European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 1998
Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions.
The validity of video-assisted thoracoscopic pericardial fenestration was prospectively assessed for loculated effusions. effusions previously treated by percutaneous catheter manoeuvres and those with concurrent pleural diseases. ⋯ Video-assisted thoracoscopic pericardial fenestration is safe and effective for loculated pericardial effusions previously treated by percutaneous drainage manoeuvres and those with concomitant pleural disease.
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Eur J Cardiothorac Surg · Oct 1998
Randomized Controlled Trial Comparative Study Clinical TrialAprotinin counterbalances an increased risk of peri-operative hemorrhage in CABG patients pre-treated with Aspirin.
As Aspirin (ASA) has proven efficacy in preventing patients with CAD from complications related to cardiovascular diseases, most patients scheduled for CABG are treated with ASA therapy. Consequently, impaired hemostasis is a problem in the management of CABG patients. Clinical studies have shown that Aprotinin can reduce bleeding and the use of blood products by 50% in patients both with and without pre-operative ASA therapy. Concerning the combined effect of peri-operative low-dose ASA therapy and intra-operative high-dose Aprotinin therapy, the gathering of additional and prospective data seemed to be necessary. ⋯ A reduction in post-operative blood loss in primary elective CABG surgery with intra-operative Aprotinin treatment could be confirmed. A low-dose ASA treatment combined with a high-dose aprotinin administration during surgery not only neutralized a potentially higher risk of bleeding, but did in fact reduce the post-operative blood loss. The protective effect of ASA on peri-operative MI has been evident through a reduction of MI rate in ASA treated patients.
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During a consecutive 12-month period from January 1996 to January 1997 inclusive, 108 aortic valve replacements were performed by one group of surgeons in two community hospitals The majority of the valve replacements were done in combination with other procedures or were redo surgeries. Thirty-one patients had primary isolated aortic valve replacement. Fourteen patients underwent aortic valve replacement via a standard sternotomy, and seventeen patients underwent aortic valve replacement using a minimally invasive parasternal approach, as described by Dr. ⋯ In the follow-up which ranges from 4-15 months, all patients in the minimally invasive group were New York Heart Class I or II. Patients with the parasternal incisions are permitted to return to work much earlier than those with a standard sternotomy incision. The decreased blood loss and postoperative pain, combined with the anticipated ease of re-entry via a median sternotomy in the future (should redo aortic valve replacement become necessary), make this approach our procedure of choice in isolated primary aortic valve replacement.
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Eur J Cardiothorac Surg · Oct 1998
Does the extended use of arterial grafts compromise the myocardial recovery after coronary artery bypass grafting in left ventricular dysfunction?
To assess the prognostic factors of myocardial recovery expected after coronary bypass surgery and the impact of surgical technique used, a prospective non-randomized study including a 1-year postoperative evaluation of left ventricular function was performed in patients with left ventricular dysfunction (left ventricular ejection fraction (LVEF) < 0.40). ⋯ This study confirms the excellent clinical results of coronary artery bypass grafting (CABG) in patients with coronary artery disease and LV dysfunction; improvement in LV function can be documented objectively and is correlated with reperfusion of hibernating myocardium. However, the extended use of arterial grafts does not allow to achieve the significant myocardial recovery observed with the use of one internal mammary artery (IMA) and associated sequential vein graft; it seems to be related to the preoperative selection of patients, but a direct negative impact of arterial grafts was documented and leads to be cautious in patients with severe LV dysfunction.
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Eur J Cardiothorac Surg · Oct 1998
Is the femoral cannulation for minimally invasive aortic valve replacement necessary?
Minimally invasive cardiac surgery through a small transverse sternotomy is a new promising technique that can be considered an alternative in most cases to aortic valve replacement thus reducing surgical trauma and subsequent time of hospitalization. The need to avoid the risks associated with femoro-femoral bypass has lead to the interest in aortic valve replacement (AVR) operations without femoral vessels cannulation. We want to emphasize a few important points of our technique, which differs somewhat from the one applied by Cosgrove and associates. ⋯ Minimally invasive AVR surgery without femoral vessel cannulation is a safe procedure with less surgical aggression. After a learning curve, benefits on fast-track programs will be accomplished.