The Annals of thoracic surgery
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Comparative Study
Effects of mast cell membrane stabilizing agents in a rat lung ischemia-reperfusion model.
The aim of this study was to test the hypothesis that agents which stabilize the mast cell membrane may modulate the phenotype of the vascular wall in a lung ischemia-reperfusion model, including altering expression of endothelial and leukocyte adhesion receptors and the inducible nitric oxide synthase (NOS-2). ⋯ These data establish that mast cell stabilizing agents modulate the vascular phenotype in the setting of pulmonary ischemia and reperfusion by decreasing ICAM-1 expression, augmenting expression of NOS-2, and increasing tissue cGMP levels. As decreasing ICAM-1 expression and increasing cGMP levels have proven useful to limit proinflammatory mechanisms of tissue injury, mast cell stabilizing agents may provide a new therapeutic option to improve organ function in the setting of reperfusion.
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Lung rest is the primary goal of venovenous extracorporeal membrane oxygenation for severe acute respiratory failure. To achieve this there has to be adequate extracorporeal flow. ⋯ We report 8 patients in whom we achieved adequate blood and oxygen delivery using a three-cannula technique. Five patients survived (62.5%).
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In off-pump coronary bypass grafting (CABG), invasiveness is reduced but technically perfect anastomosis is jeopardized by cardiac motion and the need to hurry to reduce the time of ischemia. Also, a major cause of postoperative morbidity and mortality is ungrafted circumflex coronary artery disease. We have devised a means of overcoming these shortcomings and performing multivessel CABG. The objective of this study was to assess the safety and efficacy of our technique. ⋯ These results suggest that off-pump CABG with our techniques is effective and safe. Early clinical outcome and excellent patency rates suggest its more widespread use in selected cases.
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Contemporary residency training in the cardiac component of cardiothoracic operation is focused mainly on attaining technical proficiency in coronary artery revascularization. Most trainees in cardiothoracic operation are required to perform 35 cases of coronary revascularization in order to fulfill the minimum requirements for certification by the American Board of Thoracic Surgery. Although experience in minimally invasive coronary revascularization is not required for board certification in cardiothoracic operation, it is recognized by both trainees and program directors as an important component of contemporary training in less-invasive surgical approaches (LISA) for coronary artery disease. The objective of this study was to describe the training of residents in off-pump coronary revascularization in an accredited training program. ⋯ Technical innovations and evolution of techniques to better stabilize the heart for off-pump coronary revascularization have made the procedure both effective and safe. Our experience has shown that cardiothoracic residents can be taught the skills necessary to perform coronary revascularization off cardiopulmonary bypass. There are currently no standards for the training of cardiothoracic residents in off-pump coronary artery operation. We propose that at least 50 cases be performed under supervision by a trained surgeon to obtain adequate credentials in minimally invasive coronary revascularization.
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Health care reform, public disclosure of hospital and surgeon-specific results, plus changes in reimbursement patterns have raised the specter of volume-based credentialing. ⋯ Excellent results can be obtained for patients undergoing coronary artery bypass grafting in the presence of both low surgeon and low hospital case volume.