The Annals of thoracic surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of leukocyte depletion on endothelial cell activation and transendothelial migration of leukocytes during cardiopulmonary bypass.
Although leukocyte depletion from systemic circulation during cardiopulmonary bypass (CPB) has been studied, the effect of leukocyte depletion on the leukocyte-endothelial cascade remains poorly understood. So far, there has been no published work on the effects of leukocyte filters during cardiac operations from the viewpoint of endothelial activation and transendothelial neutrophil migration. ⋯ Our results demonstrate a rationale for using a leukocyte filter in patients undergoing cardiac surgery to attenuate the endothelial-mediated component of the CPB-induced inflammatory response by reducing endothelial activation and neutrophil transmigration.
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Satisfactory neurologic outcome following aortic arch repair through right brachial artery perfusion is well established. However, how neurocognitive functions are affected following selective cerebral perfusion, still needs to be elucidated. ⋯ The low-flow selective antegrade cerebral perfusion technique through the right brachial artery may safely be used for the great majority of patients undergoing aortic arch repair without causing deteriorations in neurocognitive functions.
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The outcome in patients treated surgically for coronary artery disease is known to be influenced by the extent of the disease. Whether this factor also has an effect in patients undergoing isolated minimally invasive revascularization of the left anterior descending (LAD) artery using the internal thoracic artery (ITA) (MIDCAB) has not been looked at. Thus, this study sought to evaluate the impact of multivessel disease (MVD) on midterm outcome after MIDCAB. ⋯ Patients with isolated disease of the LAD appear to benefit from ITA grafting in the form of a MIDCAB procedure. Here, it should be an approach of choice. The results show that MVD is an independent risk factor for outcome in patients undergoing a MIDCAB procedure. Nevertheless, the midterm morbidity and mortality in MVD patients after a MIDCAB procedure where the LAD is the only target vessel for interventional or surgical treatment is acceptable despite a higher morbidity than in SVD patients.
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Review
Impact of intraoperative transesophageal echocardiography in patients undergoing valve replacement.
The role of intraoperative transesophageal echocardiography (IOTEE) in valve replacement surgery is not well established. The aim of this study was to explore the impact of immediate postpump IOTEE in valve replacement surgery at a single tertiary medical center. ⋯ Immediate postpump IOTEE is an important diagnostic and therapeutic role in valve replacement surgery and should be widely implemented.
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We aimed to identify risk factors for reexploration for bleeding after surgical revascularization in our practice. We also looked at the impact of resternotomy and the effect of time delay on mortality and other in-hospital outcomes. ⋯ Risk factors for reexploration for bleeding after coronary artery bypass grafting include older age, smaller body mass index, nonelective cases, and 5 or more distal anastomoses. Preoperative aspirin and heparin were risk factors for the on-pump coronary artery surgery group. Patients needing reexploration are at higher risk of complications if the time to reexploration is prolonged. Policies that promote early return to the operating theater for reexploration should be encouraged.