Journal of cardiac surgery
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Randomized Controlled Trial Comparative Study
Sixteen-slice multidetector computed tomography for graft patency evaluation after coronary artery bypass surgery.
To investigate the ability of 16-slice multidetector computed tomography (MDCT) to assess coronary artery bypass graft patency and to detect bypass stenosis by comparison with coronary angiography. ⋯ Sixteen-slice MDCT allows for noninvasive evaluation of coronary bypass grafts patency with high diagnostic accuracy. Assessment of distal anastomotic stenosis was deficient, particularly for arterial grafts, still limited by low resolution or artifacts. Improved accuracy may be obtained by more aggressive heart rate reduction.
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Randomized Controlled Trial
Evaluation by cardiac troponin I: the effect of ischemic preconditioning as an adjunct to intermittent blood cardioplegia on coronary artery bypass grafting.
Ischemic preconditioning (IPC) is commonly regarded as having a powerful internal protective effect on the organs. The mechanism of IPC is not clear yet, and the controversy over the benefits and protocol of IPC still continues. In this study, we used the sensitive and specific biochemical marker: cardiac troponin-I (CTnI) to evaluate whether IPC as an adjunct to intermittent cold blood cardioplegia (CBC) could reduce myocardial injury, as opposed to simple CBC during coronary artery bypass grafting (CABG). ⋯ Compared to the simple CBC in lower-risk CABG patients, IPC as an adjunct to CBC reduced CTnI release, improved heart function after surgery, and shortened the time of recovery in CAD patients.
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Randomized Controlled Trial
Biocompatibility of heparin-coated cardiopulmonary bypass circuits in coronary patients with left ventricular dysfunction is superior to PMEA-coated circuits.
Several coating techniques for extracorporeal circulation have been developed to diminish the systemic inflammatory response during cardiopulmonary bypass (CPB). The aim of this study was to evaluate the clinical effectiveness and biocompatibility of heparin-coated and poly-2-methoxyethylacrylate (PMEA)-coated CPB circuits on coronary patients with left ventricular systolic dysfunction. ⋯ Heparin-coated circuit provided better suppression of perioperative inflammatory markers and exhibited more favorable effects on hematologic variables than PMEA-coated circuit.
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Randomized Controlled Trial
Effect of low-dose amiodarone and magnesium combination on atrial fibrillation after coronary artery surgery.
To evaluate whether postoperative administration of intravenous low-dose amiodarone and magnesium sulfate (MgSO(4)) combination would reduce the incidence of atrial fibrillation following coronary artery bypass grafting (CABG) in normomagnesemic high-risk patients for postoperative atrial fibrillation (POAF). ⋯ Combined prophylactic therapy with amiodarone and MgSO(4) at the early postoperative period without a maintenance phase is an effective, simple, well-tolerated, and possibly cost-effective regimen to prevent POAF in normomagnesemic, high-risk patients.
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Randomized Controlled Trial
Topical cooling for myocardial protection: the results of a prospective randomized study of the "shallow technique".
Respiratory distress following cardiac surgery is a troublesome complication. In several cases it is associated to cool-related phrenic nerve injury (PNI) after adoption of iced slush or hypothermic cardiopulmonary bypass. We compare two different strategies for myocardial protection: the "shallow technique" (ST) (dripping and prompt removal of cold saline solution from the epicardial surface) plus normothermic cardiopulmonary bypass, versus mild hypothermic cardiopulmonary bypass plus iced slush. ⋯ ST likely reduces the incidence of postoperative PNI and might be protective mainly in the event of ITA harvest. It should be considered as a valuable tool for myocardial protection protocols.