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
Predictive factors of myasthenic crisis after extended thymectomy for patients with myasthenia gravis.
Postoperative myasthenic crisis (POMC) is one of the serious complications after extended thymectomy for patients with myasthenia gravis (MG). This study aims to clarify the risk factors of POMC occurrence. ⋯ POMC occurred more frequently in unstable MG before surgery or in patients with a history of MC. Adequate preoperative medical therapy and perioperative care should be provided to these patients.
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Eur J Cardiothorac Surg · Oct 2015
Review Meta Analysis Comparative StudyA systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy.
There is a growing trend to perform off-bypass surgical ablation for atrial fibrillation (AF) because it is perceived to be safer and more effective than the Cox-Maze procedure with cardiopulmonary bypass (CPB) support. In this systematic review, we compared three minimally invasive stand-alone surgical ablation procedures for AF: the endocardial Cox-Maze procedure, epicardial surgical ablation and a hybrid epicardial surgical and catheter-based endocardial ablation procedure (hybrid procedure). Relevant studies were identified in MEDLINE and the Cochrane Database of Systematic Reviews according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ⋯ At 12 months, rates of sinus rhythm restoration were 93, 80 and 70%, and sinus restoration without anti-arrhythmic medications was 87, 72 and 71%, for Cox-Maze, epicardial and hybrid procedures, respectively. Of the three procedures, the minimally invasive Cox-Maze procedure with CPB support was most effective for the treatment of stand-alone AF and had important safety advantages in conversion to sternotomy and major bleeding. The minimally invasive Cox-Maze procedure with CPB support also demonstrated the potential for a higher success rate 12 months following the procedure.
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Eur J Cardiothorac Surg · Oct 2015
Randomized Controlled Trial Comparative StudyStopping antiplatelet medication before coronary artery bypass graft surgery: is there an optimal timing to minimize bleeding?
As the indication for antiplatelet medication expands, patients may be exposed to an increased risk of excessive blood loss when cardiac surgery is required. The optimal timing to stop acetylsalicylic acid (ASA) or ASA combined with clopidogrel (ASA+Clo) before surgery is the subject of controversy. ⋯ There is no clinically relevant effect on blood loss indicating an optimal stop day for ASA alone or in combination with Clo. Last use on Day -2 resulted in the reduction of percentage of patients receiving platelet transfusions, especially in the ASA+Clo group.
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Eur J Cardiothorac Surg · Oct 2015
Review Case ReportsBacterial pericarditis as a fatal complication after endobronchial ultrasound-guided transbronchial needle aspiration.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and effective diagnostic tool for mediastinal evaluation. The guidelines for mediastinal evaluation of lung cancer were recently revised for both endoscopic procedures and surgical medical staging, and EBUS-TBNA is expected to be used more often in lung cancer diagnosis and staging. The major complication rate reported in previous meta-analyses is very low at 0.07-.15%; however, the mortality rate has not been reported. We present 2 cases of acute bacterial pericarditis after EBUS-TBNA, with 1 case resulting in mortality, and we discuss the appropriate management.
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Eur J Cardiothorac Surg · Oct 2015
Pitfalls and premature failure of the Freedom SOLO stentless valve.
This study reports a series of pitfalls, premature failures and explantation of the third-generation Freedom SOLO (FS) bovine pericardial stentless valve. ⋯ The FS stentless valve is safe to implant and shows satisfying mid-term results in our single institution experience. Freedom from SVD and explantation decreased markedly after only 6-7 years, so that patients with FS require close observation and follow-up. Exact sizing, symmetric positioning and observing patient limitations are crucial for optimal outcome.