European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Apr 2004
Randomized Controlled Trial Comparative Study Clinical TrialDiltiazem provides higher internal mammary artery flow than nitroglycerin during coronary artery bypass grafting surgery.
Perioperative internal mammary artery (IMA) vasospasm in patients undergoing coronary artery bypass grafting (CABG) surgery may lead to morbidity and mortality. Surgical stimulus is one of the common causes of IMA vasospasm. Preventive measures, beside treatment should be taken into consideration to obtain vasospasm free IMA. The effect of a pharmacologic agent on IMA flow when it is administered before harvesting the artery has not been documented. We designed a prospective randomized clinical study to compare the IMA free blood flows in patients receiving either diltiazem or nitroglycerin, starting infusion of study drugs before a surgical stimulus was applied to the IMA region and continuing throughout the isolation period. ⋯ Diltiazem infusion which started prior to harvesting provided higher IMA blood flow compared to nitroglycerin infusion. Considering the percentage of increases in flows after resection of distal segment, the most prone part to vasospasm, we assume that a certain amount of spasm occurred in IMA in spite of infusion of study drugs, such that less with diltiazem and more with nitroglycerin. Diltiazem plays more important role than nitroglycerin in the prevention of vasospasm.
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Eur J Cardiothorac Surg · Apr 2004
Peripheral blood dendritic cells in human end-stage heart failure and the early post-transplant period: evidence for systemic Th1 immune responses.
Dendritic cells (DCs) are antigen presenting cells that play a central role in inflammation, allograft rejection and immune tolerance. Myeloid (mDC) and plasmacytoid (pDC) subsets regulate immune reactions by polarising naive T-helper cells into a Th1 or Th2 response, respectively. In this study we examined total peripheral blood DCs, mDC and pDC subsets in chronic heart failure (CHF) and clinical heart transplantation (HTx). ⋯ Total peripheral blood DCs are elevated during CHF due to an increase in the mature fraction of the mDC subset suggesting a possible Th1 response in end-stage heart failure. The decrease in total DCs and mature mDCs and pDCs seen post-HTx, probably reflects immunological quiescence through adequate immunosuppression. Peripheral blood DC monitoring may provide a new insight into mechanisms of heart failure and allograft rejection by safe weaning from immunosuppression after clinical HTx.
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Eur J Cardiothorac Surg · Apr 2004
Weaning from ventilator after cardiac operation using the Ciaglia percutaneous tracheostomy.
To determine the predictors of weaning from mechanical ventilation after cardiac operation with the Ciaglia percutaneous dilatational tracheostomy (PDT) in our preliminary experience in the use of this technique. ⋯ Early PDT was a safe and effective method to wean from mechanical ventilation the cardiosurgical patients of this series.
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Patients with hematologic malignancies are frequently in need of major cardiac operations. Previous reports suggest an increased risk for perioperative complications in these immunodeficient patients. ⋯ Cardiac operations can be performed with acceptable mortality but significant morbidity rates in patients with hematologic malignancies. Bleeding and infectious complications are most frequently seen and usually lead to reoperations. These findings warrant caution during patient selection.