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 2013
Randomized Controlled TrialMeasurement of extravascular lung water following human brain death: implications for lung donor assessment and transplantation.
The measurement of extravascular lung water could aid the assessment and guide the management of potential lung donors following brain death. We therefore sought to validate a single indicator thermodilution extravascular lung water index (EVLWI-T) measurement using gravimetry and to assess the impact and clinical correlates of elevated EVLWI-T in potential lung donors and transplant recipients. ⋯ Elevated lung water is found in >50% of potential lung donors, predicts lung suitability for transplant and may adversely affect recipient outcome. Although EVLWI-T intrinsically overestimates gravimetric lung water, its measurement may aid the assessment of organ suitability. Lung water accumulation and the proinflammatory response may both be targets for modifying therapy.
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Eur J Cardiothorac Surg · Jun 2013
Randomized Controlled TrialAcetylsalicylic acid treatment until surgery reduces oxidative stress and inflammation in patients undergoing coronary artery bypass grafting.
Acetylsalicylic acid (ASA) is a cornerstone in the treatment of coronary artery disease (CAD) due to its antiplatelet effect. Cessation of aspirin before coronary artery bypass grafting (CABG) is often recommended to avoid bleeding, but the practice is controversial because it is suggested to worsen the underlying CAD. The aims of the present prospective, randomized study were to assess if ASA administration until the day before CABG decreases the oxidative load through a reduction of inflammation and myocardial damage, compared with patients with preoperative discontinuation of ASA. ⋯ Continued ASA treatment until the time of CABG reduced oxidative and inflammatory responses. Also, a likely beneficial effect upon myocardial injury was noticed. Although none of the genes known to be involved in oxidative stress or inflammation took a different expression in myocardial tissue, the genetic analysis showed interesting differences in the mRNA level. Further research in this field is necessary to understand the role of the genes.
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Eur J Cardiothorac Surg · May 2013
Randomized Controlled TrialTreatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial.
This prespecified subgroup analysis examined the effect of diabetes on left main coronary disease (LM) and/or three-vessel disease (3VD) in patients treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in the SYNTAX trial. ⋯ In both diabetic and non-diabetic patients, PCI resulted in higher rates of MACCE and repeat revascularization at 5 years. Although PCI is a potential treatment option in patients with less-complex lesions, CABG should be the revascularization option of choice for patients with more-complex anatomic disease, especially with concurrent diabetes.
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Eur J Cardiothorac Surg · May 2013
Randomized Controlled TrialRegulated tailored suction vs regulated seal: a prospective randomized trial on air leak duration.
The objective of this study was to compare the air leak duration of two regulated chest tube modes following pulmonary lobectomy. ⋯ Regulated seal is as effective and safe as regulated suction in managing chest tubes following lobectomy. This information demonstrates with objective data the non-superiority of regulated suction vs regulated seal and may assist in future investigations on regulated pleural pressure.
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Eur J Cardiothorac Surg · Mar 2013
Randomized Controlled Trial Comparative StudyComparison of non-divided intercostal muscle flap and intercostal nerve cryoanalgesia treatments for post-oesophagectomy neuropathic pain control.
Oesophagectomy is at present considered to be the optimal curative treatment for patients with severe oesophageal disease. Postoperative pain, both acute and chronic, plays a significant role in the quality of life for post-oesophagectomy patients. The present study compared the effects of two methods-application of a non-divided intercostal muscle flap (NIMF) and intercostal nerve cryoanalgesia (INC) treatment-in reducing neuropathic pain in post-oesophagectomy patients. ⋯ Both NIMF and INC treatments were effective and safe for the treatment of acute pain after oesophagectomy. NIMF was the better technique in reducing chronic postoperative pain.