The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Aug 2000
Clinical Trial Controlled Clinical TrialOptimizing cerebral oxygenation during cardiac surgery: a review of experimental and clinical investigations with near infrared spectrophotometry.
Near-infrared spectrophotometry (NIRS) is a promising method for non-invasive monitoring of cerebral oxygenation and hemodynamics. This paper reviews studies in which we aimed to validate NIRS in an experimental model of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) (validation study), use the method in experimental settings to optimize cerebral oxygenation during CPB (oxygenation study), and test its utility during routine cardiac surgery (clinical study). ⋯ NIRS measurements, especially the CytOx signal, correlate well with high energy phosphates and have a high sensitivity to predict histologic brain damage. NIRS is an important and useful tool in studies investigating cerebral oxygenation during CPB. The CytOx signal predicted impaired neuropsychological outcome in patients. Therefore, the CytOx signal holds much interest for future studies.
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Thorac Cardiovasc Surg · Aug 2000
Comparative StudyClinical use of a computer-enhanced surgical robotic system for endoscopic coronary artery bypass grafting on the beating heart.
The aim of the study was to perform endoscopic coronary artery bypass grafting on the beating heart using a surgical robotic system. In the study, the surgical system ZEUS was used in combination with 3D visualization for endoscopic coronary artery bypass grafting in 25 patients. ⋯ All patients had an uneventful angiographic control result. An endoscopic coronary artery anastomosis is possible on the arrested as well as on the beating heart.
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Thorac Cardiovasc Surg · Aug 2000
Case ReportsBilobectomy and amphotericin B in a case of endobronchial mucormycosis.
Lung mucormycosis is a rare fungal infection that has been described mainly in oncologic and diabetic patients. We here report the case of an endobronchial lesion caused by this fungus in an immunocompetent person. Prompt diagnosis, and therapy with Amphotericin B and surgery, permitted the complete resolution.
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Thorac Cardiovasc Surg · Aug 2000
Complete transposition of the great arteries: surgical concepts for patients with systemic right ventricular failure following intraatrial repair.
One of the most serious late complications of the intraatrial baffle procedure (Mustard or Senning correction) in patients suffering from transposition of the great arteries, (TGA) is the late systemic right ventricular failure. Nearly all patients presenting with right ventricular dysfunction have severe associated tricuspid regurgitation. The surgical options for these patients include tricuspid valve reconstruction or replacement, staged conversion to the arterial switch operation and orthotopic heart transplantation. ⋯ Tricuspid valve repair or replacement do not improve right ventricular function in patients with a failing right ventricle following the Mustard/Senning operation. Staged conversion to arterial switch may improve right ventricular function by decreasing the work load of the right ventricle and provides anatomic repair with left ventricle-to-aorta continuity. Orthotopic heart transplantation is the only alternative if the left ventricle does not respond to pulmonary artery banding.