European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Nov 2005
Randomized Controlled TrialMinimal versus conventional cardiopulmonary bypass: assessment of intraoperative myocardial damage in coronary bypass surgery.
Minimal extracorporeal circulation (mini-ECC) is a new technology, consisting of a centrifugal pump, an oxygenator, and a modified suction system. The main advantage of mini-ECC is the reduction of tubing length (reduction of the priming volume). Additional beneficial effects are a decrease of coagulation cascade and a reduction of blood transfusion in patients undergoing coronary artery bypass grafting (CABG) surgery. We compared the intraoperative and early postoperative myocardial damage and outcome of patients who underwent CABG surgery with conventional cardiopulmonary bypass (CPB) or mini-ECC. ⋯ Mini-ECC is a safe procedure and is followed by a diminished release of CK-MB and cTnI than after CPB. Postoperative recovery is accelerated following mini-ECC and there is a significantly lower incidence of postoperative atrial fibrillation.
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Vasoplegic syndrome is a recognized complication following cardiac surgery using cardiopulmonary bypass and is associated with increased morbidity and mortality. In several patients profound post-operative vasodilatation does not respond to conventional vasoconstrictor therapy. Methylene blue has been advocated as an adjunct to conventional vasoconstrictors in such situations. ⋯ However, dosing regimens and protocols need to be clearly defined before widespread routine use. Whether methylene blue should be the first line of therapy in patients with vasoplegia is a matter of debate, and there is inadequate evidence to support its use as a first line drug. More scientific evidence is needed to define the role of MB in the treatment of catecholamine refractory vasoplegia.
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Eur J Cardiothorac Surg · Nov 2005
ReviewRepair of persistent truncus arteriosus with interrupted aortic arch.
The aim of our study was to analyse experience with repair of truncus arteriosus with interrupted aortic arch. ⋯ Primary repair of persistent truncus arteriosus with interrupted aortic arch can be done with low mortality and good mid-term results. Aortic arch reconstruction in isolated low-flow perfusion of the head and the heart influences favourably the postoperative recovery. The main postoperative problems are associated with conduit obstruction and aortic insufficiency.
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Eur J Cardiothorac Surg · Nov 2005
Thoracoscopic collagen pleurodesis in the treatment of malignant pleural effusions.
Pleurodesis is of a potential benefit in pleural carcinomatosis and symptomatic malignant effusions, but the best way of achieving this is still uncertain. The aim of this prospective study was to analyse the results of pleurodesis after intra-pleural thoracoscopic administration of collagen powder. ⋯ Thoracoscopic collagen pleurodesis is a simple and effective method of treatment of malignant pleural effusions.
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Eur J Cardiothorac Surg · Nov 2005
Changes in pulmonary function test and cardio-pulmonary exercise capacity in COPD patients after lobar pulmonary resection.
Pulmonary Function Tests (PFT) and Cardio-Pulmonary Exercise Testing (C-PET) are useful to evaluate operability in functionally compromised patients. Although modifications of PFT and C-PET after lung surgery have been widely explored, little information exists as to modifications of exercise capacity in COPD patients undergoing lung resection. We prospectively analyzed the changes in PFT and C-PET in patients with COPD after a pulmonary lobar resection. ⋯ Three months after a lobar pulmonary resection, patients with COPD were found to have a significant decrease in exercise tolerance. PFT alone can underestimate the postoperative loss of exercise capacity through exercise.