European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · May 2005
Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation.
Ischemic mitral regurgitation can be treated with a restrictive mitral annuloplasty, with or without coronary revascularization. In this study, the extent of reverse remodeling of the left ventricle following this strategy is assessed, as well as the factors that influence it. ⋯ Stringent restrictive mitral annuloplasty with or without revascularization provides excellent clinical results with acceptable mortality. At 18 months follow-up, there is no significant residual mitral regurgitation. Reverse remodeling occurs in the majority of patients, but is limited by preoperative left ventricular dimensions. In patients with a left ventricular end-diastolic dimension exceeding 65mm, additional surgical procedures are necessary to try and obtain reverse remodeling in this subgroup.
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Eur J Cardiothorac Surg · May 2005
A normogram to anticipate dimension of neo-sinuses of valsalva in valve-sparing aortic operations.
The aim of the present study was to define a method to pre-determine the correct size of neo-sinuses of Valsalva in the reimplantation type of valve-sparing aortic operation. ⋯ We proposed a simplified approach for sizing of the neo-aortic root in the reimplantation type of valve-sparing aortic operation focussed on the size of sinuses of Valsalva. Our normogram showed to be reliable in anticipating beyond leaflets area. It can be helpful in avoiding the selection of an undersized or excessively oversized graft.
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Eur J Cardiothorac Surg · May 2005
Risk stratification with cardiac troponin I in patients undergoing elective coronary artery bypass surgery.
Cardiac troponin I (cTnI) is a highly sensitive and specific marker for postoperative prediction of patients outcome after coronary artery bypass surgery (CABG). Whether preoperatively elevated cTnI levels similarly predict the outcome in patients scheduled for elective CABG is currently unknown. ⋯ Risk stratification by measurement of cTnI levels within 24h before elective CABG clearly identifies a subgroup of patients with increased risk for postoperative adverse outcome and in-hospital mortality.
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Issues concerning the training and certification of surgical specialists have taken on great significance in the last decade. A realistic computer-assisted, tissue-based simulator developed for use in the training of cardiac surgical residents in the conduct of a variety of cardiac surgical procedures in a low-volume cardiothoracic surgery unit of a typical developing country is described. The simulator can also be used to demonstrate the function of technology specific to cardiac surgical procedures in a way that previously has only been possible via the conduct of a procedure on a live animal or human being. ⋯ The cardiac surgical simulation preparation described here would appear to be able to contribute positively to the training of residents in low-volume centres, as well as having the potential for application in other settings as a training tool or clinical skills assessment or accreditation device. Collaboration with larger centres is recommended in order to accurately assess the utility of this preparation as an adjunctive cardiothoracic surgical training aid.
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Eur J Cardiothorac Surg · Apr 2005
Platelet function tests predict bleeding and thrombotic events after off-pump coronary bypass grafting.
A balanced coagulation system after cardiac surgery minimizes bleeding and thrombotic events. However, the best method to monitor this balance has not been established. We used a series of tests of coagulation and platelet function to define the risk of bleeding and thrombotic events after OPCAB. ⋯ In contrast to standard coagulation testing, platelet function predicted both bleeding and thrombosis after OPCAB. Titration of perioperative platelet function according to these tests may minimize thrombosis without increasing bleeding.