European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Nov 2015
Randomized Controlled TrialEvaluation of the efficacy of a haemostatic matrix for control of intraoperative and postoperative bleeding in major lung surgery: a prospective randomized study.
This prospective randomized study was designed to assess the safety and efficacy of a haemostatic matrix in intraoperative bleeding control and prevention of postoperative bleeding after major lung surgery. ⋯ In conclusion, the application of Floseal® in major lung resections proved safe and effective in increasing the intraoperative successful haemostasis rate and in reducing postoperative variation in haemoglobin and haematocrit levels. The sealant use was also related with a significantly shorter chest drain duration and hospitalization.
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Eur J Cardiothorac Surg · Nov 2015
Randomized Controlled TrialRNase1 as a potential mediator of remote ischaemic preconditioning for cardioprotection†.
Remote ischaemic preconditioning (RIPC) is a non-invasive and virtually cost-free strategy for protecting the heart against acute ischaemia-reperfusion injury (IRI). We have recently shown that the inhibition of extracellular RNA (eRNA) using non-toxic RNase1 protected the heart against acute IRI, reduced myocardial infarct (MI) size and preserved left ventricular systolic function in rodent animal MI models. Based on this previous work in animals, the role of the eRNA/RNase1 system in cardiac RIPC in humans should be defined. ⋯ Upon RIPC, the level of cardioprotective RNase1 increased, while the concentration of damaging eRNA and TNF-α decreased. The present findings imply a significant contribution of the RIPC-dependent (endothelial) RNase1 for improving the outcome of cardiac surgery. However, the exact mechanism of RNase1-induced cardioprotection still remains to be explored.
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Eur J Cardiothorac Surg · Nov 2015
Obstructive carotid and/or intracranial artery disease rarely affects the incidence of haemodynamic ischaemic stroke during cardiac surgery: a study on brain perfusion single-photon emission computed tomography with acetazolamide.
Ischaemic stroke is a major complication of cardiac surgery. The optimal strategies for operating on patients with obstructive carotid and/or intracranial artery disease (CIAD) are controversial. We aimed to clarify whether single-photon emission computed tomography (SPECT) with acetazolamide, to quantify the cerebral perfusion reserve, could predict the risk of haemodynamic ischaemic stroke during cardiac surgery. ⋯ It is unusual for CIAD to affect the incidence of haemodynamic ischaemic stroke during cardiac surgery. Brain perfusion SPECT with acetazolamide is effective for narrowing down patients at high risk of ischaemic stroke during cardiac surgery. Meanwhile, the application of brain perfusion single-photon emission tomography should be confined only to patients with obstructive CIAD because it is an expensive examination tool.
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Eur J Cardiothorac Surg · Nov 2015
Dilated left atrium as a predictor of late outcome after pulmonary vein isolation concomitant with aortic valve replacement and/or coronary artery bypass grafting†.
Left atrial (LA) dimension can predict atrial fibrillation (AF) recurrence after catheter-based or surgical ablation. Pulmonary vein isolation (PVI) may be a surgical option during aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG), though consensus regarding patient selection and late outcome is lacking. ⋯ In patients with paroxysmal AF related to aortic valve disease and/or coronary artery disease, a dilated left atrium (≥45 mm) was associated with inferior AF- and event-free survival after PVI, accompanied by persistent abnormalities in cardiac and haemodynamic function. These findings may assist patient selection for PVI during AVR and/or CABG.
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Eur J Cardiothorac Surg · Nov 2015
Results of heart transplantation following failed staged palliation of hypoplastic left heart syndrome and related single ventricle anomalies.
Multistage palliation is the mainstay management strategy of children with hypoplastic left heart syndrome (HLHS) and related single ventricle anomalies. If this palliation strategy fails, heart transplantation (HT) is required. The results of HT in children who had a prior Norwood operation are reportedly poor due to several immune, clinical and anatomical risk factors. We report our institutional outcomes following HT in children who had a prior Norwood operation. ⋯ Children failing multistage palliation of HLHS may require HT, often following the Glenn operation. HT results in this group are comparable with those in other children with congenital heart disease. Improvements in pretransplant management, immune suppression and outpatient care in the later era might have specifically benefited this particularly risky group of patients.