The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Randomized Controlled TrialLocal infusion of bupivacaine combined with intravenous patient-controlled analgesia provides better pain relief than intravenous patient-controlled analgesia alone in patients undergoing minimally invasive cardiac surgery.
This prospective randomized double-blind study examined the effect of local wound infusion of anesthetics on pain control in the thoracotomy wound of patients undergoing minimally invasive cardiac surgery. ⋯ In this controlled double-blind study, thoracotomy wound infusion and patient-controlled analgesia were superior to patient-controlled analgesia alone in reducing pain at 1, 3, and 90 days after minimally invasive cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Comparative StudyImpact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function.
Left atrial geometry and mechanical functions exert a profound effect on left ventricular filling and overall cardiovascular performance. We sought to investigate the perioperative factors that influence left atrial geometry and mechanical functions after the Maze procedure in patients with refractory atrial fibrillation and left atrial enlargement. ⋯ Left atrial reduction concomitant with the Maze procedure helped restore both contraction (booster pump) and compliance (reservoir) of the left atrium and facilitated left atrial reverse remolding. Left atrial volume reduction and postoperative maintenance of sinus rhythm may be desirable in patients with refractory AF and left atrial enlargement.
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Comparative StudyThe "occasional open heart surgeon" revisited.
Case volume in cardiac surgery has been a concern since the term "the occasional open heart surgeon" was used more than 40 years ago, indicating one who performs cardiac surgery infrequently. ⋯ A high-volume surgeon becomes an "occasional open heart surgeon" when working at multiple hospitals and performing a small volume of procedures at some of them. This study suggests that volume is not as important as processes of care in determining outcomes of coronary artery bypass grafting procedures and that system factors might be more important to outcomes than surgeon experience.
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Comparative StudyAssociation of device surface and biomaterials with immunologic sensitization after mechanical support.
Biomaterials and textured surfaces in early pulsatile left ventricular assist devices (HeartMate I; Thoratec Corporation, Pleasanton, Calif) may increase immunologic risk through allosensitization. We hypothesized that axial-flow devices without biologic membranes or textured surfaces (HeartMate II; Thoratec; and DeBakey; MicroMed Cardiovascular, Inc, Houston, Tex) would cause less allosensitization than devices with such membranes and surfaces. ⋯ Hemodynamic support with HeartMate II and DeBakey devices produced less allosensitization than did HeartMate I devices. Device selection may improve clinical outcomes for high-risk patients.
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Surgical treatment of congenital mitral valve disease: midterm results of a repair-oriented policy.
Management of congenital mitral valve disease is challenging because of a wide morphologic spectrum, frequent associated lesions, and small patient size. We evaluated the results of a repair-oriented policy. ⋯ Surgical repair of the congenital mitral valve can be successfully performed with low mortality, satisfactory valvular function at midterm follow-up, and acceptable reoperation rate while obviating risks associated with valvular prostheses. Suboptimal primary repair was significant predictor for reoperation but re-repair was often successful.