Journal of cardiac surgery
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Review Meta Analysis
Preoperative intra-aortic balloon pump in patients undergoing coronary bypass surgery: a systematic review and meta-analysis.
To assess the effectiveness of preoperative intra-aortic balloon pump (IABP) placement in high-risk patients undergoing coronary bypass surgery (CABG). The primary outcome was hospital mortality and secondary outcomes were IABP-related complications (bleeding, leg ischemia, aortic dissection). ⋯ Evidence from this meta-analysis support the use of preoperative IABP in high-risk patients to reduce hospital mortality.
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The foramen ovale remains patent in about 25% of the population. Paradoxical embolism through a patent foramen ovale (PFO) may produce ischemic events. The closure of a PFO may prevent recurrence of cerebrovascular events. Percutaneous closure of a PFO is now-a-days a standard procedure and it appears to carry a low rate of complications. A surgical approach, in some cases, may be needed. ⋯ Minimally invasive surgery may be effective to treat PFO or even complications after previous percutaneous attempts of closure. An aesthetically acceptable conclusion, especially in young female patients, and a very low rate of morbidity may be accomplished.
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Randomized Controlled Trial Comparative Study
Sixteen-slice multidetector computed tomography for graft patency evaluation after coronary artery bypass surgery.
To investigate the ability of 16-slice multidetector computed tomography (MDCT) to assess coronary artery bypass graft patency and to detect bypass stenosis by comparison with coronary angiography. ⋯ Sixteen-slice MDCT allows for noninvasive evaluation of coronary bypass grafts patency with high diagnostic accuracy. Assessment of distal anastomotic stenosis was deficient, particularly for arterial grafts, still limited by low resolution or artifacts. Improved accuracy may be obtained by more aggressive heart rate reduction.
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Comparative Study
Does the trainee's level of experience impact on patient safety and clinical outcomes in coronary artery bypass surgery?
There is a relative dearth of information on how the resident's level of training affects patient outcomes in cardiac surgery. We designed this study to determine if there were any significant differences in patient demographics and clinical outcomes of coronary artery bypass procedures (CABG) performed by residents of PGY 4/lower, residents of PGY 5/6, fellows, or consultants. ⋯ Preoperative patient demographics and operative data were similar in all groups except that patients requiring IABP preoperatively were more likely operated on by consultants and arterial revascularization was performed more commonly by consultants and fellows. Postoperative mortality and morbidity rates were similar among all groups, thus demonstrating that with appropriate supervision, trainees of all levels can safely be taught CABG.
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We have previously reported that sensory, motor neocortex, and hippocampus are selectively vulnerable to injury in an acute porcine model of HCA at 18 degrees C. This study was undertaken to assess whether further cooling to 10 degrees C can reduce neurological injury during HCA. ⋯ This data support that cerebral protection may be better at very cold temperatures compared to 18 degrees C hypothermia. Regions selectively vulnerable to neuronal injury are offered more neural protection by profound hypothermia. These affects are observed in the acute state, suggesting activation of the apoptotic mechanisms at early stages can be inhibited by profound hypothermia.