European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Feb 2006
Review Case ReportsTracheal replacement with an aortic autograft.
Tracheal replacement after extensive resection remains a challenge for the thoracic surgeon. We propose an innovative solution: the use of an aortic autograft. After an experimental work on animals with aortic autografts and allografts [Martinod E, Seguin A, Pfeuty K, Fornes P, Kambouchner M, Azorin JF, Carpentier AF. ⋯ The stent was removed at three months. The patient died at six months from an acute pulmonary infection without any sign of anastomosis leakage or graft rupture. A new field of clinical study has to be investigated.
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Eur J Cardiothorac Surg · Feb 2006
Randomized Controlled TrialLeft ventricular reconstruction benefits patients with ischemic cardiomyopathy and non-viable myocardium.
There are subsets of patients with ischemic cardiomyopathy for whom the optimal treatment strategies are not clear. The objective of this study was to delineate the relationship between clinical outcomes and surgical procedure in patients who were treated either with a coronary artery bypass graft or with a coronary artery bypass graft and additional ventricular restoration. ⋯ We have demonstrated that the short-term and mid-term outcomes of coronary artery surgery alone in patients with a large left ventricle are inferior to coronary artery surgery plus ventricular restoration.
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Eur J Cardiothorac Surg · Feb 2006
Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery: a prospective study.
Clopidogrel decreases recurrent ischemic events and improves intracoronary stent patency. There are scarce data on the effect of short-term and long-term clopidogrel on symptom recurrence and adverse cardiac events following off-pump coronary artery bypass graft surgery (OPCAB). ⋯ Clopidogrel therapy was independently associated with decreased symptom recurrence and adverse cardiac events following OPCAB. Extending clopidogrel use beyond 30 days did not have a significant effect on defined end points.
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Eur J Cardiothorac Surg · Feb 2006
Nodal status at repeat mediastinoscopy determines survival in non-small cell lung cancer with mediastinal nodal involvement, treated by induction therapy.
Remediastinoscopy is a valuable tool in restaging non-small cell lung cancer after induction therapy for mediastinal nodal involvement as it provides pathological evidence of response and may select patients for subsequent thoracotomy. However, long-term survival data after remediastinoscopy are scarce. ⋯ Remediastinoscopy is a valuable restaging procedure after induction therapy. Prognosis is poor in patients with persisting mediastinal nodal involvement, proven at repeat mediastinoscopy.
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Eur J Cardiothorac Surg · Feb 2006
Total arch replacement using a stepwise distal anastomosis for arch aneurysms with distal extension.
A total of 120 patients having arch to distal arch aneurysm with downstream extension underwent total arch replacement, with individual arch-vessel reconstruction through median sternotomy using a novel "stepwise" distal aortic anastomosis. Cardiopulmonary bypass was established by cannulating the right axillary artery and the ascending aorta or femoral artery. Hypothermia was at 22-28 degrees C. ⋯ Two patients (1.7%) developed permanent neurological dysfunction and three patients (2.5%) suffered transient cerebral deficits. Three patients (2.5%) required reentry for postoperative bleeding although in none of them bleeding was from the distal anastomosis site with the stepwise technique. Stepwise anastomosis is a useful and secure alternative for distal anastomosis in total arch replacement for arch to distal arch aneurysms with distal extension.