European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Nov 1999
Randomized Controlled Trial Comparative Study Clinical TrialThe effects of cardiopulmonary bypass temperature on inflammatory response following cardiopulmonary bypass.
The inflammatory response to cardiopulmonary bypass is believed to play an important role in end organ dysfunction after open heart surgery and may be more profound after normothermic systemic perfusion. The aim of the present study was to investigate the effects of cardiopulmonary bypass temperature on the production of markers of inflammatory activity after coronary artery surgery. ⋯ Normothermic systemic perfusion was not shown to produce a more profound inflammatory response compared to hypothermic and moderately hypothermic cardiopulmonary bypass.
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Eur J Cardiothorac Surg · Nov 1999
Comparative Study Clinical TrialA contrastive analysis of release patterns of biochemical markers of brain damage after coronary artery bypass grafting and valve replacement and their association with the neurobehavioral outcome after cardiac surgery.
The present study aimed at a comparative analysis of neurobiochemical markers of brain damage and the neurobehavioral outcome in patients undergoing either valve replacement (VR) or isolated coronary artery bypass surgery (CABG). In order to control for well known risk factors both samples were strictly matched according to age, sex and preoperative neuropsychological performance. ⋯ Our data indicate that--apart from patients' age and preoperative neuropsychological performance--type of surgery remains a risk factor for postoperative neurobehavioral disorders. The different vulnerability of neurobehavioral disorders might be mirrored in different postoperative release patterns of NSE. We assume that both, NSE release and neurobehavioral disorders might be caused by a higher amount of intraoperative cerebral embolic events in VR patients.
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Eur J Cardiothorac Surg · Nov 1999
Comparative StudyComparison of post-operative pain, stress response, and quality of life in port access vs. standard sternotomy coronary bypass patients.
Although it has been postulated that minimally invasive cardiac surgery using the port access method would reduce operative stress and postoperative pain and accelerate postoperative recovery to a good quality of life, few data are currently available to document this intuitively appealing claim. Therefore, this study was designed to examine differences in stress response, postoperative pain, rapidity of recovery, and quality of life after port access (PA) isolated coronary artery bypass surgery compared with standard sternotomy (STD) isolated coronary bypass surgery. ⋯ These results show that compared with STD coronary bypass patients PA patients enjoyed significant postoperative physiologic and quality of life advantages with less pain, less early stress response, better pulmonary function, and superior Duke Activity scores during the first 2 postoperative months.
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Eur J Cardiothorac Surg · Nov 1999
Comparative StudyQuality assessment in minimally invasive coronary artery bypass grafting.
The most important determinant for the success of minimally invasive coronary artery bypass grafting (MIDCAB) is the quality and long-term patency of the graft and anastomosis. Intra and postoperative quality assessment is important to confirm the safety and effectiveness of minimally invasive techniques. ⋯ A standardized protocol for quality assessment is mandatory for MIDCAB surgery. The proposed algorithm serves to ensure the safety and effectiveness of this new technique. Our recent series document an excellent outcome of the MIDCAB approach. Postoperative multiplan angiography is the only technique to achieve valid information about the quality of graft and anastomosis.
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Eur J Cardiothorac Surg · Nov 1999
Review Comparative StudyInterventional cardiology versus minimally invasive cardiac surgery.
Comparing interventional cardiology with minimally invasive cardiac surgery 1998 goes back to the early 80s when cardiologists treated coronary artery disease patients with balloon angioplasty under a permanent observation of cardiac surgeons who could offer to the patient the well established Conventional CABG, which already had proven to be safe, effective, durable, reproducible, and complete. At that time some critics predicted PTCA would remain the hobby of some cardiologists. During the last two decades, however, an explosive proliferation in the number of PTCA procedures has occurred, which soon exceed the number of CABG procedures. ⋯ Within the last 5 years the minimally invasive cardiac surgery has progressed, which allows the performance of even complex cardiac surgery through small incisions with (port-access technique) or without (MIDCAB technique) cardiopulmonary bypass. The rationale of enthusiastic users of these new techniques leads to improved cosmetic results, less surgical trauma, decreased length of hospital stay, reduced cost, and comparable long-term results with respect to conventional CABG. Similar to the prediction about PTCA two decades ago, some critics say that minimally invasive cardiac surgery would remain the hobby of some cardiac surgeons.