The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Randomized Controlled TrialErythropoietin neuroprotection in neonatal cardiac surgery: a phase I/II safety and efficacy trial.
Neonates undergoing complex congenital heart surgery have a significant incidence of neurologic problems. Erythropoietin has antiapoptotic, antiexcitatory, and anti-inflammatory properties to prevent neuronal cell death in animal models, and improves neurodevelopmental outcomes in full-term neonates with hypoxic ischemic encephalopathy. We designed a prospective phase I/II trial of erythropoietin neuroprotection in neonatal cardiac surgery to assess safety and indicate efficacy. ⋯ Safety profile for erythropoietin administration was not different than placebo. Neurodevelopmental outcomes were not different between groups; however, this pilot study was not powered to definitively address this outcome. Lessons learned suggest optimized study design features for a larger prospective trial to definitively address the utility of erythropoietin for neuroprotection in this population.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Comparative StudyRestraint to the left ventricle alone is superior to standard restraint.
In standard ventricular restraint therapy, a single level of restraint is applied to the entire ventricular surface. We showed previously that at high restraint levels, cardiac tamponade develops because of the thin-walled right ventricle, even while the left ventricle remains unaffected. We now hypothesize that applying restraint exclusively to the left ventricle permits higher levels of restraint, resulting in increased benefit to the left ventricle. ⋯ We showed previously that, with standard restraint, right ventricle tamponade develops at high restraint levels, limiting restraint therapy. We now show that restraint applied to the left ventricle alone permits increased restraint levels, without causing right ventricle or left ventricle tamponade, for greater therapeutic benefit. We conclude that partial left ventricle restraint may be more effective than standard restraint.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Randomized Controlled Trial Comparative StudyA randomized comparison of different ventilator strategies during thoracotomy for pulmonary resection.
Protective lung ventilation is reported to benefit patients with acute respiratory distress syndrome. It is not known whether protective lung ventilation is also beneficial to patients undergoing single-lung ventilation for elective pulmonary resection. ⋯ The use of Hi-TV during single-lung ventilation for pulmonary resection resulted in no increase in morbidity and was associated with less hypercarbia, less dead space ventilation, better dynamic compliance, and less postoperative atelectasis.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Randomized Controlled TrialPenehyclidine hydrochloride preserves the intestinal barrier function in patients undergoing cardiopulmonary bypass.
The study objective was to investigate the protective effect of penehyclidine hydrochloride on intestinal barrier function integrity and its therapeutic potential on endotoxemia and systemic inflammatory response in patients undergoing cardiopulmonary bypass. ⋯ Penehyclidine hydrochloride preserves intestinal barrier function integrity, attenuates endotoxemia, and inhibits systemic inflammatory response in patients undergoing cardiopulmonary bypass, possibly by improving intestinal microcirculation and depressing stress response.