The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2010
Baseline left ventricular function and surgical annular stiffening to predict outcome and reverse left ventricular remodeling after undersized annuloplasty for intermediate-degree ischemic mitral regurgitation.
We sought to identify determinants of clinical and functional outcome after myocardial revascularization and associated undersized annuloplasty in patients with intermediate-degree ischemic mitral regurgitation. ⋯ Combination of undersized mitral annuloplasty and coronary revascularization presents low operative mortality and determines left ventricular unloading in patients with intermediate-degree ischemic mitral regurgitation. Global and regional wall motion are powerful predictors of late outcome. Stiffer mitral annular repair promotes functional recovery and predicts higher probability and earlier timing of reverse remodeling.
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J. Thorac. Cardiovasc. Surg. · Jun 2010
The effectiveness of prestorage leukocyte-reduced red blood cell transfusion on perioperative inflammatory response with a miniaturized biocompatible bypass system.
Since 2007, the Japanese Red Cross Blood Center has provided prestorage leukocyte-reduced red blood cell concentrates in which the leukocytes were reduced soon after collection. We have established a miniaturized bypass system (140 mL) to reduce the perioperative inflammatory responses. This study was designed to reveal the effectiveness of leukocyte-reduced red blood cell concentrate transfusion on perioperative inflammatory responses in pediatric cardiac surgery. ⋯ Our study revealed that in neonates and small infants, compared with transfusions with stored red blood cell concentrate, transfusion of leukocyte-reduced red blood cell concentrates was associated with reduced perioperative inflammatory responses and improved clinical outcomes.
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J. Thorac. Cardiovasc. Surg. · Jun 2010
Effects of head-up tilt on intrapulmonary shunt fraction and oxygenation during 1-lung ventilation in the lateral decubitus position.
Hypoxemia is a common problem of 1-lung ventilation. Arterial oxygenation progressively decreases after 1-lung ventilation. The surgical position influences the shunt and arterial oxygenation. Therefore we evaluated the effect of head-up tilt on intrapulmonary shunt and oxygenation during 1-lung ventilation in the lateral decubitus position. ⋯ Head-up tilt during 1-lung ventilation in the lateral decubitus position caused a significant decrease in shunt and an increase in arterial oxygenation that persisted after the patient was returned to the horizontal lateral decubitus position.
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J. Thorac. Cardiovasc. Surg. · Jun 2010
Early and midterm results of thoracic endovascular aortic repair of chronic type B aortic dissection.
The optimal treatment for chronic type B dissection remains controversial. This study reports early and midterm results of thoracic endovascular aortic repair for chronic type B aortic dissection. ⋯ Early and midterm results show that thoracic endovascular aortic repair was effective in the treatment of chronic type B aortic dissection. Endoleak was the main cause of death during follow-up. With increased surgical experience and refinement of the stent graft, results are likely to improve in the future.
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J. Thorac. Cardiovasc. Surg. · Jun 2010
Effect of pressure management during hypothermic selective cerebral perfusion on cerebral hemodynamics and metabolism in pigs.
The effect of perfusion pressure on cerebral hemodynamics and metabolism during selective cerebral perfusion in patients undergoing aortic surgery is still unknown. This study explored cerebral blood flow, metabolic rate, and intracranial pressure at different pressure rates. ⋯ High-pressure perfusion provides no benefit during long-term selective cerebral perfusion at 25 degrees C. Higher cerebral blood flow during the initial 25 minutes of selective cerebral perfusion leads to cerebral edema, with no alteration in metabolic rate.