Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
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Ann Thorac Cardiovasc Surg · Jun 2003
Comparative StudyA retrospective comparative study of deep hypothermic circulatory arrest, retrograde, and antegrade cerebral perfusion in aortic arch surgery.
Despite theoretical advantages of antegrade (ACP) and retrograde cerebral perfusion (RCP) in addition to deep hypothermic arrest (DHA) in aortic arch surgery, there is still controversy about the best method of cerebral protection. We reviewed our experience with neurological outcome after aortic arch repair over the last five years. ⋯ Despite more complicated arch repairs requiring a significantly longer cerebral exclusion time which were performed in the group receiving ACP, there was no significant increase in stroke or death rates. Increasing confidence in the ability of ACP has led us to perform the most appropriate arch repair without compromising the extent of replacement for fear of exceeding the "safe" period of circulatory arrest.
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Ann Thorac Cardiovasc Surg · Jun 2003
Patency of saphenous vein coronary artery bypass grafts from the vascular prosthesis of the ascending aorta.
Patients who have Stanford type A aortic dissection with impaired coronary arteries or who have aneurysms from the ascending aorta to the aortic arch with coronary artery disease need coronary artery bypass grafting (CABG) with tube graft replacement of the ascending aorta simultaneously. When vein grafts are used for CABG in these patients, the proximal anastomoses of vein grafts are attached to the prosthetic tube graft of the ascending aorta. However, the validity of proximal anastomoses of vein grafts to the prosthetic tube graft of the ascending aorta has not been confirmed. ⋯ The patency rate of vein grafts anastomosed from prosthetic grafts of the ascending aorta to the native coronary arteries was similar to that of conventional CABG using saphenous vein grafts.
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The clinical features of pneumomediastinum are clarified. ⋯ In consideration of air of the esophageal origin, non per oral was prescribed. With the prevention of mediastinitis using antibiotics, all patients recovered. Emergency endoscopic examination was unnecessary.