European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jun 2008
Spinal cord blood flow and ischemic injury after experimental sacrifice of thoracic and abdominal segmental arteries.
Spinal cord blood flow (SCBF) after sacrifice of thoracoabdominal aortic segmental arteries (TAASA) during thoracoabdominal aortic aneurysm (TAAA) repair remains poorly understood. This study explored SCBF for 72 h after sacrifice of all TAASA. ⋯ This study suggests that critical spinal cord ischemia after complete TAASA sacrifice does not occur immediately (intraoperatively), but is delayed 1-5h or longer after clamping, and represents failure to mount a hyperemic response to rewarming and awakening. The short duration of low SCBF associated with spinal cord injury suggests that hemodynamic and metabolic manipulation lasting only 24-72 h may allow routine preservation of normal cord function despite sacrifice of all TAASA secondary to surgical or endovascular repair of large TAAA.
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Eur J Cardiothorac Surg · Jun 2008
Redo aortic root surgery for failure of an aortic homograft is a major technical challenge.
Aortic homografts offer many advantages over prosthetic valves. However, homograft dysfunction due to degeneration or infection may lead to reoperation. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge. To assess reoperation events a retrospective review was conducted. ⋯ Reoperation on patients with an aortic homograft as a root presents a relatively high perioperative morbidity. The surgical strategy depends on the degree of homograft wall calcification.
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Eur J Cardiothorac Surg · Jun 2008
Preventing strategy of multidrug-resistant Acinetobacter baumanii susceptible only to colistin in cardiac surgical intensive care units.
The study aimed to determine the incidence and mortality of multidrug-resistant Acinetobacter baumannii in cardiac surgery, to elucidate the effectiveness of colistin treatment and to identify if the additional measures to the recommended procedures were able to control the dissemination of the pathogen. ⋯ The increasing prevalence of multidrug-resistant A. baumannii in surgical intensive care unit patients creates demand on strict screening and contact precautions. Following this infection control strategy we were able to achieve intermittent eradication of the pathogen during a 16-month period with continuous function of the intensive care unit. Despite the significant in vitro activity of colistin against multidrug-resistant Acinetobacter baumannii the results were discouraging.