The Annals of thoracic surgery
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Minimally or less invasive surgical coronary revascularization has gained increasing interest along with new techniques and devices designed for easier and safer procedures. Until recently, it appeared questionable whether grafting techniques with avoidance of cardiopulmonary bypass techniques would allow adequate results compared with conventional techniques using cardioplegic arrest. ⋯ Using specially designed instruments for internal mammary artery access and epicardial surface stabilization, minimally invasive direct coronary artery bypass grafting procedures via a minithoracotomy avoiding cardiopulmonary bypass techniques may be applied safely and successfully, even in increased risk constellations.
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A membrane oxygenator consisting of a microporous polypropylene hollow fiber with a 0.2-microm ultrathin silicone layer (cyclosiloxane) was developed. Animal experimental and preliminary clinical studies evaluated its reliability in bypass procedures. ⋯ This oxygenator is more durable and offers greater gas transfer capabilities than the previous generation of oxygenators.
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Conventional coronary artery bypass grafting using cardiopulmonary bypass carries relatively high mortality and morbidity for patients with left ventricular dysfunction. ⋯ Coronary artery bypass grafting without cardiopulmonary bypass is a viable alternative to conventional coronary artery bypass grafting particularly for patients with extreme left ventricular dysfunction or those with coexisting risk factors, such as acute myocardial infarction and cardiogenic shock.
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Pulmonary resection is rarely required for trauma, and its mortality is reportedly high. ⋯ Pulmonary resection is infrequently required for lung injury. Overall mortality is lower than previously reported, but pneumonectomy has a high mortality. Blunt trauma has a higher mortality than penetrating trauma. Injury severity scores are higher for nonsurvivors than survivors; this shows the importance of associated injuries on outcome.
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Competitive status of percutaneous transluminal coronary angioplasty and stenting has stimulated an interest in minimally invasive direct coronary artery bypass grafting. ⋯ Minimally invasive direct coronary artery bypass grafting is safe and effective with good early and midterm clinical results, especially with left internal mammary artery-to-left anterior descending coronary artery grafting via minithoracotomy. Regional cardiac wall immobilization of coronary artery target sites enhances the early graft patency in a predictable manner (96.2%), and this method should be an essential part of all minimally invasive direct coronary artery bypass graft operations with left internal mammary artery-to-left anterior descending artery grafts via minithoracotomy. Further study is required to establish the long-term efficacy of minimally invasive direct coronary artery bypass grafting and the treatment of coronary artery disease.