European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Sep 2006
Hypothermic circulatory arrest with moderate, deep or profound hypothermic selective antegrade cerebral perfusion: which temperature provides best brain protection?
Selective antegrade cerebral perfusion (SACP) seems to be associated with a better outcome compared to hypothermic circulatory arrest (HCA) alone. This study was undertaken to evaluate the influence of different SACP temperatures on the neurological integrity. ⋯ In this model, SACP is superior to HCA alone. Regarding the optimal temperature for SACP, it seems that 20 degrees C provides adequate brain protection in comparison to the potential detrimental effects of moderate (30 degrees C) and profound (10 degrees C) temperatures.
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Eur J Cardiothorac Surg · Sep 2006
Video-assisted thoracic surgery utilizing local anesthesia and sedation.
Video-assisted thoracic surgery (VATS) is usually performed with general anesthesia and double-lumen endotracheal intubation, but minor procedures have been carried out with patients spontaneously breathing and with epidural or regional analgesia. We have broadened our indications for VATS utilizing purely local anesthesia and sedation. ⋯ VATS utilizing local anesthesia and sedation is well tolerated, safe, and valuable for an increasing number of indications.
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Eur J Cardiothorac Surg · Sep 2006
Effect of tetrahydrobiopterin on selective endothelial dysfunction of epicardial porcine coronary arteries induced by cardiopulmonary bypass.
We hypothesized that cardiopulmonary bypass induces a selective alteration of the coronary arterial endothelial cell signal transduction which could be explained by a state of depletion and/or decreased activity of endogenous tetrahydrobiopterin (BH(4)). The aim of this study was to assess the effects of cardiopulmonary bypass and BH(4) on the endothelial function of epicardial coronary arteries in a swine model of cardiopulmonary bypass. ⋯ Treatment with BH(4) improves the endothelial dysfunction of porcine epicardial coronary arteries, restores nitric oxide availability and reduces the oxidative stress associated with cardiopulmonary bypass.
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Eur J Cardiothorac Surg · Aug 2006
Monitoring activated clotting time for combined heparin and aprotinin application: in vivo evaluation of a new aprotinin-insensitive test using Sonoclot.
Kaolin-based activated clotting time assessed by HEMOCHRON (HkACT) is a clinical standard for heparin monitoring alone and combined with aprotinin during cardiopulmonary bypass (CPB). However, aprotinin is known to prolong not only celite-based but also kaolin-based activated clotting time. Overestimation of activated clotting times implies a potential hazardous risk of subtherapeutic heparin anticoagulation. Recently, a novel 'aprotinin-insensitive' activated clotting time test has been developed for the SONOCLOT analyzer (SaiACT). The aim of our study was to evaluate SaiACT in patients undergoing CPB in presence of heparin and aprotinin. ⋯ The use of SaiACT may result in more consistent heparin management that is less affected by aprotinin and a corresponding increase in heparin administration for patients receiving aprotinin.
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Eur J Cardiothorac Surg · Aug 2006
Prevention of TNFalpha-associated myocardial dysfunction resulting from cardiopulmonary bypass and cardioplegic arrest by glucocorticoid treatment.
Cardiac surgery on cardiopulmonary bypass (CPB) results in progressive myocardial dysfunction, despite unimpaired coronary blood flow, and is associated with increased myocardial tumor necrosis factor-alpha (TNFalpha) expression. We investigated whether anti-inflammatory treatment prevents increased TNFalpha expression and myocardial dysfunction after CPB. ⋯ Methylprednisolone attenuates both systemic and myocardial TNFalpha increases and progressive myocardial dysfunction induced by cardiac surgery, suggesting a key role for TNFalpha.