The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Comparative StudyIntraoperative hyperthermic chemotherapy perfusion for malignant pleural mesothelioma: an in vitro evaluation.
Hyperthermic chemotherapy perfusion has been used in the treatment of both pleural and peritoneal mesothelioma without an extensive basic science foundation. Clinical data are limited with no prospective randomized trials to support the use of this potentially toxic therapy. We sought to generate basic scientific support for this clinical practice and to define the optimal conditions for use in future clinical trials. ⋯ Intrapleural chemotherapy seems to be most effective when using 2 drug combinations. All mesothelioma cell lines showed no particular sensitivity to heat. The use of hyperthermia alone or with chemotherapy produces at best only a modest effect and does not necessarily support its current clinical use.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Comparative StudyLong-term impact of radial artery harvest on forearm function and symptoms: a comparison with leg vein.
The radial artery (RA) has gained popularity as a conduit for coronary artery bypass surgery despite a paucity of patient-centered analysis of long-term quality of life after its removal. We sought to characterize forearm function and symptoms after RA harvest and compare these with those associated with saphenous vein (SV) removal. ⋯ RA harvesting is associated with high patient satisfaction and less scar discomfort than SV removal. Overall, functionality declines with time, and a small proportion of patients seem to experience forearm pain and numbness. However, this is not different than in those without artery removal and may therefore be unrelated to the effects of surgery.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Multicenter Study Clinical TrialDynamic annuloplasty for mitral regurgitation.
The MiCardia DYANA annuloplasty system (MiCardia Corp, Irvine, Calif) is a nitinol-based dynamic complete ring that allows modification of the septal-lateral diameter under transesophageal echocardiography guidance in the loaded beating heart after mitral valve repair. Shape alteration is induced by radiofrequency via detachable activation wires. This multicenter study reports the first human experience with this device. ⋯ The implantation of the new dynamic annuloplasty ring allows for safe mitral valve repair. The option of postrepair modification of the septal-lateral diameter by radiofrequency may further optimize repair results.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Routine left atrial appendage ligation during cardiac surgery may prevent postoperative atrial fibrillation-related cerebrovascular accident.
The aim of the study was to determine whether routine left atrial appendage ligation in cardiac surgery would reduce the risk of postoperative atrial fibrillation-related cerebrovascular accident. ⋯ Although postoperative atrial fibrillation remains a common complication of cardiac surgery, there was a significant decrease in the incidence of postoperative cerebrovascular accidents since routine ligation of the left atrial appendage was undertaken. This has been found to be a safe adjunct to a wide variety of cardiac procedures and therefore deserves further study by a larger randomized controlled trial.