Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2008
Comparative StudyExercise capacity after lobectomy in patients with chronic obstructive pulmonary disease.
The aim of this study is to clarify whether patients with chronic obstructive pulmonary disease (COPD) lose less exercise capacity after lobectomy than do those without COPD, to the same extent as ventilatory capacity and lobectomy for selected patients with severe emphysema improve exercise capacity like ventilatory capacity. Seventy non-COPD patients (N group), 16 mild COPD patients (M group), and 14 moderate-to-severe COPD patients (S group) participated. Pulmonary function and exercise capacity tests were performed on the same day preoperatively and six months to one year after lobectomy. ⋯ However, their loss of exercise capacity was equivalent to that for the N and M groups. For the S group, there was a significant, negative correlation between preoperative FEV(1) % of predicted and percentage change in FEV(1) and maximum oxygen consumption (VO2 max) after lobectomy (r=-0.93, P<0.0001 and r=-0.64, P=0.01). In moderate-to-severe COPD patients, patients with a lower preoperative FEV(1) % of predicted experienced a smaller decrease in FEV(1) and VO2 max after lobectomy.
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Interact Cardiovasc Thorac Surg · May 2008
Comparative StudyBiochemical markers of myocardial injury in the pericardial fluid of patients undergoing heart surgery.
The purpose of this study was to compare cardiac markers in the pericardial fluid and serum in order to evaluate preoperative myocardial injury. Thirty patients were divided into three groups. The first group (AVR; n=10) received an aortic valve replacement. ⋯ Preoperative pericardial and serum cTnI were significantly higher in the ACS than in AVR and SA groups (P<0.01). Postoperative pericardial concentration of all markers was significantly higher (P<0.01) than in serum in all groups. We conclude that preoperative pericardial accumulation of cTnI may reflect subclinical injury which may not be demonstrated by the usual laboratory tests.
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Interact Cardiovasc Thorac Surg · May 2008
Papillary muscle realignment and mitral annuloplasty in patients with severe ischemic mitral regurgitation and dilated heart.
Chronic ischemic mitral regurgitation (IMR) is one of the leading causes of congestive heart failure and death. It is controversial whether mitral annuloplasty (MAP) per se can improve the long-term survival because IMR has been considered a disease of the left ventricle. We reviewed our experience of papillary muscle realignment in conjunction with MAP in patients with IMR. ⋯ Furthermore, a six-month echocardiographic examination demonstrated that these improvements remained unchanged. The combination of papillary muscle realignment and MAP seems to be effective in patients with IMR. The duration of the effect may be expected to be long-term with these methods.
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Interact Cardiovasc Thorac Surg · May 2008
ReviewIs blood cardioplegia superior to crystalloid cardioplegia?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether blood cardioplegia is clinically superior to crystalloid cardioplegia for myocardial protection. Altogether 501 papers were identified. ⋯ Of these, 10 reported some statistically significant clinical outcomes in favour of blood cardioplegia and five reported statistically significant differences in enzyme release in favour of blood cardioplegia. A recent survey of UK practice found that 56% of surgeons use cold blood cardioplegia, 14% use warm blood cardioplegia, 14% use crystalloid cardioplegia, 21% use retrograde infusion and 16% do not use any cardioplegia. The papers presented in our review support most of these practices!