European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Dec 2008
Multicenter Study Comparative StudySAPS 3 at dialysis commencement is predictive of hospital mortality in patients supported by extracorporeal membrane oxygenation and acute dialysis.
This study examined the association between hospital mortality and five illness-severity scoring systems evaluated at different time points in the intensive care unit (ICU) as well as clinical variables as predictors in critically ill patients supported by extracorporeal membrane oxygenation (ECMO) and acute dialysis. ⋯ Among five common ICU scoring systems evaluated at different time points, SAPS 3 at dialysis commencement is the best risk adjustment systems to predict hospital mortality in critically ill patients supported by ECMO and acute dialysis. Furthermore, the SAPS 3 score at dialysis commencement and IABP usage before ECMO are two major independent predictors for hospital mortality in patients supported by ECMO and acute dialysis.
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Eur J Cardiothorac Surg · Dec 2008
Real-time adjustment of ventricular restraint therapy in heart failure.
Current ventricular restraint devices do not allow for either the measurement or adjustment of ventricular restraint level. Periodic adjustment of restraint level post-device implantation may improve therapeutic efficacy. We evaluated the feasibility of an adjustable quantitative ventricular restraint (QVR) technique utilizing a fluid-filled polyurethane epicardial balloon to measure and adjust restraint level post-implantation guided by physiologic parameters. ⋯ QVR permits real-time measurement and physiologic adjustment of ventricular restraint therapy after device implantation.
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Eur J Cardiothorac Surg · Dec 2008
Comparative StudyReduced pulmonary inflammatory response during cardiopulmonary bypass: effects of combined pulmonary perfusion and carbon monoxide inhalation.
Pulmonary inflammation induced by cardiopulmonary bypass (CPB) is one of the main causes for lung injury after cardiac surgery. Pulmonary perfusions as well as carbon monoxide (CO) inhalation are known to reduce the inflammatory reaction of the lung. We hypothesized that a combination of pulmonary perfusion and carbon monoxide inhalation leads to an even stronger reduction of the lung inflammation. ⋯ The combination of pulmonary perfusion and inhalative carbon monoxide inhibits CPB-mediated pulmonary inflammation as well as pulmonary apoptosis stronger than pulmonary perfusion or carbon monoxide alone.
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Eur J Cardiothorac Surg · Dec 2008
Comparative StudySurgical treatment of benign neurogenic tumours of the mediastinum: a single institution report.
Neurogenic tumours of the mediastinum are uncommon neoplasms arising from nerve tissues within the thorax. We sought to evaluate and compare the outcome following surgical resection of such tumours by VATS, open thoracotomy, and by either combined with hemilaminectomy. ⋯ VATS represents the gold standard for the treatment of benign neurogenic tumours of the mediastinum with better results in terms of morbidity, operative time, postoperative stay and postoperative pain compared to open approach. Dumbbell tumours require a combined thoracic and neurosurgical approach.
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Eur J Cardiothorac Surg · Dec 2008
Comparative StudyNear infrared spectroscopy for controlling the quality of distal leg perfusion in remote access cardiopulmonary bypass.
The prevention of leg ischemia is necessary in all patients undergoing femoral artery cannulation for extracorporeal circulation. Near infrared spectroscopy (NIRS) is an established non-invasive method for measuring tissue oxygen saturation. Ten patients underwent robotically assisted endoscopic coronary surgery or ASD repair on the arrested heart using aortic endo-occlusion catheters. ⋯ During clamping of the femoral artery for installation of the remote access perfusion system the tissue oxygen saturation dropped to 38 (18-58) (p=0.001 vs baseline) while it remained stable on the contralateral leg. After successful implantation of the distal leg perfusion the NIRS values normalized to similar amounts on both legs. We conclude that transcutaneous NIRS of the lower legs might be a useful non-invasive tool for monitoring leg perfusion in patients undergoing extracorporeal circulation via the femoral vessels.