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 2007
Long-term outcome after mitral valve repair: a risk factor analysis.
Mitral valve repair is the gold standard to restore mitral valve function and is now known to have good long-term outcome. In order to help perioperative decision making, we analyzed our collective to find independent risk factors affecting their outcome. ⋯ Mitral valve repair provides excellent survival. However, long-term outcome can be negatively influenced by perioperative risk factors. Risk of reoperation is higher in younger patients with a residual mitral regurgitation and without ring annuloplasty.
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Eur J Cardiothorac Surg · Aug 2007
Lung cancer in octogenarians: factors affecting long-term survival following resection.
To identify factors associated with long-term survival following pulmonary resection for lung cancer in patients 80 years of age or older. ⋯ Meaningful long-term survival is obtainable in elderly patients undergoing surgical resection for lung cancer. Careful patient evaluation and selection is necessary to identify patients who will benefit most from resection. Shorter survival was observed in male patients and those presenting with dyspnea. As could be expected, survival was also dependent on extent of resection and initial pathologic stage.
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Eur J Cardiothorac Surg · Aug 2007
Awake anaesthesia for major thoracic surgical procedures: an observational study.
Major thoracic surgical procedures are rarely performed under awake anaesthesia. The purpose of this study is to review the experience of a tertiary center in major thoracic surgical procedures done under awake anaesthesia. ⋯ We conclude that major thoracic procedure can be safely performed under awake anaesthesia. The technique avoids general anaesthesia and endotracheal intubation, reduces postoperative hospital stay and minimizes intensive care unit admission. This study strongly suggests awake anaesthesia can improve outcomes and reduce cost. A proper multi-center trial to further evaluate this technique is needed.
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Eur J Cardiothorac Surg · Aug 2007
Randomized Controlled TrialBeneficial effects of C1 esterase inhibitor in ST-elevation myocardial infarction in patients who underwent surgical reperfusion: a randomised double-blind study.
The inflammatory cascade has been hypothesized to be an important mechanism of post-ischaemic myocardial reperfusion injury and several studies demonstrated that C1 esterase inhibitor (C1-INH) is effective in post-ischaemia myocardial protection. Therefore, we aimed to investigate prospectively in a randomised double-blind study the cardioprotective effects of C1-INH in ST segment elevation myocardial infarction (STEMI) in patients who underwent emergent reperfusion with coronary artery bypass grafting (CABG). ⋯ The inhibition of the classic complement pathway by C1-INH appears to be an effective mean of preserving ischaemic myocardium from reperfusion injury as demonstrated by low serum cTnI levels in C1-INH group. Therefore, the use of C1-INH during CABG as a rescue therapy in STEMI patients is probably an effective treatment to inhibit complement activity and to improve cardiac function and haemodynamic performance without impacting early mortality. Large randomised study should be performed to support our results.
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Eur J Cardiothorac Surg · Aug 2007
Randomized Controlled TrialDesflurane preconditioning in coronary artery bypass graft surgery: a double-blinded, randomised and placebo-controlled study.
Recent clinical and experimental data indicate that volatile anaesthetics may precondition myocardium against ischaemia and infarction. The present clinical trial was designed to verify the cardioprotective effects of desflurane in patients undergoing elective coronary artery bypass surgery. It was hypothesized that desflurane preconditioning would decrease postoperative release of troponin I and brain natriuretic peptide (NT-proBNP). Besides, we have hypothesized that desflurane preconditioning would preserve the myocardium from the dysfunction following cardioplegic arrest. ⋯ We can conclude that the use of desflurane in these patients provides a pharmacological preconditioning so as to reduce myocardial necrosis and improve the cardiac performance in the postoperative period.