The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2001
Building a clinical cardiothoracic surgical program: a multi-institutional model.
Building a multi-institutional cardiothoracic surgical program has the same guiding principles and values as a traditional single institutional program: ensuring high-quality patient care, training and fostering residents, recruiting and retaining quality faculty, and contributing to basic and clinical research. With a well-designed infrastructure and support system, this more complicated type of organization may permit academic cardiothoracic surgical programs to compete effectively and grow in a constantly changing economic and political environment.
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J. Thorac. Cardiovasc. Surg. · Apr 2001
Randomized Controlled Trial Comparative Study Clinical TrialReduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: a prospective randomized study.
Coronary artery bypass grafting on the beating heart through median sternotomy is a relatively new treatment, which allows multiple revascularization without the use of cardiopulmonary bypass. A prospective randomized study was designed to investigate the effect of coronary bypass with or without cardiopulmonary bypass on postoperative blood loss and transfusion requirement. ⋯ Coronary artery bypass grafting on the beating heart is associated with a significant reduction in postoperative blood loss, transfusion requirement, and transfusion-related cost when compared with conventional revascularization with cardiopulmonary bypass and cardioplegic arrest.
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J. Thorac. Cardiovasc. Surg. · Apr 2001
Comparative Study Clinical TrialNeuropsychologic impairment after coronary bypass surgery: effect of gaseous microemboli during perfusionist interventions.
Neuropsychologic impairment is a common complication of coronary bypass surgery. Cerebral microemboli during cardiopulmonary bypass are the principal cause of cognitive deficits after coronary bypass grafting. We have previously demonstrated that the majority of cerebral emboli occur during perfusionist interventions (ie, during the injection of air into the venous side of the cardiopulmonary bypass circuit). The purpose of this study was to determine whether an increase in perfusionist interventions is associated with an increased risk of postoperative cognitive impairment. ⋯ Introduction of air into the cardiopulmonary bypass circuit by perfusionists, resulting in cerebral microembolization, may contribute to postoperative cognitive impairment.
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J. Thorac. Cardiovasc. Surg. · Apr 2001
Randomized Controlled Trial Comparative Study Clinical TrialMinisternotomy versus complete sternotomy for coronary bypass operations: no difference in postoperative pulmonary function.
Less-invasive approaches in cardiac operations offer certain cosmetic advantages, but it is unclear whether there are additional positive effects with regard to the postoperative recovery of patients. The aim of this prospective and randomized study was to ascertain whether partial inferior midline sternotomy can improve pulmonary function, one of the best quantifiable parameters of postoperative recovery, after coronary artery bypass operations when compared with the standard full midline approach. ⋯ A less-invasive approach for coronary artery bypass operations with a partial inferior sternotomy does not improve early postoperative pulmonary function when compared with the conventional approach with a full sternotomy.
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J. Thorac. Cardiovasc. Surg. · Apr 2001
Comparative StudyMinimally invasive versus sternotomy approaches for mitral reconstruction: comparison of intermediate-term results.
This study compares intermediate-term outcomes of mitral valve reconstruction after either the standard sternotomy approach or the new minimally invasive approach. Although minimally invasive mitral valve operations appear to offer certain advantages, such as reduced postoperative discomfort and decreased postoperative recovery time, the intermediate-term functional and echocardiographic efficacy has not yet been documented. ⋯ These findings demonstrate comparable 1-year follow-up results after minimally invasive mitral valve reconstruction. Both echocardiographic results and New York Heart Association functional improvements were compatible with results achieved with the standard sternotomy approach. The minimally invasive approach for mitral valve reconstruction provides equally durable results with marked advantages for the patient and should be more widely adopted.