European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Nov 2008
Randomized Controlled Trial Comparative StudyMyocardial oxidative stress, and cell injury comparing three different techniques for coronary artery bypass grafting.
Oxidative stress as a result of reperfusion injury is a known causative factor of cardiac muscle injury. In the peripheral blood as well in the coronary sinus, oxidative stress parameters and cardiac biomarkers were measured to investigate the different levels of oxidative stress during three different CABG techniques; MCABG (with minimal prime volume and warm blood cardioplegia) that was newly introduced in our hospital, versus OPCAB, versus our current standard, conventional CABG (CCABG, consisting of high volume prime and cold crystalloid cardioplegia). Concomitantly, cardiac biomarkers were measured to detect myocardial cell injury. ⋯ In this study coronary sinus blood levels of oxidative stress parameters were consistently higher compared to peripheral blood levels. The levels were lowest in the MCABG study group. In this group also the lowest levels cardiac biomarkers of myocardial injury were found.
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Eur J Cardiothorac Surg · Nov 2008
Randomized Controlled TrialCognitive outcomes in elderly high-risk patients 1 year after off-pump versus on-pump coronary artery bypass grafting. A randomized trial.
Age is considered to be the strongest predictive factor of postoperative cognitive dysfunction (POCD) after cardiac surgery. Coronary artery bypass grafting (CABG) without the use of cardiopulmonary bypass is considered to be less harmful to the patient, especially in terms of neurological complications. ⋯ We were unable to detect that CABG surgery without cardiopulmonary bypass was associated with significantly better cognitive outcome in elderly high-risk patients 1 year after the operation.
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Eur J Cardiothorac Surg · Nov 2008
Identifying methods to improve heart surgery: an operative approach and strategy for implementation on an organizational level.
Previous research has found teamwork failures to be strongly associated with the occurrence of surgical error. There have been few efforts to prospectively collect data regarding teamwork failures and technical errors in order to create interventions that would maximize teamwork effectiveness thereby minimizing technical error. ⋯ These results indicate that the process of cardiac surgery would benefit from interventions to improve teamwork and communication. Such interventions could include preoperative briefings, revised approach to structuring of operative teams to favor members that have gained familiarity with the operating surgeon, standardized communication practices, and postoperative debriefings.
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Eur J Cardiothorac Surg · Nov 2008
Case ReportsRupture of the left atrial 'basal' appendage due to blunt trauma in an elderly patient.
Blunt traumatic cardiac rupture is associated with a high mortality rate. Motor vehicle accidents account for most cardiac ruptures, but crush injury is relatively rare. We describe a case of a 77-year-old man who had the left atrial 'basal' appendage ruptured through blunt trauma due to a fall. He was surgically treated and recovered without complication.
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Eur J Cardiothorac Surg · Nov 2008
Multicenter Study Comparative StudyHydrodynamic comparison of biological prostheses during progressive valve calcification in a simulated exercise situation. An in vitro study.
Despite continuous development of anticalcification treatment for biological valve prostheses, calcification remains one major cause of structural failure. The following study investigates hemodynamics and changes in opening and closing kinematics in progressively calcified porcine and pericardial valves in a simulated exercise situation. ⋯ In the exercise situation pericardial valves demonstrated superior systolic function compared to porcine valves. Therefore pericardial valves have some advantage in active patients due to the lower gradients. Total energy loss remained constant during progressive calcification for both valves. Leaflet opening and closing is faster in porcine valves; clinical impact of these findings is not known. Diastolic performance is also important and should always be tested also in vivo.