The Annals of thoracic surgery
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The minimally invasive reversed Z sternotomy is a surgical approach for aortic valve operations that provides an excellent view of the aortic root and allows access to the right atrium. It confers the advantages of preservation of the sternocostal articulations and both internal thoracic arteries with no need to enter either pleural cavity. It facilitates aortic and atrial cannulation for cardiopulmonary bypass and allows access for a superior pulmonary vein cardiac vent.
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The effect of inhaled nitric oxide (NO) treatment on pulmonary function in the setting of adult respiratory distress syndrome is controversial. We examined the effect of inhaled NO on pulmonary function in an isolated rabbit lung model of oleic acid (OA)-induced acute lung injury. We hypothesized that NO would decrease pulmonary artery pressure and improve oxygenation. ⋯ Contrary to our hypothesis, pretreatment with NO potentiates acute lung injury in our isolated lung model. There was significant exacerbation of pulmonary hypertension and no improvement in oxygenation. Further investigation of the possible deleterious effects of NO in acute lung injury are needed, especially in the early acute phases of this process.
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Comment Letter
Extracorporeal membrane oxygenation support and cytokines.
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Central nervous system dysfunction after cardiopulmonary bypass is frequent and can be caused by inadequate cerebral perfusion and oxygenation. ⋯ Because cerebral autoregulation is impaired during cardiopulmonary bypass, phenylephrine is effective in increasing the cerebral blood flow and may contribute to the prevention of postoperative neurologic dysfunction, especially in patients who have a low jugular venous bulb oxygen saturation.
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Randomized Controlled Trial Clinical Trial
Prospective, randomized clinical study of ischemic preconditioning as an adjunct to intermittent cold blood cardioplegia.
Ischemic preconditioning has been shown to be beneficial to myocardial preservation in a variety of models. This study was performed to determine whether ischemic preconditioning can ameliorate the postischemic myocardial dysfunction often seen in patients undergoing open heart operations. ⋯ Ischemic preconditioning significantly improves heart function in clinical cardiac operations, decreases the need for inotropic support, and could be an important adjunct to myoprotective strategies.