J Cardiovasc Surg
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Review
Evidence-based management of carotid stenosis: recommendations from international guidelines.
A 50-99% stenosis of the extracranial internal carotid artery can be in detected in 1-3% of all adults. Embolising plaques or acute carotid occlusions cause cerebral ischemia in 1-5% of all patients with an asymptomatic 50-99% stenosis of the internal carotid artery. ⋯ Therefore all recent national and international guidelines for stroke management, stroke prevention and carotid artery disease published between 2008 and 2011 were reviewed. This paper gives an overview about these guidelines and their most important recommendations with respect to carotid artery stenosis.
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Randomized Controlled Trial Comparative Study
Influence of temperature management on neurocognitive function in biological aortic valve replacement. A prospective randomized trial.
Aim of this study was to elucidate if postoperative neurocognitive function after biological aortic valve replacement (AVR) can be influenced by temperature management during cardiopulmonary bypass (CPB). ⋯ Normothermic temperature management during CPB is non-inferior to hypothermic in means of neuroprotection. Since patients after biological aortic valve replacement show a subclinical but measurable cognitive deficit up to four months after surgery, other factors have to be addressed to add further benefit to the extremely good results of open biological AVR.
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Comparative Study
Gender-related differences in patients undergoing mechanical aortic valve replacement with the CarboMedics valve.
The aim of this paper was to evaluate gender-related differences in patients undergoing mechanical aortic valve replacement with the CarboMedics valve. ⋯ Gender per se is an independent risk factor of survival after mechanical aortic valve replacement. Severely impaired LVEF independently predicts survival in males whereas additional CABG and redo surgery do in females. Age affects survival in both sexes. These findings may serve as a basis for further improving gender related outcome.
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This retrospective study compares outcomes according to anesthesia technique of a consecutive series of 48 endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) performed by one vascular surgeon at a single institution over a five-year period. ⋯ The results of this study suggest that use of MAC with local anesthesia during EVAR of AAAs is comparable to general and regional anesthesia in terms of safety and efficacy. Furthermore, MAC with local anesthesia confers additional outcome benefits versus general and regional anesthesia, as it is less invasive, offers greater hemodynamic stability, and enables better communication with the patient.
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Our aim is to analyze the ability of distal endovascular procedures, performed as first treatment option, to promote ischemic ulcer healing. ⋯ Endovascular and surgical distal procedures had a similar ulcer healing rate and limb salvage. Our experience supports endovascular-first strategy for CLI with tissue loss.