The Annals of thoracic surgery
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Hemodilution continues to be widely used during cardiopulmonary bypass (CPB) for both adults and children. Previous studies with nonbypass models have suggested that an increase in cerebral blood flow (CBF) compensates for the reduced oxygen-carrying capacity; however, this increased CBF is achieved by an increase in cardiac output. We hypothesized that even with the fixed-flow perfusion of CPB, CBF would be increased during hemodilution. ⋯ Hemodilution is associated with decreased perfusion pressure, increased CBF and increased the cerebral metabolic rate of oxygen during hypothermic CPB.
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Off-pump coronary artery bypass grafting (OPCAB) has gained wide acceptance in tandem with the development of the stabilizer and associated operative techniques. However bypass grafting to the small branches of a beating heart is technically demanding and remains controversial. In the present study we evaluated the graft patency and quality of anastomoses to small coronary arteries by early postoperative angiography. ⋯ OPCAB to small coronary artery branches with arterial grafts provided satisfactory graft patency and stenosis free rates.
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The recently introduced Impella Recover (Impella CardioSystems AG, Aachen, Germany) microaxial flow left and right ventricular assist devices (LVAD/RVAD) were evaluated as they provide circulatory support in the setting of postcardiotomy heart failure refractory to high-dose inotropic and intra-aortic balloon pump (IABP) support. ⋯ The initial experience with the Impella Recover VADs proved the new systems to be advantageous regarding the ease of implantation and device removal, low anticoagulation requirements, and advanced weaning features. In cases of severe heart failure, survival was improved by using LVADs when compared to that predicted by solely continuing IABP and drug support.
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Case Reports
Surgical resection of recurrent bilateral mediastinal liposarcoma through the clamshell approach.
Primary mediastinal liposarcoma is an unusual variant of mediastinal neoplasms. We describe a long-term survivor who underwent repeated operations. ⋯ The patient is currently well 16 years after the first operation. Aggressive surgical intervention whenever possible appears to improve the quality of life and prolong the survival of patients with mediastinal liposarcoma.
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We report a case of Klippel-Trenaunay-Weber syndrome presenting with hemoptysis.