European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 2009
Multicenter StudySubaortic obstruction in univentricular heart: results using the double barrel Damus-Kaye Stansel operation.
We review our experience with relief of subaortic obstruction in univentricular hearts following pulmonary artery banding (PAB) with double barrel Damus-Kaye Stansel procedure (DKS) and subsequent staged palliation to Fontan. The purpose was to determine if PAB alters semilunar valve function after the double barrel DKS procedure and if this staged approach negatively influences the achievement of Fontan palliation. ⋯ PAB (+/-coarctation repair) with interval double barrel DKS is effective palliation for univentricular heart and excessive pulmonary blood flow. PAB does not create significant pulmonary insufficiency and subsequent DKS effectively relieves single ventricle to aortic gradient. Optimal second stage pulmonary blood flow is usually established with a bidirectional Glenn. The need for a Blalock shunt or a Glenn plus a Blalock is associated with increased mortality.
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Eur J Cardiothorac Surg · Jan 2009
Comparative StudyRelative value of pressures and volumes in assessing fluid responsiveness after valvular and coronary artery surgery.
Cardiac function may differ after valvular (VS) and coronary artery (CAS) surgery and this may affect assessment of fluid responsiveness. The aim of the study was to compare VS and CAS in the value of cardiac filling pressures and volumes herein. ⋯ While volumes are equally useful in monitoring fluid responsiveness, the predictive and monitoring value of PAOP is greater after VS than after CAS. In contrast, the CVP is of similar value as volume measurements in monitoring fluid responsiveness after CAS. The different value of pressures rather than of volumes between surgery types is likely caused by systolic left ventricular dysfunction in VS. The study suggests an effect of systolic cardiac function on optimal parameters of fluid responsiveness and superiority of the pulmonary artery catheter over transpulmonary dilution, for haemodynamic monitoring of VS patients.
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Eur J Cardiothorac Surg · Jan 2009
Randomized Controlled Trial Comparative StudyA method to distinguish between gaseous and solid cerebral emboli in patients with prosthetic heart valves.
The difficulty of distinguishing solid from air emboli using transcranial Doppler has limited its use in situations where both types of emboli can occur, such as in mechanical heart valve patients. To make transcranial Doppler clinically useful, a method must be found to distinguish benign air bubbles from the more damaging solid particulates. Since inhalation of 100% oxygen reduces the amount of air bubbles in mechanical heart valve patients, the ultrasonic features of the remaining emboli would be characteristic of solid particulates. ⋯ The use of a signal intensity cut-off offers adequate discrimination of the embolic composition in mechanical heart valve patients. Future studies evaluating prophylactic treatments of thrombosis in these patients should assess the predictive value of this intensity threshold and their potential association with outcome indicators and procoagulant markers.
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Eur J Cardiothorac Surg · Jan 2009
Randomized Controlled Trial Comparative StudyComparison of the single or double chest tube applications after pulmonary lobectomies.
Draining of the chest cavity with two chest tubes after pulmonary lobectomy is a common practice. This study aimed to investigate whether using two tubes after a pulmonary lobectomy is more effective than using a single tube. ⋯ Insertion of two chest tubes is not more effective than the insertion of a single chest tube after pulmonary lobectomy. Moreover, using a single tube is in fact more effective than using two tubes in that it causes less postoperative pain and less pleural fluid loss.
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Eur J Cardiothorac Surg · Jan 2009
Randomized Controlled TrialPresence of coronary collaterals is associated with a decreased incidence of cognitive decline after coronary artery bypass surgery.
Coronary artery bypass grafting (CABG) is associated with significant cerebral morbidity, usually manifested as cognitive decline or stroke. The underlying mechanism leading to cognitive decline is still unclear. Presence of coronary collateral arteries, which may reflect an overall better cardiovascular condition, recently appeared to relate to a better cardiac outcome after CABG. In this study, we investigated the hypothesis that presence of coronary collaterals is associated with less cognitive decline after coronary artery bypass grafting. ⋯ In patients undergoing first-time coronary artery bypass grafting, presence of coronary collaterals is associated with a decreased risk of cognitive decline at both 3 and 12 months of follow-up. This trend persists at 5-year follow-up. Preoperative differences in the cardiac vascular condition may therefore predict cognitive outcome in patients undergoing coronary artery bypass grafting.