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 2001
Randomized Controlled Trial Clinical TrialClinical application of vacuum-assisted cardiopulmonary bypass with a pressure relief valve.
Hemodilution induced by cardiopulmonary bypass (CPB) often prevents open heart operations without blood transfusion because of a large CPB-priming volume. A vacuum-assisted venous drainage system appears to overcome this problem and our previous experimental study demonstrated the beneficial effect of a vacuum-assisted CPB with a pressure relief valve. In this study, we clinically applied this novel system, and evaluated its efficacy by comparing it with the results of a conventional siphon-dependent drainage system. ⋯ These data demonstrate that this vacuum-assisted CPB can provide simplification of the CPB circuit, resulting in a smaller CPB-priming volume and lower hemodilution. This vacuum-assisted CPB may attenuate the negative effect of CPB by minimizing hemodilution and appears to be a useful modification to accomplish no blood-requiring open heart operations.
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Eur J Cardiothorac Surg · Sep 2001
Pulmonary function testing after operative stabilisation of the chest wall for flail chest.
This is a prospective evaluation of chest wall integrity and pulmonary function in patients with operative stabilisation for flail chest injuries. ⋯ Antero-lateral flail chest injuries accompanied by respiratory insufficiency can be effectively stabilised using reconstruction plates. Early restoration of the chest wall integrity and respiratory pump function may be cost effective through the prevention of prolonged mechanical ventilation and restriction-related working incapacity.
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Eur J Cardiothorac Surg · Sep 2001
Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease.
We have reviewed 260 patients who underwent initial tricuspid valve surgery for functional tricuspid valve regurgitation (TR) and analyzed independent predictors for early and late unfavorable results. ⋯ Tricuspid valve surgery for functional TR can be performed with acceptable levels of early mortality. Cardiac-related late mortality after tricuspid surgery may be improved by earlier surgical treatment before NYHA class IV or deterioration of LVEF occurs. To prevent late tricuspid reoperation, it is important not to leave residual TR of grade 2+ or more after tricuspid annuloplasty.
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Eur J Cardiothorac Surg · Sep 2001
Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine > or =2.0 mg/dl).
Patients with renal dysfunction carry a risk of coronary atherosclerosis. The purpose of this study was to evaluate the outcome after coronary artery bypass grafting (CABG) in patients with decreased renal function (serum creatinine > or =2.0 mg/dl). ⋯ Patients with decreased renal function carry significant operative risks and require prolonged hospital care. Even after adequate surgical revascularization was completed, the long-term cardiac event-free and survival rates in the patients with renal dysfunction were inferior to the patients with normal renal function.
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Eur J Cardiothorac Surg · Sep 2001
Randomized Controlled Trial Clinical TrialEffects of cryoanalgesia on post-thoracotomy pain and on the structure of intercostal nerves: a human prospective randomized trial and a histological study.
The choice of analgesia in the management of post-thoracotomy pain remains controversial. Although several alternative forms of post-thoracotomy analgesia exist, all have their disadvantages. Cryoanalgesia, localized freezing of intercostal nerves, has been reported to have variable effectiveness and an incidence of long-term cutaneous sensory changes. We carried out an animal study to assess the reversibility of histological changes induced by cryoanalgesia and a prospective randomized trial to compare the effectiveness of cryoanalgesia with conventional analgesia (parenteral opiates). ⋯ We suggest that cryoanalgesia be considered as a simple, inexpensive, long-term form of post-thoracotomy pain relief, which does not cause any long-term histological damage to intercostal nerves.