European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Feb 2008
Randomized Controlled TrialEffect of ischemic postconditioning in adult valve replacement.
Ischemic postconditioning (POC) by brief episodes of ischemia performed just at the time of reperfusion can reduce infarct size in animal models and clinical settings of percutaneous coronary intervention. However, the clinical applicability of postconditioning in cardiac surgery remains to be determined. We investigated the effect of postconditioning on myocardial protection in patients undergoing valve replacement. ⋯ The present study demonstrated that postconditioning may protect adult myocardium undergoing cold blood cardioplegic arrest. These data support the need for a further clinical trial of postconditioning in cardiac surgery.
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Eur J Cardiothorac Surg · Feb 2008
Comparative StudyPropensity score analysis of early and late outcome after redo off-pump and on-pump coronary artery bypass grafting.
The purpose of this study was to compare early and late results of redo-CABG with (redo-ONCAB) and without (redo-OPCAB) cardiopulmonary bypass. ⋯ OPCAB is an acceptable strategy in selected patients requiring redo-CABG. Employing a strategy of OPCAB for those patients with 2 or fewer lesions and ONCAB for those with more diffuse disease, redo-OPCAB and redo-ONCAB have similar early and late outcomes.
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Eur J Cardiothorac Surg · Feb 2008
Comparative StudyConventional surgical repair and endovascular treatment of acute traumatic aortic rupture.
Endoluminal aortic stent grafting offers a potentially less invasive alternative to open chest surgery, especially in patients with polytrauma. We compare the results of conventional surgical repair and endovascular treatment of traumatic aortic rupture. ⋯ In the treatment of traumatic thoracic aortic rupture, the early outcome of patients treated with endovascular stent grafts appears to be better than that with conventional surgical repair. The new technique allows safe and successful repair of this life-threatening injury in the early phase of trauma management. How far this potential benefit is sustained in the long term remains unclear at present.
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Eur J Cardiothorac Surg · Feb 2008
Case ReportsHaemodynamic complications after pneumonectomy: atrial inflow obstruction and reopening of the foramen ovale.
Haemodynamic impairments after pneumonectomy are rare complications and present in different forms. Due to a low awareness of these potential complications their diagnosis is difficult and often established late. The most important forms are: firstly reopening of a previously closed foramen ovale (PFO) caused by a combination of changed anatomic position of the left atrium and elevated pulmonary artery pressure leading to a significant right-left shunt; secondly diaphragmatic relaxation can lead to a dislocation of the liver into the right hemithorax, compressing the right atrium with subsequent inflow obstruction. ⋯ Haemodynamic alterations due to a reopened foramen ovale or right atrial inflow obstruction are rare, however they are severe complications after pneumonectomy. They occur at variable points in time after pneumonectomy. Diagnostic efforts are often made at a late stage due to a low awareness of the problem. Closure of the PFO either surgical or interventional and/or plication of the elevated diaphragm are mandatory. In our experience these complications occur only after right pneumonectomy.
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Eur J Cardiothorac Surg · Feb 2008
Improved results with single-stage total correction of Taussig-Bing anomaly.
The arterial-switch operation (ASO) for management of Taussig-Bing anomaly is associated with important morbidity, mainly related to multiple associated cardiac anomalies. Our surgical management has evolved to suggest a single-stage total repair strategy tailored to address all abnormalities on an individual basis. We examine the efficacy of this treatment approach. ⋯ The Taussig-Bing anomaly is complex and often associated with other cardiac anomalies (arch obstruction, RVOTO, unusual coronary pattern). Advances in perioperative care have significantly mitigated mortality. In our experience with single-stage total repair, event-free survival, especially freedom from RVOT re-operation, has significantly improved.