European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Aug 2009
Anomalous origin of the left coronary artery from the pulmonary artery: late results with special attention to the mitral valve.
Evaluate the late results of a uniform approach to the surgical management of children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). ⋯ (1) Early mortality is related to the severity of preoperative left ventricular dysfunction; it may be reduced by a careful use of postoperative cardiac support techniques. (2) Late results are satisfactory and left ventricular function always recovers. (3) Mitral regurgitation improves along with left ventricular function, but recovery may be incomplete and need reoperation. The data suggest that mitral valve surgery is probably not indicated at initial surgery, except in selected cases with a low potential of recovery (severe regurgitation with relatively well-preserved left ventricular function).
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Eur J Cardiothorac Surg · Aug 2009
Montgomery T-tube placement in the treatment of benign tracheal lesions.
Although surgery remains the gold standard for the treatment of benign tracheal stenosis, airway stenting may be indicated in the event of complex lesions or associated diseases. We retrospectively investigated Montgomery T-tube placement as an alternative or complementary treatment to surgery. ⋯ Montgomery T-tube placement represents a useful option in patients with complex benign tracheal stenosis or associated diseases as an alternative or complementary treatment to surgery, and is effective even when other types of stents are unsuccessful.
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Eur J Cardiothorac Surg · Aug 2009
Fast-track rehabilitation for lung cancer lobectomy: a five-year experience.
Fast-track rehabilitation is a group of simple measures that reduces morbidity, postoperative complication and accelerates postoperative rehabilitation reducing hospital stay. It can be applied to lung cancer lobectomy. Fast-track rehabilitation cornerstones are: minimally invasive surgical techniques using video-assisted and muscle sparring incisions, normovolemia, normothermia, good oxygenation, euglicemia, no unnecessary antibiotics, epidural patient-controlled analgesia, systemic opiods-free analgesia, early ambulation and oral feeding. Our objective is to describe a five-year experience with fast-track rehabilitation for lung cancer lobectomy. ⋯ Fast-track rehabilitation for lung cancer lobectomies can be safely performed in a selected group of patients if a motivated multidisciplinary group of professionals is available and seems to reduce postoperative complication and hospital stay.
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Eur J Cardiothorac Surg · Aug 2009
Randomized Controlled Trial Comparative StudyTranexamic acid and aprotinin in low- and intermediate-risk cardiac surgery: a non-sponsored, double-blind, randomised, placebo-controlled trial.
Tranexamic acid has been suggested to be as effective as aprotinin in reducing blood loss and transfusion requirements after cardiac surgery. Previous studies directly comparing both antifibrinolytics focus on high-risk cardiac surgery patients only or suffer from methodological problems. We wanted to compare the effectiveness of tranexamic acid versus aprotinin in reducing postoperative blood loss and transfusion requirements in the patient group representing the majority of cardiac surgery patients: low- and intermediate-risk patients. ⋯ Aprotinin has clinically significant advantages over tranexamic acid in patients with normal renal function scheduled for low- or intermediate-risk cardiac surgery.
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Eur J Cardiothorac Surg · Aug 2009
ReviewThe present status of off-pump coronary artery bypass grafting.
Coronary revascularisation using cardiopulmonary bypass remains the gold standard treatment for coronary artery disease. Over the past decade, techniques of revascularisation on the beating heart without the use of cardiopulmonary bypass (off-pump surgery) have evolved with an attempt to reduce the potential deleterious effects of extracorporeal circulation. ⋯ The impact of this mode of revascularisation has probably been underestimated especially in an era where surgical revascularisation is being increasingly undertaken in older patients with significant comorbidities. In this contribution, the current evidence from randomised trials, meta-analyses and observational studies is critically reviewed.