The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Comparative StudyAssociation of device surface and biomaterials with immunologic sensitization after mechanical support.
Biomaterials and textured surfaces in early pulsatile left ventricular assist devices (HeartMate I; Thoratec Corporation, Pleasanton, Calif) may increase immunologic risk through allosensitization. We hypothesized that axial-flow devices without biologic membranes or textured surfaces (HeartMate II; Thoratec; and DeBakey; MicroMed Cardiovascular, Inc, Houston, Tex) would cause less allosensitization than devices with such membranes and surfaces. ⋯ Hemodynamic support with HeartMate II and DeBakey devices produced less allosensitization than did HeartMate I devices. Device selection may improve clinical outcomes for high-risk patients.
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Randomized Controlled TrialLocal infusion of bupivacaine combined with intravenous patient-controlled analgesia provides better pain relief than intravenous patient-controlled analgesia alone in patients undergoing minimally invasive cardiac surgery.
This prospective randomized double-blind study examined the effect of local wound infusion of anesthetics on pain control in the thoracotomy wound of patients undergoing minimally invasive cardiac surgery. ⋯ In this controlled double-blind study, thoracotomy wound infusion and patient-controlled analgesia were superior to patient-controlled analgesia alone in reducing pain at 1, 3, and 90 days after minimally invasive cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Comparative StudyThe "occasional open heart surgeon" revisited.
Case volume in cardiac surgery has been a concern since the term "the occasional open heart surgeon" was used more than 40 years ago, indicating one who performs cardiac surgery infrequently. ⋯ A high-volume surgeon becomes an "occasional open heart surgeon" when working at multiple hospitals and performing a small volume of procedures at some of them. This study suggests that volume is not as important as processes of care in determining outcomes of coronary artery bypass grafting procedures and that system factors might be more important to outcomes than surgeon experience.
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Comparative StudyA novel bioengineered small-caliber vascular graft incorporating heparin and sirolimus: excellent 6-month patency.
A bioengineered microporous polycarbonate-siloxane polyurethane graft has been developed for coronary artery bypass grafting. Biological agents can be impregnated into its absorbable collagen and hyaluronan microstructure and stable macrostructure to promote patency. The objective of this study was to examine the in vivo biological performance and biomechanical characteristics of this graft. ⋯ A unique drug-eluting graft had excellent patency throughout the 6 months after implantation. The heparin-sirolimus graft encouraged luminal endothelialization without excessive intimal hyperplasia. This graft performed significantly better than the expanded polytetrafluoroethylene graft. This graft has the potential to become an implantable graft for coronary artery bypass grafting.