The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 2011
Review Meta AnalysisDrug-eluting stents versus coronary artery bypass grafting for the treatment of coronary artery disease: a meta-analysis of randomized and nonrandomized studies.
We performed the present systematic review and meta-analysis of randomized and nonrandomized comparative studies in an attempt to compare the safety and efficacy of drug-eluting stents with coronary artery bypass grafting for patients with coronary artery disease. ⋯ Drug-eluting stents are associated with less periprocedural risks but a higher incidence of postprocedural myocardial infarction, repeat revascularization, and 12-month major adverse cardiac and cerebrovascular events compared with coronary artery bypass grafting.
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J. Thorac. Cardiovasc. Surg. · May 2011
Review Meta AnalysisShort- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis.
Our objectives were to evaluate short- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting and to identify preoperative and intraoperative patient characteristics associated with new-onset atrial fibrillation. ⋯ New-onset atrial fibrillation after coronary artery bypass grafting appears to increase short- and long-term mortality. Preoperative use of ß-blockers, avoidance of angiotensin-converting enzyme inhibitors, and shorter cardiopulmonary bypass and aortic clamp times potentially reduce occurrence of new-onset atrial fibrillation.
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J. Thorac. Cardiovasc. Surg. · May 2011
Randomized Controlled Trial Comparative StudyComparison of the effectiveness and safety of a new de-airing technique with a standardized carbon dioxide insufflation technique in open left heart surgery: a randomized clinical trial.
We have compared the effectiveness, time required for de-airing, and safety of a newly developed de-airing technique for open left heart surgery (Lund technique) with a standardized carbon dioxide insufflation technique. ⋯ The Lund de-airing technique is safer, simpler, and more effective compared with the carbon dioxide insufflation technique. The technique is also more cost-effective because the de-airing time is shorter and no extra expenses are incurred.
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J. Thorac. Cardiovasc. Surg. · May 2011
Randomized Controlled Trial Comparative StudyNeurocognitive and neuroanatomic changes after off-pump versus on-pump coronary artery bypass grafting: long-term follow-up of a randomized trial.
It is unknown whether avoidance of cardiopulmonary bypass during coronary artery bypass grafting affects cerebral injury or long-term neuropsychological function. ⋯ After a mean of 7.5 years of follow-up, patients undergoing off-pump coronary artery bypass performed better than those undergoing cardiopulmonary bypass in several neuropsychological domains; these differences were small and of uncertain clinical importance. Early brain magnetic resonance imaging showed no significant differences in acute cerebral infarctions between the off-pump coronary artery bypass and cardiopulmonary bypass groups.
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J. Thorac. Cardiovasc. Surg. · May 2011
Randomized Controlled Trial Comparative StudyCardiotomy suction, but not open venous reservoirs, activates coagulofibrinolysis in coronary artery surgery.
Closed and miniaturized cardiopulmonary bypass circuits, which eliminate cardiotomy suction and open venous reservoirs with a reduced priming volume, have been reported to be advantageous. We comparatively examined the respective contribution of cardiotomy suction and open venous reservoirs to perioperative activation in coagulofibrinolysis and inflammation systems, with identical conditions of priming volume and anticoagulation. ⋯ Cardiotomy suction, but not open venous reservoirs, causes perioperative coagulofibrinolysis activation, although neither affects the inflammation system. The use of cardiotomy suction needs to be examined further in association with postoperative PAI-1 elevation and early vein graft occlusion.