The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 1999
Randomized Controlled Trial Comparative Study Clinical TrialDecreased cerebral emboli during distal aortic arch cannulation: a randomized clinical trial.
Cerebral emboli occur during cardiopulmonary bypass and are a principal cause of postoperative neurologic dysfunction. We hypothesized that arterial cannulation of the distal aortic arch, with placement of the cannula tip beyond the left subclavian artery, will result in fewer cerebral microemboli than conventional cannulation of the ascending aorta. ⋯ Cannulation of the distal aortic arch results in less cerebral microembolism than conventional cannulation of the ascending aorta. Provided it is performed safely, distal arch cannulation may be an important surgical option for patients with severe atherosclerosis of the ascending aorta.
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J. Thorac. Cardiovasc. Surg. · Oct 1999
Primary mediastinal nonseminomatous germ cell tumors: the influence of postchemotherapy pathology on long-term survival after surgery.
The treatment of nonseminomatous germ cell tumors with cisplatin-based chemotherapy followed by aggressive surgical resection of residual disease is one of the most successful models for multimodality cancer therapy. We reviewed the case histories of 91 patients treated at our institution from 1981 to 1998 with primary mediastinal nonseminomatous germ cell tumors to evaluate variables that may influence survival after surgery. ⋯ Primary nonseminomatous germ cell tumors of the mediastinum can be cured with a multimodality therapy, particularly in the subset of patients with postchemotherapy pathologic findings of tumor necrosis and teratoma. Survival is poor but possible in patients with unfavorable pathologic findings after chemotherapy, currently justifying an aggressive surgical approach in patients with otherwise operable disease.
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J. Thorac. Cardiovasc. Surg. · Oct 1999
Comparative StudyOutcome of valve repair and the Cox maze procedure for mitral regurgitation and associated atrial fibrillation.
The objective was to determine whether the Cox maze procedure provides adjunctive benefit in patients with atrial fibrillation undergoing mitral valve repair. ⋯ The addition of the Cox maze procedure to mitral valve repair is safe and effective for selected patients, and elimination of atrial fibrillation decreased late complications.
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J. Thorac. Cardiovasc. Surg. · Oct 1999
Autotransfusion in coronary artery bypass grafting: disparity in laboratory tests and clinical performance.
Autotransfusion during and after cardiac surgery is widely performed, but its effects on coagulation, fibrinolysis, and inflammatory response have not been known in detail. ⋯ The hemostatic and immunologic systems were moderately activated in the autologous blood remaining in the extracorporeal circuit, whereas the mediastinal shed blood was highly activated in all aspects. However, autotransfusion had no correlating clinical side-effects and the subsequent exposure to allogeneic blood products was minimal.
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J. Thorac. Cardiovasc. Surg. · Oct 1999
Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: clinical relevance to the ross procedure.
Bicuspid aortic valve disease is often associated with dilation of the aortic root and ascending aorta. This study examines the histologic features of the ascending aorta and main pulmonary artery of patients with and without aortic valve disease. ⋯ Patients with bicuspid aortic valve disease have more severe degenerative changes in the media of the ascending aorta and main pulmonary artery than patients with tricuspid aortic valve disease. These findings may explain root and ascending aortic dilation in patients with bicuspid aortic valve disease and pulmonary autograft dilation in certain patients after the Ross procedure.