European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Sep 2012
Comparative StudyAge and neo-adjuvant chemotherapy increase the risk of atrial fibrillation following oesophagectomy.
Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic strategies. ⋯ Despite the identification of age and neo-adjuvant chemotherapy as predictors of AF, the moderate discriminative ability of predictive modelling does not support the use of prophylactic anti-arrhythmic drugs. However, the high incidence of AF after major thoracic surgery makes it necessary to understand its underlying mechanisms better before prophylactic strategies are considered.
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Eur J Cardiothorac Surg · Sep 2012
Comparative StudyLungs from donation after circulatory death donors: an alternative source to brain-dead donors? Midterm results at a single institution.
Donor organ shortage remains to be the major limitation in lung transplantation, and donation after circulatory death (DCD) might represent one way to alleviate this problem. DCD was introduced to our institution in 2007 and has been a part of our clinical routine since then. Here, we present the mid-term results of lung transplantation from DCD in a single institution and compare the outcomes with the lung recipient cohort receiving lungs from donation after brain death (DBD). ⋯ Medium-term results after lung transplantation with organs procured after circulatory death are comparable with those obtained after standard lung transplantation. Therefore, DCD could be used to significantly increase the donor pool.
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Eur J Cardiothorac Surg · Sep 2012
Comparative StudyLong-term results and mid-term features of left ventricular reconstruction procedures on left ventricular volume, geometry, function and mitral regurgitation.
We retrospectively analysed the long-term results and mid-term features of the surgical procedures on left ventricular (LV) volume, geometry, function and mitral regurgitation (MR) in patients with ischaemic cardiomyopathy (antero-septal dominant) who underwent LV reconstruction (LVR). ⋯ Despite the more spherical LV change, LVR led to a significant volume reduction (45%), still maintaining its physiological shape that confirmed an improved LV function and better long-term results. The Dor procedure could significantly reduce the larger LV volume without losing the end-systolic elliptical shape and mitral valvular competence like other techniques without the Fontan stitch.
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Eur J Cardiothorac Surg · Sep 2012
Comparative StudyImpact of previous cardiac operations on patients undergoing transapical aortic valve implantation: results from the Italian Registry of Transapical Aortic Valve Implantation.
Redo cardiac surgery has an increased risk of morbidity and mortality when compared with the initial operation. The aim of this study was to assess the impact of previous cardiac operations on patients undergoing transapical aortic valve implantation (TA-TAVI). ⋯ According to our data, patients undergoing TAVI with previous cardiac operations have a higher preoperative risk profile but have similar outcomes when compared with patients undergoing a first operation. In these subset of patients, TAVI is a promising therapeutic option.
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Eur J Cardiothorac Surg · Sep 2012
Comparative StudyIschaemic postconditioning: does cardioplegia influence protection?
Ischaemic postconditioning attenuates reperfusion injury and may be a useful adjunct to cardiac surgery. We examined the efficacy of postconditioning following ischaemic protection with cardioplegic arrest and the importance of index ischaemia and cardioplegia formulation. ⋯ We conclude that postconditioning does not enhance the protective effect of St Thomas' Hospital cardioplegia (under these strict experimental conditions); however, the efficacy of postconditioning correlates with the magnesium concentration of the cardioplegic solution, which may imply involvement of magnesium on mitochondria during ischaemia. There is a limited window of postconditioning protection dependent on the duration of the index ischaemia.