European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Apr 2010
Review Meta Analysis Comparative StudyWarm versus cold cardioplegia for heart surgery: a meta-analysis.
Much controversy persists regarding the optimal techniques for myocardial protection during heart surgery. Numerous studies have compared warm cardioplegia with cold cardioplegia for myocardial preservation, but the outcomes were inconclusive. The aim of this meta-analysis of randomised controlled trials (RCTs) was to compare the beneficial and harmful effects of warm and cold cardioplegia during heart surgery. ⋯ Warm cardioplegia was associated with improved postoperative cardiac index. CK-MB and cardiac troponin concentrations after surgery were significantly lower in the warm group as compared with the cold group. Using warm cardioplegia for myocardial protection during heart surgery resulted in similar incidences of clinical events, significant improvement in postoperative cardiac index and reduction in postoperative enzyme release as compared with cold cardioplegia.
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Eur J Cardiothorac Surg · Apr 2010
Randomized Controlled TrialA prospective, single-blind randomised study on the effect of intercostal nerve protection on early post-thoracotomy pain relief.
Intracostal suture or intercostal muscle flap can reduce post-thoracotomy pain through the preservation of intercostal nerves below or above the incision. This study aims to test whether combining intracostal suture with intercostal muscle flap might achieve better pain relief than intracostal suture alone. ⋯ The combination of intracostal suture with intercostal muscle flap may not necessarily achieve better post-thoracotomy pain control than using intracostal suture alone.
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Eur J Cardiothorac Surg · Apr 2010
Randomized Controlled TrialOff-pump coronary artery bypass surgery versus standard linear or pulsatile cardiopulmonary bypass: endothelial activation and inflammatory response.
Poor outcomes after coronary artery bypass grafting (CABG) have been linked to perioperative endothelial activation and systemic inflammatory responses. The use of pulsatile cardiopulmonary bypass (PCPB) or off-pump CABG (OPCABG) may minimise these phenomena. We compared biochemical and clinical outcomes among patients who underwent CABG with PCPB, CABG with linear CPB (LCPB) or OPCABG. ⋯ LCPB appears to promote endothelial activation and cytokine secretion, which may delay recovery. OPCABG was associated with slight endothelial activation and cytokine response. PCPB significantly attenuates endothelial/cytokine leakage, resulting in hospital outcomes comparable with those after OPCABG.
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Eur J Cardiothorac Surg · Apr 2010
The modified Ross operation using a Dacron prosthetic vascular jacket does prevent pulmonary autograft dilatation at 4.5-year follow-up.
Following the Ross operation, pulmonary autografts tend to dilate over time. This study researches the fate of the pulmonary autograft - at 4.5 years following the modified Ross operation - with special reference to the impact of the modification on (a) pulmonary autograft dilatation, (b) the neo-aortic root geometry, (c) neo-aortic valve function and (d) the coronary artery reserve. ⋯ Provision of external support to the entire pulmonary autograft with a DVPJ prevents its dilatation following free-standing pulmonary autograft Ross operation when evaluated at the 4.5-year follow-up. The function and the geometry of the neo-aortic root are not affected negatively by this modification and the patients demonstrated normal exercise capacity.