European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Mar 2013
The long-term effects of developing renal failure post-coronary artery bypass surgery, in patients with normal preoperative renal function.
Renal failure post-cardiac surgery is associated with an increased in hospital morbidity and mortality. We investigated the effect of new onset renal risk, injury or failure [risk, injury, failure, loss and end-stage kidney disease (RIFLE)] post-coronary artery bypass graft (CABG) on long-term survival, in patients with normal preoperative renal function. ⋯ Despite being a biochemically reversible process, the development of renal risk, injury and failure as defined by the RIFLE criteria post-cardiac surgery in patients with a normal preoperative renal function is associated with a significantly worse long-term outcome.
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Eur J Cardiothorac Surg · Mar 2013
Cardioprotection with esmolol cardioplegia: efficacy as a blood-based solution.
Current cardiac surgery patients are older, sicker, with more diffuse disease and hence a reduced tolerance to ischaemia-reperfusion injury. We previously demonstrated that esmolol, an ultra-short-acting β-blocker, can be used as an arresting agent at high (millimolar) concentrations, and that a crystalloid-based esmolol cardioplegia afforded cardioprotection at least equivalent to hyperkalaemic (St Thomas' Hospital) cardioplegia. Esmolol is rapidly metabolized by blood esterases, so it was important to determine the feasibility of its use in blood-based solutions. This study compared the efficacy of blood-based esmolol cardioplegia with hyperkalaemic cardioplegia in a novel blood-perfused rat heart preparation. ⋯ Blood-based esmolol cardioplegia improved cardioprotective efficacy compared with hyperkalaemic cardioplegia; the metabolic effects of blood esterase did not appear to influence this efficacy. An esmolol-based cardioplegic solution may be a beneficial alternative to hyperkalaemic solutions.
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Eur J Cardiothorac Surg · Mar 2013
Comparative Study Clinical TrialSurgical treatment of left main disease and severe carotid stenosis: does the off-pump technique provide a better outcome?
Left main disease (LMD), combined with carotid artery stenosis (CAS), constitutes a high-risk patient population. Priority is often given to coronary revascularization, due to the severity of the angina. However, the choice of revascularization strategy [off-pump coronary artery bypass (OPCAB) vs coronary artery bypass grafting (CABG)] remains elusive. ⋯ Off-pump coronary revascularization may offer risk reduction of neurological complications in patients with a significant carotid artery disease and a history of previous stroke, but a larger study population is needed to support this thesis. The growing discrepancy in long-term survival should draw attention to a more complete revascularization in OPCAB patients.
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Eur J Cardiothorac Surg · Mar 2013
Impact of the maze procedure and postoperative atrial fibrillation on progression of functional tricuspid regurgitation in patients undergoing degenerative mitral repair.
The aim of this study is to investigate the factors contributing to the progression of functional tricuspid regurgitation (TR) after mitral repair for degenerative mitral regurgitation (MR) in relation to pre and postoperative atrial fibrillation (AF) and performance of the maze procedure. ⋯ Preoperative AF without the maze procedure and postoperative AF can contribute to the development of moderate or greater functional TR after mitral repair for degenerative MR.
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Eur J Cardiothorac Surg · Mar 2013
Impact of preoperative atrial fibrillation on mortality and cardiovascular outcomes of mechanical mitral valve replacement for rheumatic mitral valve disease.
The prognostic significance of preoperative atrial fibrillation on mitral valve replacement remains unclear. The aim of this study was to explore the effects of the presence of preoperative atrial fibrillation on mortality and cardiovascular outcomes of mitral valve replacement for rheumatic valve disease. ⋯ Preoperative atrial fibrillation is a risk factor for long-term mortality, thromboembolism complications and tricuspid regurgitation, and it also has an adverse effect on the degree of improvement when considering left ventricular function.