European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Aug 2007
Randomized Controlled TrialDesflurane preconditioning in coronary artery bypass graft surgery: a double-blinded, randomised and placebo-controlled study.
Recent clinical and experimental data indicate that volatile anaesthetics may precondition myocardium against ischaemia and infarction. The present clinical trial was designed to verify the cardioprotective effects of desflurane in patients undergoing elective coronary artery bypass surgery. It was hypothesized that desflurane preconditioning would decrease postoperative release of troponin I and brain natriuretic peptide (NT-proBNP). Besides, we have hypothesized that desflurane preconditioning would preserve the myocardium from the dysfunction following cardioplegic arrest. ⋯ We can conclude that the use of desflurane in these patients provides a pharmacological preconditioning so as to reduce myocardial necrosis and improve the cardiac performance in the postoperative period.
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Eur J Cardiothorac Surg · Aug 2007
Long-term outcome after mitral valve repair: a risk factor analysis.
Mitral valve repair is the gold standard to restore mitral valve function and is now known to have good long-term outcome. In order to help perioperative decision making, we analyzed our collective to find independent risk factors affecting their outcome. ⋯ Mitral valve repair provides excellent survival. However, long-term outcome can be negatively influenced by perioperative risk factors. Risk of reoperation is higher in younger patients with a residual mitral regurgitation and without ring annuloplasty.
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Eur J Cardiothorac Surg · Aug 2007
Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations.
The aim of this study was to assess the significance of malperfusion syndromes in patients with acute type A aortic dissection following a contemporary surgical management algorithm and the effects on morbidity, hospital mortality, and long-term survival. We believe that obliteration of the primary tear site with restoration of flow in the true aortic lumen results in decreased need for revascularization of malperfused organ systems. ⋯ The occurrence of malperfusion in patients with acute type A dissection is associated with significant increased risk of in-hospital mortality and complications. Additional revascularization is generally needed in patients with coronary malperfusion and ileofemoral malperfusion. Patients presenting with cardiac and cerebral malperfusions have a high hospital mortality and preoperative cerebral malperfusion is associated with dismal long-term survival.
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Eur J Cardiothorac Surg · Aug 2007
A novel approach to restore atrial function after the maze procedure in patients with an enlarged left atrium.
Left atrial (LA) volume reduction surgery concomitant with the maze procedure has been reported to facilitate sinus rhythm recovery even in patients with refractory atrial fibrillation (AF) with an enlarged LA. However, it is unknown whether the procedures can also restore effective atrial function of the enlarged LA with over-stretched myocardium. ⋯ The LA volume reduction surgery concomitant with the maze procedure restored contraction of the enlarged LA; however, the maze procedure alone did not restore LA contraction in spite of successful sinus rhythm recovery. LA volume reduction surgery may be desirable to the patients with refractory AF with over-stretched LA.
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Eur J Cardiothorac Surg · Aug 2007
New ultrasonic radiation reduces cerebral emboli during extracorporeal circulation.
Cardiac surgery is associated with intraoperative cerebral emboli, which can result in postoperative neurological complications. A new ultrasonic transducer (EmBlocker) can be positioned on the ascending aorta and activation of the EmBlocker is expected to divert emboli to the descending aorta, thereby decreasing emboli in the cerebral arteries. In this preliminary animal study, safety and efficiency of this technology were examined. ⋯ The new ultrasound technology can safely be applied and is capable of reducing emboli in the cerebral arteries during extracorporeal circulation. Use of the EmBlocker in cardiac surgery bears the potential to lower the risk of postoperative neurological complications. Clinical feasibility studies are in progress.