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 2008
Randomized Controlled TrialHuman adaptation to ischemia by preconditioning or unstable angina: involvement of nuclear factor kappa B, but not hypoxia-inducible factor 1 alpha in the heart.
Ischemic preconditioning reduces infarct size and improves hemodynamic function. Unstable angina may be a clinical analogue to ischemic preconditioning, and involve activation of gene programs. We hypothesized that preceding unstable angina and/or ischemic preconditioning activated genes regulated by nuclear factor kappa B (NFkappaB) or hypoxia-inducible factor 1 alpha in parallel to improved cardiac function. ⋯ Cardiac function was improved by ischemic preconditioning in both stable and unstable patients. Unstable angina per se had no effect. NFkappaB-regulated genes were influenced by ischemic preconditioning, but hypoxia-inducible genes were not.
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Eur J Cardiothorac Surg · Nov 2008
Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery.
Previous studies have been unable to identify independent valve-related risk factors for postoperative respiratory failure (RF) in patients undergoing valve surgery. This study was designed to determine the incidence and predictors of RF in these patients. We also aimed to create a model based on these risk factors that could serve as a tool for the prediction of this complication. ⋯ Respiratory failure is a common complication particularly in patients undergoing complex valve operations such as endocarditis or multiple valve procedures. The independent predictors of RF including valve-related factors allowed us to create a predictive model with great accuracy. The poor long-term survival of patients with RF underlines the need to direct more resources towards prevention and treatment of this complication.
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Eur J Cardiothorac Surg · Nov 2008
Review Meta AnalysisIschaemic preconditioning during cardiac surgery: systematic review and meta-analysis of perioperative outcomes in randomised clinical trials.
Numerous small trials have been conducted to confirm the existence of the ischaemic preconditioning (IP) mechanism in the human heart and to clarify whether it can be induced in a clinical situation. The effect on clinical end-points remains unclear. Most of the available trials reported some clinical outcomes. ⋯ These effects persisted when the analyses were restricted to those patients receiving cardioplegia. The effect disappeared when the analyses were restricted to patients receiving ICCF. IP may provide additional myocardial protection over cardioplegia alone, but a large-scale clinical trial may be required to determine the role of IP with any certainty.
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Eur J Cardiothorac Surg · Nov 2008
Efficacy and safety of modified bilateral thoracoscopy-assisted Nuss procedure in adult patients with pectus excavatum.
Several modifications for increasing the efficacy and safety of the minimally invasive surgery (Nuss procedure) for repair of pectus excavatum in pediatric patients were presented. In this study, we apply a modified bilateral thoracoscopic approach to adapt the Nuss procedure to adult patients. ⋯ The modified bilateral thoracoscopy-assisted Nuss repair for adult patients could eliminate the risk of cardiopulmonary injuries. It could allow direct inspections in mediastinum and facilitate mediastinal dissection, especially in patients with recurrence, history of previous thoracic procedure or double-bar insertion. Other methods for ensuring safety such as substernal dissection or elevation may be unnecessary.
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Eur J Cardiothorac Surg · Nov 2008
Influence of ectopic thymic tissue on clinical outcome following extended thymectomy in generalized seropositive nonthymomatous myasthenia gravis.
We determined the effect of detecting ectopic thymic tissue in thymectomy specimens on the long-term outcome of patients with myasthenia gravis. ⋯ The clinical outcome of patients with nonthymomatous seropositive myasthenia gravis is significantly affected by the presence of ectopic thymic tissue in the mediastinal fat.