European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Apr 2007
Aortic valve surgery in octogenarians: predictive factors for operative and long-term results.
To assess factors influencing operative and long-term outcome in octogenarians undergoing aortic valve surgery (AVR). ⋯ AVR in octogenarians can be performed with acceptable mortality, although significant morbidity. These results stress the importance of early operation on elderly patients with aortic valve disease, avoiding urgent procedures. Associated coronary artery disease is a harbinger of poor operative outcome. Long-term survival and functional recovery are excellent.
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Eur J Cardiothorac Surg · Apr 2007
Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia.
Although antegrade selective cerebral perfusion (ASCP) has been demonstrated to be the best method of protection of brain ischemia during aortic arch surgery, there is no consensus regarding optimal temperature during ASCP. The study analyzed the outcomes of aortic surgery using ASCP at different degree of systemic hypothermia. ⋯ In our experience, ASCP was a safe technique for thoracic aorta surgery allowing complex aortic repairs to be performed with good results in terms of hospital mortality and neurologic outcomes. The fact that there was no difference between the two groups suggests that moderate systemic hypothermia (26 degrees C) appears to be a safe and sufficient tool for brain protection. Moreover, the well known hypothermia-related side effects may be avoided.
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Eur J Cardiothorac Surg · Apr 2007
Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented?
Understanding the ability of the paraspinal anastomotic network to provide adequate spinal cord perfusion pressure (SCPP) critical for both surgical and endovascular repair of thoracoabdominal aortic aneurysms (TAAA). ⋯ Interruption of all SAs at 32 degrees C in this pig model results in a spectrum of cord injury, with normal function in a majority of pigs postoperatively. The short duration of low SCPP suggests that hemodynamic manipulation lasting only 24-48h may allow routine complete preservation of normal cord function despite sacrifice of all SAs.
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Eur J Cardiothorac Surg · Mar 2007
Randomized Controlled Trial Comparative StudyTopical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective, randomized study.
Postoperative bleeding is still one of the most common complications of cardiac surgery. Antifibrinolytic agents successfully reduce bleeding, but there are controversies concerning adverse effects after their systemic use. By topical application of antifibrinolytic agents in pericardial cavity, most of these effects are avoided. We compared the effects of topically applied aprotinin, tranexamic acid and placebo on postoperative bleeding and transfusion requirements. ⋯ Topical use of either tranexamic acid or aprotinin efficiently reduces postoperative bleeding. TA seems to be at least as potent as aprotinin, but potentially safer and with better cost-effectiveness ratio.
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Eur J Cardiothorac Surg · Mar 2007
Comparative StudyA comparison of outcomes after robotic open extended thymectomy for myasthenia gravis.
The aim of this study was to analyze the effect of the surgical approach on surgical and neurologic outcomes after extended thymectomy for myasthenia gravis. ⋯ The results of this small series favour the robotic approach for extended thymectomy for myasthenia gravis in respect of both surgical and early neurologic outcome. However, prospective randomized trials are required to prove a general validity.