The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 2011
Management of esophageal anastomotic leaks, perforations, and fistulae with self-expanding plastic stents.
Esophageal anastomotic leaks, perforations, and fistulae are associated with considerable morbidity and mortality. The aim of the present study was to assess the efficacy of self-expanding plastic stents in the treatment of esophageal leaks. ⋯ In combination with effective interventional or surgical drainage, stenting is a viable option for the treatment of esophageal anastomotic leaks and perforations, but the success in tracheoesophageal fistula is limited.
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J. Thorac. Cardiovasc. Surg. · May 2011
Activated protein C attenuates cardiopulmonary bypass-induced acute lung injury through the regulation of neutrophil activation.
Cardiopulmonary bypass is known to induce systemic inflammatory responses that injure multiple organs, especially the lungs. Activated protein C has been demonstrated to play an important role in the regulation of inflammation in addition to coagulation. We investigated the anti-inflammatory effects of activated protein C in a rat model of cardiopulmonary bypass. ⋯ Administration of activated protein C before cardiopulmonary bypass attenuates acute lung injury induced by cardiopulmonary bypass at least in part through the inhibition of neutrophil activation and possibly via the attenuation of proinflammatory cytokine production in this rat model of cardiopulmonary bypass.
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J. Thorac. Cardiovasc. Surg. · May 2011
Review Meta AnalysisShort- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis.
Our objectives were to evaluate short- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting and to identify preoperative and intraoperative patient characteristics associated with new-onset atrial fibrillation. ⋯ New-onset atrial fibrillation after coronary artery bypass grafting appears to increase short- and long-term mortality. Preoperative use of ß-blockers, avoidance of angiotensin-converting enzyme inhibitors, and shorter cardiopulmonary bypass and aortic clamp times potentially reduce occurrence of new-onset atrial fibrillation.
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J. Thorac. Cardiovasc. Surg. · May 2011
Randomized Controlled Trial Comparative StudyComparison of the effectiveness and safety of a new de-airing technique with a standardized carbon dioxide insufflation technique in open left heart surgery: a randomized clinical trial.
We have compared the effectiveness, time required for de-airing, and safety of a newly developed de-airing technique for open left heart surgery (Lund technique) with a standardized carbon dioxide insufflation technique. ⋯ The Lund de-airing technique is safer, simpler, and more effective compared with the carbon dioxide insufflation technique. The technique is also more cost-effective because the de-airing time is shorter and no extra expenses are incurred.
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J. Thorac. Cardiovasc. Surg. · May 2011
Randomized Controlled Trial Comparative StudyNeurocognitive and neuroanatomic changes after off-pump versus on-pump coronary artery bypass grafting: long-term follow-up of a randomized trial.
It is unknown whether avoidance of cardiopulmonary bypass during coronary artery bypass grafting affects cerebral injury or long-term neuropsychological function. ⋯ After a mean of 7.5 years of follow-up, patients undergoing off-pump coronary artery bypass performed better than those undergoing cardiopulmonary bypass in several neuropsychological domains; these differences were small and of uncertain clinical importance. Early brain magnetic resonance imaging showed no significant differences in acute cerebral infarctions between the off-pump coronary artery bypass and cardiopulmonary bypass groups.