Journal of cardiac surgery
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Clinical Trial
Assessing the immediate and sustained effectiveness of circular epicardial surgical ligation of the left atrial appendage.
Obliterating the left atrial appendage from systemic circulation in patients with atrial fibrillation has been proposed to reduce thromboembolic events. The goal of this study was to assess the effectiveness of a circular method of epicardial surgical ligation in obliterating the left atrial appendage and maintaining sustained exclusion. ⋯ Epicardial suture ligation of the left atrial appendage resulted in successful intra-operative exclusion on TEE; however, a significant portion of patient's demonstrated communication of contrast on CT. This is suggestive of incomplete long-term exclusion. The clinical significance of reduction in left atrial appendage orifice area and volume with a persistent communication requires further study.
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Antegrade cerebral perfusion (ACP) under moderate hypothermia may improve cerebral protection. Intraoperative measurement of cerebral regional oxygen saturations (rSO2) using near-infrared spectroscopy (NIRS) can provide accurate monitoring of cerebral perfusion during ACP. We evaluated the role, outcomes, and advantages of using NIRS in providing effective cerebral protection with ACP. ⋯ Cerebral rSO2 and left radial artery pressure monitoring with ACP during aortic surgery provides accurate measurement of cerebral perfusion resulting in minimal neurological and perioperative complications and good midterm QoL outcomes.
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Ascending aorta and aortic arch replacement combined with antegrade stent grafting of the descending thoracic aorta represents an emerging hybrid surgical approach for complex and extensive thoracic aortic disease. We present a case of a patient at low risk for spinal cord ischemia who underwent hybrid thoracic aortic surgery (aortic arch replacement and E-vita prosthesis implantation) and developed a spinal cord injury (SCI) after the intervention. Treatment aimed at increasing spinal cord perfusion pressure with the aid of cerebrospinal fluid (CSF) drainage was effective in recovering neuromuscular function.