European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 2006
Randomized Controlled TrialThe role of leukocyte depleting filters in heart transplantation: early outcomes in prospective, randomized clinical trial.
Leukocyte-mediated reperfusion injury to cardiac allograft in the perioperative period is most likely associated with the early and late mortality after heart transplantation (Htx). Our aim is to determine the efficacy and safety of using leukocyte-depleting filters in a cardiopulmonary bypass (CPB) and secondary blood cardioplegia (SBC) circuit in Htx. ⋯ The use of leukocyte depleting filters in heart transplantation is an effective, easy and safe method of myocardial protection, reducing significant myocardial reperfusion injury and improving posttransplant graft functional recovery.
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Eur J Cardiothorac Surg · Oct 2006
Multicenter Study Comparative StudyPredicted versus observed FEV1 in the immediate postoperative period after pulmonary lobectomy.
Scanty information can be found regarding ppoFEV1% correlation with true FEV1% in the immediate days after surgery, when most cardio-respiratory complications are developed. This prospective multicentric investigation aims to describe the evolution of FEV1 in a series of uneventful lobectomy cases before hospital discharge, and to identify factors associated with the variation of postoperative residual FEV1, with the ratio between the actual and the predicted postoperative FEV1 measured during the first 6 postoperative days. ⋯ Current methods of prediction of postoperative FEV1 greatly underestimated the real functional loss in the immediate postoperative period. Therefore, for the purpose of a more accurate risk stratification we need to correct the traditional prediction of postoperative FEV1.
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Eur J Cardiothorac Surg · Oct 2006
Randomized Controlled Trial Comparative StudyEvaluation of myocardial metabolism with microdialysis during bypass surgery with cold blood- or Calafiore cardioplegia.
For the first time, microdialysis was used to investigate in vivo and online the myocardial metabolism during and after cardiac surgery in patients treated with two different methods of myocardial protection. ⋯ The oxidative stress measured was significantly higher in patients undergoing CABG using modified Calafiore cardioplegia, whereas the cold cardioplegia minimised the effects of aortic clamping. The results indicate that cold cardioplegia offers superior protection of the heart, in terms of more rapid normalisation of myocardial metabolism. In elective myocardial revascularisation, intermittent antegrade warm blood cardioplegia is a comparable safe method of myocardial protection. However, in patients referring to a long clamping time, advantages of cold cardioplegia for myocardial revascularisation may be magnified.
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Eur J Cardiothorac Surg · Oct 2006
Comparative StudyBronchial stump reinforcement with the intercostal muscle flap without adverse effects.
Bronchopleural fistula is a serious complication of pulmonary resection. For anatomical reasons, lower lobectomy is thought to carry a higher risk for bronchopleural fistula. We investigated the efficacy of bronchial stump reinforcement with a pedicled intercostal muscle flap after lower lobectomy and compared the responses in patients treated with the flap, without the flap, and with other types of flap. We also investigated whether harvesting the intercostal muscle flap leads to an increase in blood loss during surgery and whether the type of flap influences chest-tube volume and pain after surgery. ⋯ Bronchial stump reinforcement with the intercostal muscle flap after pulmonary resection is safe and effective when performed during lower and lower-middle lobectomy and does not increase the risk of complications.
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Eur J Cardiothorac Surg · Oct 2006
Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients.
Extracorporeal membrane oxygenation (ECMO) has been used as initial, biventricular circulatory support for patients with severe postcardiotomy cardiogenic shock (PCS). Due to its aggressiveness and limited weaning quote, concerns have been raised about maintenance of ECMO support regarding duration. However, it is frequently hazardous for physicians to make an individualized decision, whether and when discontinuation of ECMO support should be considered. We tried to find measurable values during ECMO support that could predict the patient mortality on ECMO support. ⋯ For adult non-transplantation patients with postcardiotomy cardiogenic shock, the CK-MB relative index 48 h after ECMO initiation can be a predictor of mortality on ECMO support. This might be a useful tool for considering a patient either for discontinuation of ECMO support or further treatment.