European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2011
Is off-pump superior to conventional coronary artery bypass grafting in diabetic patients with multivessel disease?
Diabetic patients often present with diffuse coronary disease than nondiabetic patients posing a greater surgical challenge during off-pump revascularization. In this study, the safety, feasibility, and completeness of revascularization for this subset of patients was assessed. ⋯ OPCAB offers a lower mortality and superior postoperative outcomes in diabetic patients with multivessel disease. Arterial grafts are used more frequently that may contribute to better long-term outcomes and the OPCAB approach does not come at the cost of less complete revascularization.
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Eur J Cardiothorac Surg · Jul 2011
Meta AnalysisGlucose-insulin-potassium therapy in adult patients undergoing cardiac surgery: a meta-analysis.
Glucose-insulin-potassium (GIK) has long been used as adjuvant treatment for patients with serious cardiovascular disease. Although many studies have reported their results based on GIK therapy in the setting of heart surgery, the outcomes remain controversial and inconclusive. The aim of this meta-analysis of randomized controlled trials (RCTs) was to determine the clinical effects of GIK in adult cardiac surgery patients. ⋯ Further analysis showed that diabetic patients were benefited from GIK with glycemic control, but not GIK infusion without glucose control. GIK significantly reduced myocardial injury and improved hemodynamic performance in patients undergoing cardiac surgery. Glycemic control with GIK might be required for cardiac surgery patients with diabetes.
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Eur J Cardiothorac Surg · Jul 2011
Randomized Controlled Trial Comparative StudyRandomized double-blind comparison of phrenic nerve infiltration and suprascapular nerve block for ipsilateral shoulder pain after thoracic surgery.
Despite the use of thoracic epidural analgesia, a constant severe ache occurs in the ipsilateral shoulder of almost 75% of patients after thoracotomy. The aim of this prospective-randomized study was to investigate the effect of phrenic nerve infiltration (PNI) compared with suprascapular nerve block (SNB) on ipsilateral shoulder pain after thoracic surgery. ⋯ Phrenic nerve block with 2% lidocaine should be performed in all patients undergoing a major thoracic surgery procedure. These results strongly support the hypothesis that irritation of the pericardium and/or mediastinal-diaphragmatic pleural surfaces results in pain that is referred to the shoulder via the phrenic nerve.
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Eur J Cardiothorac Surg · Jul 2011
Randomized Controlled TrialDeep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery--a randomised controlled trial.
In addition to early mobilisation, a variety of breathing exercises are used to prevent postoperative pulmonary complications after cardiac surgery. The optimal duration of the treatment is not well evaluated. The aim of this study was to determine the effect of 30 versus 10 deep breaths hourly, while awake, with positive expiratory pressure on oxygenation and pulmonary function the first days after cardiac surgery. ⋯ A significantly increased oxygenation was found in patients performing 30 deep breaths the first two postoperative days compared with control patients performing 10 deep breaths hourly. These results support the implementation of a higher rate of deep breathing exercises in the initial phase after cardiac surgery.
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Eur J Cardiothorac Surg · Jul 2011
ReviewPersistent sensitivity disorders at the radial artery and saphenous vein graft harvest sites: a neglected side effect of coronary artery bypass grafting procedures.
The use of radial artery conduits in coronary artery bypass grafting (CABG) surgery is associated with improved long-term patency and patient survival rates as compared with saphenous vein conduits. Despite increasing popularity, relative incidence of local harvest-site complications and subjective perception of adverse long-term sequelae remain poorly described. ⋯ Persistent harvest-site discomfort occurs with astonishing frequency after CABG surgery and affects arms and legs equally. Although usually considered a minor complication, long-term limitation to quality of life may be substantial, particularly in younger and relatively healthy patients. Thus, harvest-site discomfort clearly belongs to the list of possible post-CABG complications of which patients need to be aware.