The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2002
Comparative StudyImpact of Cox maze procedure on outcome in patients with atrial fibrillation and mitral valve disease.
We sought to determine whether the Cox maze procedure provides additional benefit to patients with atrial fibrillation undergoing mitral valve operations. ⋯ The addition of the Cox maze procedure to mitral valve repair and replacement was safe and effective for selected patients. Elimination of atrial fibrillation significantly decreased the incidence of late stroke.
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J. Thorac. Cardiovasc. Surg. · Sep 2002
Comparative StudyImproved outcomes in coronary artery bypass grafting with beating-heart techniques.
Although improved outcomes for selected patients by elimination of cardiopulmonary bypass have been demonstrated, a benefit for all patients undergoing coronary artery bypass grafting by all surgeons has yet to be definitively proved. ⋯ Beating-heart surgery can be safely assimilated into a cardiac surgical practice, although adoption rates vary significantly among individual surgeons. Gradual integration can lead to improved outcomes in the total coronary artery bypass surgery population.
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J. Thorac. Cardiovasc. Surg. · Sep 2002
Comparative StudyTumor necrosis factor-alpha production in whole blood after cardiopulmonary bypass: downregulation caused by circulating cytokine-inhibitory activities.
Cardiopulmonary bypass is associated with the release of proinflammatory cytokines (tumor necrosis factor alpha, interleukin 1beta, interleukin 6, and interleukin 8) and anti-inflammatory cytokines (interleukin 10 and transforming growth factor beta(1)). On the one hand this cytokine release is related to the postoperative systemic inflammatory response syndrome, and on the other hand it is related to deterioration of the immune system, for example in monocyte or polymorphonuclear neutrophil function, leading to an increased susceptibility to infections. To gain further insight into the alterations of immune cell reactivity and possible regulatory mechanisms, we studied lipopolysaccharide-induced tumor necrosis factor alpha synthesis in whole blood from cardiac surgical patients. ⋯ These results suggest that during cardiac operations cytokine-inhibitory serum activities are released or newly formed. These activities could not be explained by the actions of interleukins 4 and 10 or transforming growth factor beta(1). Although their exact nature remains undetermined, these substances may contribute to the diminished immune cell functions after cardiopulmonary bypass and thus need further characterization.
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J. Thorac. Cardiovasc. Surg. · Sep 2002
Comparative StudyLong-term neurodevelopmental outcomes in school-aged children after neonatal arterial switch operation.
Neurodevelopmental status of children between 8 and 14 years of age after neonatal arterial switch operation for transposition of the great arteries has not previously been systematically evaluated. ⋯ The neonatal arterial switch operation with combined circulatory arrest and low-flow bypass is associated increasingly with age, with reduced neurodevelopmental outcome but not with cognitive dysfunction. In our experience, the risk of long-term neurodevelopmental impairment after neonatal corrective cardiac surgery is related to deleterious effects of the global perioperative management and to special adverse effects of prolonged bypass duration. Severe preoperative acidosis and hypoxia and postoperative hemodynamic instability must be considered as important additional risk factors.