J Cardiovasc Surg
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Randomized Controlled Trial
L-arginine supplemented nondiluted blood cardioplegia: a clinical trial.
L-arginine was shown to improve protection of the myocardium during coronary artery bypass graft (CABG) surgery. The objective of the present study was to determine the concentration of L-arginine to obtain the most effective protection of the myocardium during CABG surgery. ⋯ Nondiluted blood cardioplegic solution supplemented with 4 mmol/L of L-arginine was associated with a significant decrease of myocardial lactate release after aortic cross-clamping and reperfusion during CABG surgery.
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Randomized Controlled Trial Comparative Study
Reduction of postoperative hypothermia with a new warming device: a prospective randomized study in off-pump coronary artery surgery.
Hypothermia has been used for decades in cardiac surgery to limit the ischemic insult to the heart. With the diffusion of off-pump coronary artery surgery, the practice of arresting and cooling the heart has been abandoned. At University of Miami Miller School of Medicine, we tested a new warming device by performing a prospective study in which 50 patients were randomized to either the use of the Kimberly-Clark warming system or to standard methods of control of body temperature. ⋯ The Kimberly-Clark Patient Warming System allowed for better control of core body temperature during off pump coronary artery bypass surgery compared to traditional techniques. This translated in less intra and postoperative blood loss and shorter hospital length of stay. Other advantages, such as decreased blood-products transfusions, decreased incidence of infections, decreased ICU length of stay and overall reduction of costs might be evident on larger study groups.
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Several previous studies focusing on comparison between outcomes of carotid artery stenting (CAS) and carotid endoarterectomy (CEA) have put forward conflicting results about the non-inferiority of CAS compared to CEA. Likely outcomes after CAS have been greatly limited by incomplete knowledge of atherosclerotic carotid pathology and probably inappropriate patient selection criteria. In the current practice, only the degree of lumen obstruction is indication to an invasive treatment (CEA or CAS) in symptomatic or asymptomatic patients, but it has been recently demonstrated that histology of carotid plaques also plays a major role. ⋯ This manuscript reports authors' experience with the use of IVUS-VH during CAS. This new technology, by characterizing morphology, extension and histology of carotid plaque, seems to provide important information for confirming percentage of carotid stenosis and judging its embolic potential, tailoring the procedure and guiding the choice of stent and finally for checking stent apposition and complete covering of vulnerable plaques. According to authors' opinion IVUS-VH has the potential to optimize patients' and lesions' selection criteria for CAS in order to improve its outcomes.
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Comparative Study
Use of intravascular ultrasound as a "Quality Control" technique during carotid stent-angioplasty: are there risks to its use?
Intravascular ultrasound (IVUS) provides high-resolution vessel imaging and has been shown to improve clinical outcomes when used to assess the technical result of peripheral angioplasty procedures. Our vascular group compared anatomic and clinical outcomes of carotid artery stent-angioplasty (CAS) performed with angiogram monitoring alone, or in combination with IVUS imaging to select stent/balloon diameter and interrogate stent deployment region for residual stenosis. A retrospective review of our carotid stent registry (N=306) identified 220 CAS procedures performed with either a digital C-arm fluoroscopy alone (N=110) or in conjunction with IVUS (N=110) with at least 6-month of clinical follow-up. ⋯ The quality control of the CAS procedure was enhanced by IVUS imaging which directed stent /balloon sizing and was more accurate than angiography in confirming adequate stent expansion. No IVUS related adverse events occurred. Based on the anatomic information provided by IVUS, larger diameter angioplasty balloons were used which correlated with less residual stenosis after CAS based on duplex ultrasound testing.