The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2011
Randomized Controlled Trial Comparative StudyThe influence of bypass temperature on the systemic inflammatory response and organ injury after pediatric open surgery: a randomized trial.
Systemic cooling for cardiopulmonary bypass is widely used to attenuate the systemic inflammatory response syndrome and organ injury in children after open surgery. We compared the effects of moderate (24 °C) and mild (34 °C) hypothermia during bypass on markers of the systemic inflammatory response syndrome and organ injury, and on clinical outcome after corrective surgery for congenital heart disease. ⋯ There is no evidence that the systemic inflammatory response syndrome and organ injury after pediatric open surgery are influenced by bypass temperature. The routine use of hypothermic bypass may not be warranted in the pediatric population.
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J. Thorac. Cardiovasc. Surg. · Jul 2011
Randomized Controlled Trial Comparative StudyResults of mitral valve repair for Barlow disease (bileaflet prolapse) via right minithoracotomy versus conventional median sternotomy: a randomized trial.
The results of mitral repair for complex Barlow valves are adequate and support earlier intervention. It is unknown whether these results are reproducible in the context of minimally invasive surgery via right minithoracotomy. ⋯ Our data indicate that the optimal standard-of-care results of mitral repair for complex disease (Barlow) are reproducible in the minimally invasive settings through right minithoracotomy and direct vision. The minimally invasive technique can be proposed for complex mitral disease and early referral of these patients can be encouraged.
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J. Thorac. Cardiovasc. Surg. · Jul 2011
Randomized Controlled TrialEffect of remote ischemic preconditioning on renal dysfunction after complex valvular heart surgery: a randomized controlled trial.
Acute kidney injury after cardiac surgery with cardiopulmonary bypass is closely related to systemic inflammatory reactions and oxidative stresses. Remote ischemic preconditioning is a systemic protective strategy whereby brief limb ischemia confers systemic protection against prolonged ischemia and inflammatory reactions in distant organs. This study investigated whether remote ischemic preconditioning provides systemic protective effect on kidneys that are not directly exposed to ischemia-reperfusion injury during complex valvular heart surgery. ⋯ In patients undergoing complex valvular heart surgery, remote ischemic preconditioning did not reduce degree of renal injury or incidence of acute kidney injury whereas it did reduce myocardial injury and intensive care unit stay.
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J. Thorac. Cardiovasc. Surg. · Jul 2011
Left ventricular pacing lead insertion via the coronary sinus cardioplegia cannula: a novel method for temporary biventricular pacing during reoperative cardiac surgery.
Temporary biventricular pacing to treat low output states after cardiac surgery is an active area of investigation. Reoperative cases are not studied due to adhesions, which preclude left ventricular mobilization to place epicardial pacing wires. In such patients, inserting a temporary left ventricular lead via the coronary sinus cardioplegia cannula may allow for biventricular pacing. We developed a novel technique for intraoperative left ventricular lead placement. ⋯ Intraoperative biventricular pacing with a left ventricular pacing lead inserted via the coronary sinus cardioplegia cannula is feasible, using standard instrumentation and without requiring cardiac manipulation. This approach merits further study in patients undergoing reoperative cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Jul 2011
Comparative StudyEffect of preoperative non-dialysis-dependent renal dysfunction on isolated aortic and mitral valve surgery: a propensity score analysis.
Our objective was to examine whether preoperative non-dialysis-dependent renal dysfunction is associated with operative mortality or morbidity in isolated valve surgery. ⋯ Preoperative renal dysfunction is associated with higher morbidity in both cohorts, and patients undergoing mitral valve surgery also experienced higher mortality. The impact of non-dialysis-dependent preoperative renal dysfunction appears to be more pronounced in patients undergoing mitral valve surgery, potentially owing to their relative intolerance to volume overload.