The Annals of thoracic surgery
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Use of profoundly hypothermic cardiopulmonary bypass may increase the risk of postoperative bleeding and lung and renal dysfunction. The aim of this study was to analyze postoperative blood loss and indices of pulmonary and renal dysfunction in patients undergoing proximal aortic surgery with and without the use of profound hypothermia to determine risk factors for nonneurologic morbidity. ⋯ Profound hypothermia may cause a coagulopathy, but procedure extent is the primary determinant of postoperative bleeding. Profoundly hypothermic cardiopulmonary bypass does not appear to be a risk factor for renal or early pulmonary dysfunction or intensive therapy unit length of stay.
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To objectively measure long-term neurocognitive deficit in patients undergoing coronary artery bypass grafting and compare the findings with nonsurgical controls. ⋯ As shown by means of objective measures, and in comparison to nonsurgical controls, coronary artery bypass grafting with cardiopulmonary bypass grafting causes long-term neurocognitive deficit.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization.
Cardiopulmonary bypass (CPB) is associated with a systemic stress hormonal response, which can lead to changes in hemodynamics and organ perfusion. We examined perioperative stress hormone release in low-risk patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass. ⋯ Despite the avoidance of cardiopulmonary bypass, off-pump coronary artery bypass grafting surgery triggers a systemic stress hormone response that is comparable to conventional surgical revascularization. The neurohormonal environment during beating-heart surgery should be further explored.
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The operative technique of a transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy without sternotomy is described and the early results of the follow-up of patients operated on are analyzed. ⋯ We conclude that the "maximal" transcervical-subxiphoid-videothoracoscopic thymectomy is a safe operative technique, avoiding a sternotomy, performed partly in an open fashion with the extensiveness comparable with the transsternal extended and "maximal" thymectomies. The two-team approach helps to reduce the operative time. However, because of the limited time of follow-up it is too early for the final assessment of the long-term results of this method in the treatment of myasthenia gravis.
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Randomized Controlled Trial Comparative Study Clinical Trial
Bradykinin preconditioning in coronary artery bypass grafting.
Experimental studies have shown that activation of bradykinin B2 receptor is one of the most important triggers of ischemic preconditioning. However, the effect of exogenous administration of bradykinin in cardiac surgery is not yet known. The present prospective randomized study was designed to investigate the effect of bradykinin pretreatment in patients undergoing elective coronary artery bypass surgery. ⋯ Exogenous bradykinin infusion showed weak cardioprotective effect in the low-risk patients undergoing coronary artery bypass surgery but the dose used in the study caused acute decrease of systemic blood pressure.