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 2014
Perioperative outcomes of cardiac surgery patients with ongoing ticagrelor therapy: boon and bane of a new drug.
Ticagrelor (Brilique®) is a novel reversible platelet inhibitor at P2Y12 receptor used in patients with acute coronary syndrome and patients undergoing percutaneous coronary interventions. Unlike clopidogrel (Plavix®), ticagrelor has a quicker offset of action, and therefore, it seems that platelet function recovers faster on discontinuation of therapy. These drugs sometimes cannot be stopped before coronary artery bypass grafting due to the risk of stent thrombosis or in case of emergency operations. Therefore, we investigated whether the continued preoperative use of ticagrelor influences the perioperative course of cardiac surgical patients. ⋯ In cardiac surgical patients who are treated with ticagrelor + ASA until surgery, ticagrelor therapy is associated with a significantly higher blood loss, a significantly higher use of blood products and coagulation factors and higher incidence of rethoracotomies for bleeding compared with patients treated with clopidogrel + ASA.
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Eur J Cardiothorac Surg · Aug 2014
Endovascular therapy in patients with genetically triggered thoracic aortic disease: applications and short- and mid-term outcomes.
For patients with genetically triggered thoracic aortic disease, the morbidity and mortality associated with reoperation are high, making endovascular treatment an appealing option. We evaluated the short- and mid-term outcomes of different applications of endovascular intervention in such patients. ⋯ Endovascular technology can be helpful in treating selected young patients with genetically triggered thoracic aortic disease. Long-term studies and further evolution of endovascular technology will be necessary for it to be incorporated into the armamentarium of surgical options for this challenging patient population.
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Eur J Cardiothorac Surg · Jul 2014
Time to refine N2 staging? cN2α and cN2β based on local regional involvement provide a more accurate prognosis in surgically treated IIIA non-small-cell lung cancer than N2 alone or the number of node stations involved.
The number of stations of N2 nodes involved has been considered to be one of the most important prognostic factors for lung cancer. However, most reports have dealt with the pathological nodal status rather than with the clinical nodal status. We investigated the relationship between the prognosis and the location of the primary tumour and nodes involved. ⋯ Clinical mediastinal lymph node status based on the location of the primary tumour and the node involved was an important preoperative prognostic factor. Thus, this factor should be considered when planning and evaluating clinical trials. Another important finding was that clinical single-station N2 is not always pathological single-station N2 disease.
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Eur J Cardiothorac Surg · Jul 2014
Randomized Controlled TrialPerioperative gabapentin for the prevention of persistent pain after thoracotomy: a randomized controlled trial.
To evaluate the effect of perioperative gabapentin treatment for the prevention of persistent post-thoracotomy pain and to establish whether gabapentin has a significant therapeutic impact on acute postoperative pain. ⋯ We found no evidence for the superiority of gabapentin over placebo for the treatment of acute pain following thoracotomy or for the prevention of persistent post-thoracotomy pain.
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Eur J Cardiothorac Surg · Jul 2014
Safety and feasibility of concomitant surgical ablation of atrial fibrillation in patients with severely reduced left ventricular ejection fraction.
Concomitant surgical ablation of atrial fibrillation (AF) is a safe and feasible procedure. However, many surgeons are reluctant to perform it in patients with heart failure. We investigated the safety and efficacy of AF ablation in patients with a severely reduced left ventricular ejection fraction (LVEF <35%). ⋯ Surgical AF ablation was safe and feasible in patients with severely reduced LVEF. The restoration of SR led to a significantly higher improvement in LVEF and alleviation of clinical heart failure symptoms, not observed if AF persisted postoperatively.