The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2007
Multicenter Study Clinical TrialFeasibility, safety, and efficacy of totally endoscopic coronary artery bypass grafting: multicenter European experience.
The invention of robotic systems has begun a new era of endoscopic cardiac surgery. Reports on totally endoscopic coronary artery bypass grafting are limited, however, and data regarding feasibility, safety, and efficacy are needed to determine this technique's position in the therapeutic armamentarium. This study describes the largest multicenter experience in the literature with robotic totally endoscopic coronary artery bypass grafting specifically addressing procedural feasibility, safety, and efficacy. ⋯ Both on- and off-pump totally endoscopic coronary artery bypass grafting are feasible, with a conversion rate that diminishes with increasing experience. Conversion does not adversely affect outcome and thus constitutes a safe alternative. Although target vessel reintervention may be slightly higher than that reported for open coronary artery bypass grafting, graft patency and major adverse cardiac events for both approaches are comparable to those reported in the Society of Thoracic Surgeons database, demonstrating the safety and efficacy of the totally endoscopic coronary artery bypass grafting procedure.
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J. Thorac. Cardiovasc. Surg. · Sep 2007
Opening and closing kinematics of fresh and calcified aortic valve prostheses: an in vitro study.
In vitro testing of biologic valves has been performed using only fresh but treated valves suitable for patient implantation. The present study investigates changes in hemodynamic performance and leaflet kinematics in progressively calcified porcine and pericardial aortic valve prostheses. ⋯ On the basis of visual inspection, despite the new ThermaFix (Edwards Lifesciences) tissue treatment, the Perimount Magna pericardial valves calcified in vitro faster and more severely than did the Mosaic Ultra porcine valves, which demonstrated a more constant performance throughout the calcification process. Leaflet kinematics showed a progressive prolongation of opening and closing times for pericardial valves, leading to higher closing volume.
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J. Thorac. Cardiovasc. Surg. · Sep 2007
Comparative StudyTwo-year general and neurodevelopmental outcome after neonatal complex cardiac surgery in patients with deletion 22q11.2: a comparative study.
Neonatal complex cardiac surgery carries a significant risk for adverse neurodevelopmental outcome. We hypothesized this risk to be higher in patients with deletion 22q11.2. ⋯ Neonates affected by deletion 22q11.2 and having neonatal complex cardiac surgery have significantly worse neurodevelopmental outcome than do those without deletion 22q11.2.
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J. Thorac. Cardiovasc. Surg. · Sep 2007
Randomized Controlled TrialEffects of head-down tilt on intrapulmonary shunt fraction and oxygenation during one-lung ventilation in the lateral decubitus position.
During one-lung ventilation, surgical positions significantly affect deterioration of oxygenation, and the lateral decubitus position is superior in preventing dangerous hypoxemia compared with the supine position. However, additional head-down tilt causes more compression of the dependent ventilated lung by the abdominal contents and may result in dangerous hypoxemia, as occurs in the supine position. Therefore, we evaluated the effect of head-down tilt on intrapulmonary shunt and oxygenation during one-lung ventilation in the lateral decubitus position. ⋯ Head-down tilt during one-lung ventilation in the lateral decubitus position caused a significant increase in shunt and a decrease in percent change of arterial oxygen tension, without causing dangerous hypoxemia.