The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Nov 2003
Randomized Controlled Trial Clinical TrialThe dynamic air bubble trap reduces cerebral microembolism during cardiopulmonary bypass.
Neuropsychologic disorders are common after coronary artery bypass operations. Air microbubbles are identified as a contributing factor. A dynamic bubble trap might reduce the number of gaseous microemboli. ⋯ Gaseous microemboli can be removed with a dynamic bubble trap. Subclinical cerebral injury detectable by increases of S100 beta disappears earlier after surgical intervention.
-
J. Thorac. Cardiovasc. Surg. · Nov 2003
Comparative StudyIn situ retrocaval skeletonized right internal thoracic artery anastomosed to the circumflex system via transverse sinus: technical aspects and postoperative outcome.
The aim of this study was to investigate whether, by using the in situ right internal thoracic artery via the transverse sinus (eventually retrocaval), both the proximal and distal major branches of the circumflex system could be grafted and to evaluate the early and late outcome in these patients. ⋯ The skeletonized right internal thoracic artery, placed via the transverse sinus and eventually retrocaval, can reach most branches of the circumflex system and is associated with an excellent patency rate. The predictors for poor overall event-free survival seem to be similar to those of the general population undergoing conventional coronary artery bypass grafting. Use of bilateral internal thoracic arteries and in situ right internal thoracic artery grafting via the transverse sinus offers the possibility of various configuration constructions, making possible total arterial myocardial revascularization with a minimum number of arterial conduits.
-
J. Thorac. Cardiovasc. Surg. · Nov 2003
Comparative StudySkeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes.
Deep sternal wound infection is a dreaded complication of coronary artery bypass surgery, particularly in patients with diabetes. This study determines whether skeletonization of internal thoracic artery conduits compared with pedicled harvesting reduces the risk of deep sternal wound infection in patients with diabetes undergoing bilateral internal thoracic artery grafting. ⋯ Skeletonization of internal thoracic artery conduits lowers the risk of deep sternal wound infection in patients with diabetes undergoing bilateral internal thoracic artery grafting. We no longer consider diabetes a contraindication to bilateral internal thoracic artery grafting, provided the internal thoracic arteries are skeletonized.
-
J. Thorac. Cardiovasc. Surg. · Nov 2003
Comparative StudyDecreasing significance of left ventricular dysfunction and reoperative surgery in predicting coronary artery bypass grafting-associated mortality: a twelve-year study.
Patients undergoing coronary artery bypass grafting are older and have greater comorbidity than those operated on previously. We evaluated the changes in the predictors of in-hospital mortality among patients undergoing coronary artery bypass grafting during the last 12 years. ⋯ Despite increasing patient age and comorbidity, improvements in perioperative management have reduced the significance of severe left ventricular dysfunction and reoperative coronary artery bypass grafting but not emergency surgery as predictors of in-hospital mortality.
-
J. Thorac. Cardiovasc. Surg. · Nov 2003
Comparative Study Clinical TrialExtrapleural regional versus systemic analgesia for relieving postthoracotomy pain: a clinical study of bupivacaine compared with metamizol.
The effects of a local anesthetic delivered through a catheter inserted in the extrapleural region by a surgeon and an analgesic agent given systemically on pain after thoracotomy were assessed. ⋯ Bupivacaine given through a catheter to the extrapleural region before finishing thoracotomy is substantially beneficial for the prevention of postoperative pain and reduction of postoperative complications.