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 1998
Comparative StudyNeutrophil-endothelial cells modulation in diabetic patients undergoing coronary artery bypass grafting.
Diabetes mellitus is a well-known risk factor in patients undergoing coronary artery bypass grafting. Myocardial and pulmonary injury often occurs after cardiopulmonary bypass (CPB), mediated in part by neutrophil activation and adhesion to endothelial cells. The objectives of the present study are to compare the degree of neutrophil activation and neutrophil-endothelial cells adhesive interactions in diabetic patients after CPB. ⋯ These results indicate that diabetes mellitus is associated with an increased neutrophil-endothelial cell adhesion probably mediated by the CD1 1b/CD18 molecule; this, in turn, might be responsible for the increased risk of postoperative complications observed in diabetic patients undergoing coronary artery bypass grafting.
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Eur J Cardiothorac Surg · Oct 1998
Monitoring of regional cerebral oxygenation by near-infrared spectroscopy during continuous retrograde cerebral perfusion for aortic arch surgery.
To assess the value of monitoring of regional cerebral oxygen saturation (rSO2) during aortic arch surgery using continuous retrograde cerebral perfusion (CRCP) in conjunction with profound hypothermic circulatory arrest (HCA). ⋯ The study suggests that the combination of HCA and CRCP has a limit of safe duration in spite of its potential usefulness for brain protection, and that rSO2 monitored by NIRS is useful in testing for adequate brain protection. It is hoped that monitoring of rSO2 can facilitate prediction of the safe duration of HCA with CRCP and a more favorable adjustment of CRCP.
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Eur J Cardiothorac Surg · Oct 1998
Minimally invasive coronary surgery: surgical considerations and assessment of cardiac troponin I.
Minimally invasive coronary artery bypass grafting (MICABG) using internal thoracic artery (ITA) without median sternotomy and cardiopulmonary bypass (CPB) become a viable option for the management of proximal left anterior descending artery (LAD) disease. Recent studies have demonstrated that cardiac troponine I (cTnI), a new highly specific diagnostic marker of cardiomyocyte damage, is a reliable marker of cardiac ischemia during heart operations under CPB. ⋯ cTnI did not increase during and after coronary artery occlusion and local immobilization of the heart. It can be used to evaluate postoperative myocardial damage on the beating heart using MICABG.
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Eur J Cardiothorac Surg · Oct 1998
Mammary coronary artery anastomosis without cardiopulmonary bypass through minithoracotomy: one year clinical experience.
The recent concept of minimally invasive coronary artery surgery in selected patients has dramatically affected surgical management of coronary artery disease. We explored the possibility of coronary artery bypass grafting of anterior coronary arteries with in situ internal mammary artery through a limited anterior thoracotomy on beating heart. ⋯ In our experience mammary coronary artery anastomosis without CPB through minithoracotomy is a safe, simple and minimally invasive procedure. Favorable cost/benefit ratio, has been achieved due to no early/late mortality and minimal early morbidity. Postoperative check angiogram and Doppler flow study revealed excellent mid term results.
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Eur J Cardiothorac Surg · Oct 1998
S-shaped in comparison to L-shaped partial sternotomy for less invasive aortic valve replacement.
Evaluation of less invasive aortic valve replacement to minimize surgical trauma and achieve a better postoperative quality of life. ⋯ Less invasive aortic valve replacement is feasible with good functional results. The S-shaped sternotomy approach is advantageous whereas the horizontal sternotomy is no longer performed due to a high rate of instability. This new technique will be further evaluated in comparison to the conventional approach.