European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · May 2011
Randomized Controlled TrialThe myocardial protective effects of adenosine pretreatment in children undergoing cardiac surgery: a randomized controlled clinical trial.
Adenosine pretreatment reduces injury caused by ischemia-reperfusion. To investigate the hypothesis that adenosine pretreatment would modulate injury induced by cardiopulmonary bypass (CPB) and myocardial ischemia/reperfusion, we conducted a randomized controlled trial on the effects of adenosine pretreatment in children undergoing surgery to repair congenital heart defects. ⋯ This study demonstrates that adenosine pretreatment is protective of the myocardium during open-heart surgery in pediatric patients.
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Eur J Cardiothorac Surg · May 2011
Value of the average basal daily walked distance measured using a pedometer to predict maximum oxygen consumption per minute in patients undergoing lung resection.
Maximum oxygen consumption per min (VO(₂max)) is currently considered the most accurate test for the preoperative risk assessment in patients scheduled for pulmonary resection. Due to its high-technology requirements and cost, VO(₂max) is performed less frequently than is desired. The objective of this investigation is to determine if the measurement of the basal daily ambulatory activity of the patients, with a pedometer, can be used to predict VO(₂max) values. ⋯ These preliminary data show that a combination of the measured daily ambulatory activity using a pedometer, especially the mean daily walked distance in km, and the DLCO% of the patient could predict the VO(₂max) value. Larger data series are needed for conclusive results.
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Eur J Cardiothorac Surg · May 2011
High-dose tranexamic acid is related to increased risk of generalized seizures after aortic valve replacement.
To investigate the incidence of postoperative generalized seizures in patients undergoing aortic valve replacement (AVR) under extracorporeal circulation, who received either high-dose tranexamic acid (TXA) or epsilon aminocaproic acid (EACA) as an antifibrinolytic agent. ⋯ Our results indicate that high-dose TXA is associated with an increased incidence of postoperative generalized seizures in patients undergoing AVR compared with EACA, especially when suffering from renal impairment. A possible association between recombinant activated factor VIIa and the occurrence of postoperative seizures needs further investigation.
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Eur J Cardiothorac Surg · May 2011
Failure of noninvasive ventilation after lung surgery: a comprehensive analysis of incidence and possible risk factors.
Noninvasive ventilation has been successfully used after thoracic surgery. However, noninvasive ventilation fails in about 20% of patients. The aim of the study was to analyze episodes of noninvasive ventilation failure and to assess possible risk factors, while taking into account the performance of fiberoptic bronchoscopy for secretion management. ⋯ Noninvasive ventilation failure is associated with higher mortality, but is merely a marker of progression of a more severe disease. This may at least indicate the need for caution in some patients. Interestingly, increased use of fiberoptic bronchoscopies during noninvasive ventilation appliance was identified as a risk factor of failure.
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Eur J Cardiothorac Surg · May 2011
Case ReportsExtracorporeal membrane oxygenation as a bridge to lung transplantation in a patient with persistent severe porto-pulmonary arterial hypertension following liver transplantation.
Idiopathic pulmonary artery hypertension (IPAH) is a progressive disease with a dismal prognosis and lung transplantation is often the only option for patients, who do not respond to pharmacological therapy. We report the use of an extracorporeal membrane oxygenation (ECMO) system in a 49-year-old woman with primary pulmonary hypertension, previously liver transplanted. The patient, listed for lung transplantation, developed respiratory and circulatory failure despite maximal pharmacological therapy and was successfully bridged to emergent bilateral lung transplantation with veno-arterial ECMO. Emergent veno-arterial ECMO was able to rescue the patient and bridge her to bilateral lung transplantation and should therefore be an option for patients with PAH and circulatory collapse.