrest in Rats.
MicroRNAs (miRNA) have been identified to exert a wide range of biological functions in acute kidney injury (AKI) after deep hypothermic circulatory arrest (DHCA). We sought to investigate the renoprotection of miRNA-106b-5p in a rat model of DHCA by targeting phosphatase and tensin homolog (PTEN). ⋯ Overexpression of miRNA-106b-5p attenuates kidney injuries after DHCA, possibly by inhibition of PTEN.
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Thorac Cardiovasc Surg · Jan 2018
Impact of Acute Intestinal Ischemia and Reperfusion Injury on Hemodynamics and Remote Organs in a Rat Model.
Acute mesenteric ischemia following cardiovascular surgery is a rare but fatal complication. We established a new rat model for hemodynamic monitoring during mesenteric ischemia/reperfusion (I/R) and evaluated the impact of mesenteric I/R on hemodynamics and remote organ injury. ⋯ A new model for CO monitoring after mesenteric I/R injury demonstrated severe hypovolemic shock during reperfusion followed by remote myocardial and lung injury. Far less colloid volume is needed for hemodynamic stabilization after I/R compared with crystalloid volume.