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 2004
Influence of obesity on in-hospital and early mortality and morbidity after myocardial revascularization.
Obese patients are thought to have an increased risk for complications in coronary artery bypass surgery. Several risk stratification systems do not identify obesity as a variable for risk adjustment. The aim of this study is to evaluate the in-hospital and early (one year) mortality and morbidity in obese and non-obese patients after a CABG in the UMC St Radboud. ⋯ Obese patients do not have an increased risk of in-hospital and early (1 year) mortality after CABG. However, obese patients have an increased risk of postoperative wound infections compared to non-obese patients.
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Eur J Cardiothorac Surg · Sep 2004
Fibrinolytic treatment of complicated pediatric thoracic empyemas with intrapleural streptokinase.
Proper antibiotic treatment and adequate pleural drainage is essential in successful management of pleural effusions. In complicated effusions the increased production of fibrin results in formation of loculations and septations within the thoracic cavity, leading ineffective chest tube drainage. Intrapleural fibrinolytic agents are employed to avoid thoracotomy in such complicated pleural effusions. Our study reviews the results of streptokinase treatment in children with pleural effusion. ⋯ Intrapleural streptokinase is an effective and safe adjunct in facilitating drainage in early and late stage II empyemas. A tendency of decreased rate of drainage besides persisting fever and respiratory symptoms, despite fibrinolytic treatment may be a clue for early surgical intervention.
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Eur J Cardiothorac Surg · Aug 2004
Repair of the descending thoracic aorta: impact of open distal anastomosis technique on spinal cord perfusion, neurological outcome and spinal cord histopathology.
We investigated the impact of equilibrating distal aortic pressure with atmospheric pressure (open distal anastomosis) on spinal cord perfusion, neurological outcome and spinal cord histopathology in a rat model of descending thoracic aortic surgery. ⋯ Equilibrating distal arterial pressure with atmospheric pressure during thoracic aortic occlusion decreased spinal cord blood flow, increased mortality and worsened spinal cord injury in rats. These results suggest that the open distal anastomosis technique should be used with caution in patients undergoing repair of the descending thoracic or thoracoabdominal aorta.
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Eur J Cardiothorac Surg · Aug 2004
Randomized Controlled Trial Clinical TrialProphylactic tranexamic acid in elective, primary coronary artery bypass surgery using cardiopulmonary bypass.
Perioperative use of tranexamic acid (TA), a synthetic antifibrinolytic drug, decreases perioperative blood loss, and the proportion of patients receiving blood transfusion in cardiac surgery, but the results may vary in different clinical settings. The primary objective of the present study was to determine the efficacy of TA to decrease chest tube drainage and the proportion of patients requiring perioperative allogeneic transfusions following primary, elective, on-pump coronary artery bypass grafting (CABG) in patients with a low baseline risk of postoperative bleeding. ⋯ An antifibrinolytic effect following prophylactic use of TA in elective, primary CABG among patients with a low risk of postoperative bleeding, did not result in any significant decrease in postoperative bleeding compared to a placebo group.
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Eur J Cardiothorac Surg · Aug 2004
Changes in coagulation condition, cytokine, adhesion molecule after repair of type A aortic dissection.
Because residual dissection often exists even after the repair of a type A dissection, we evaluated coagulation conditions, cytokine levels, and adhesion molecule levels in mid-term follow up after repair of type A dissections. ⋯ Hypercoagulation conditions continued even after repair. Both TAT and D-dimer would be good indices for following up patients having repaired aortic dissections. Furthermore, cytokine, adhesion molecules, and collagen turnover would return to a stable state unless impairment and expansion of the vessel wall occurred.