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
Tumor necrosis factor-α -863 C/A promoter polymorphism affects the inflammatory response after cardiac surgery.
Cardiac surgery using cardiopulmonary bypass (CPB) initiates an inflammatory response that shows a wide inter-individual range and determines postoperative morbidity. Previous research suggests that genetic diversity contributes to individual susceptibility to perioperative trauma and stress. Nevertheless, the genetic triggering of the tumor necrosis factor-alpha (TNF-α) release remains unclear. We tested two genetic single-nucleotide polymorphisms (SNPs) from the promoter region of the TNF-α gene for associations with perioperative TNF-α level after CPB. ⋯ The current study suggests that the major -863 CC variant determines elevated TNF-α level preoperatively and throughout the postoperative course after CPB.
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Eur J Cardiothorac Surg · Jul 2011
Case ReportsSpontaneous expectoration of an obstructive fibrinous tracheal pseudomembrane after tracheal intubation.
We report a rare and potentially life-threatening complication related to tracheal intubation in the formation of obstructive tracheal pseudomembrane. In the present case, the pseudomembrane was spontaneously expectorated; this is very unusual and not been reported before. This condition was first misdiagnosed as edema subglottis. ⋯ Control at 1 and again 3 months later showed no further tracheal stenosis. The diagnosis of obstructive tracheal pseudomembrane should be considered in cases of post-extubation stridor. Flexible bronchoscopic guidance after extubation may allow to diagnose such a complication earlier, but rigid bronchoscopy remains the treatment of choice.
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Eur J Cardiothorac Surg · Jul 2011
Comparative StudyEffect of cutting technique at the intersegmental plane during segmentectomy on expansion of the preserved segment: comparison between staplers and scissors in ex vivo pig lung.
Cutting the intersegmental plane by using a stapler during segmentectomy might interfere with the expansion of the preserved lung due to visceral pleura caught in a staple line, especially in a large regional segmentectomy, such as left upper division or basal segmentectomy. We compared the preserved lung volume after segmentectomy among the methods using stapler, sharp dissection, and their combination for cutting the intersegmental plane in ex vivo pig lungs. We also examined a covering effect of polyglycolic acid mesh and fibrin glue. ⋯ Coverage with polyglycolic acid mesh and fibrin glue prevented air leakage from the opened intersegmental plane. The stapler interferes with the expansion of preserved lung in comparison to scissors or combined methods in a large regional segmentectomy.
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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
Cardiac surgery and hematologic malignancies: a retrospective single-center analysis of 56 consecutive patients.
Patients with a history of hematologic malignancies (HMs) are considered high-risk candidates for cardiac surgery. Increased perioperative rates of infections, thrombo-embolic complications, and bleeding disorders are reported. However, low patient numbers and lack of control groups limit all published studies. ⋯ Cardiac surgery in patients with a history of a malignant hematologic disorder might achieve acceptable results. However, a higher complication and mortality rate have to be anticipated. Patients with hematologic disorders and a history of either irradiation or chemotherapy appear to be at an increased risk to develop postoperative end-organ failure.