bluuebunny/crossref_metadata_2025_split huggingface dataset:
Choice of conduit for coronary artery bypass grafting in poor ventricles
Authors: Attaran Saina , Shaw Matthew , Saleh Hesham Z , Pullan Mark D , Fabri Brian M 
Published: May 2013

Background: advantages in the use of arterial grafts for coronary artery revascularizations have been reported previously. Objectives: we aimed to compare the outcome and survival rates of different conduits in patients with poor ventricular function (ejection fraction <30%). Methods: in a 10-year period, 979 patients with an ejection fraction <30%, who underwent isolated first-time coronary artery bypass grafting, were divided into in 3 groups: (A) total arterial grafts ( n = 257), (B) total vein grafts ( n = 76), and (C) left internal mammary artery and vein grafts ( n = 610). Multivariate logistic regression was used to assess the effect of graft type on mortality, while adjusting for patient and disease characteristics. Hospital mortality and 5-year survival rates were compared among the groups. Results: hospital mortality was 8.9% for group A, 11.8% for group B, and 5.7% for group C. Mortality at 5 years was 27.2% for group A, 42.3% for group B, and 28.7% for group C. After risk adjustment, hospital mortality and mid- and long-term mortality showed no significant differences among the groups. Conclusions: patients with poor ventricular function have a high mortality rate in both the short- and long-term with any type of conduit. Mortality rates with total arterial grafts and vein plus arterial grafts were comparable before and after risk adjustment.
Cardiac surgery in cases of myeloproliferative neoplasm: risk factor for stroke
Authors: Sommer Sebastian-Patrick , Wagner Christoph , Sommer Stefanie , Krannich Jens-Holger , Aleksic Ivan , Schimmer Christoph , Schuster Christoph , Leyh Rainer G 
Published: May 2013

Objectives: a history of myeloproliferative neoplasms is considered to increase the risks in cardiac surgery. In patients with myeloproliferative neoplasms, increased rates of perioperative infections and thromboembolic complications are suspected, but studies analyzing the impact of myeloproliferative neoplasms on results after cardiac surgery are lacking. Methods: 13 patients with the diagnosis of myeloproliferative neoplasm underwent cardiac surgery. These patients were matched to 36 controls. Matching criteria consisted of sex, age, diagnosis, and comorbidities. Patients were analyzed regarding laboratory parameters, blood transfusion demands, morbidity, and mortality. Results: compared to controls, patients with myeloproliferative neoplasms demonstrated a significantly lower body-mass index ( p < 0.01), creatinine ( p = 0.024), prothrombin time ( p = 0.001), and urea level ( p = 0.012). The perioperative leukocyte response ( p = 0.03) was ameliorated, and platelet counts ( p < 0.02) increased. Patients with myeloproliferative neoplasms had a reduced need for erythrocyte concentrates (54% vs. 86%, p = 0.047) but increased need for plasma and thrombocytes (15% vs. 0%, p = 0.07). Patients with myeloproliferative neoplasms had a significantly increased incidence of thromboembolic events compared to controls (31% vs. 3%, p = 0.014). Hospital mortality remained at zero, but mid-term survival was lower in patients with myeloproliferative neoplasms ( p = 0.078). Conclusions: myeloproliferative neoplasm as a concomitant diagnosis increases the risk of thromboembolic complications during cardiac surgery. Plasma and platelet substitutions have to be administered, although strokes were not associated with hemostatic treatment.
Surgery in thoracic actinomycosis
Authors: Boudaya Mohamed Sadok , Smadhi Hanène , Marghli Adel , Mouna Mlika , Charmiti Fatma , Ismail Olfa , Kilani Tarek 
Published: May 2013

Background: diagnosis and treatment of thoracic actinomycosis is difficult. In most cases, surgery is performed to rule out lung cancer or to control severe symptoms such as hemoptysis. Methods: 6 patients with a mean age of 42 years underwent pulmonary resection and were given a pathologic diagnosis of thoracic actinomycosis at our institution between 2003 and 2010. We reviewed preoperative clinical characteristics, computed tomography findings, surgical indication, postoperative clinical course and outcome. Results: All patients were symptomatic. One patient had a history of cervical actinomycosis. The mean interval between radiographic identification of the abnormality and surgical intervention was 8 months (range, 4–17 months). Radiographic findings in all cases included a mass-like appearance, simulating lung malignancy or chronic suppuration. The various histological and bacteriological examinations had failed to make the diagnosis. Thoracic actinomycosis was confirmed after thoracic surgery. All patients received penicillin-based antibiotic treatment for at least 2 to 3 months. Good clinical results were observed in 5 patients. In one patient, we noted recurrence of actinomycosis after 10 months; it was a multidrug-resistant form. Conclusion: diagnosis of actinomycosis can be problematic because of difficulty in isolating actinomyces. In these cases, surgery is very helpful.
High-sensitive C-reactive protein predicts outcome after coronary artery bypass
Authors: Wang Jianyang , Zheng Zhe , Yang Limeng , Zhang Lu , Fan Hongguang , Hu Shengshou 
Published: May 2013

Background: Elevated high-sensitive C-reactive protein is a powerful independent predictor of cardiovascular events. However, there are scant data on its impact on midterm or long-term outcomes of coronary artery bypass grafting. Method: We analyzed data of 2863 patients who underwent coronary artery bypass in 2006–2007. Early endpoints were hospital mortality and major morbidity. Midterm endpoints were overall mortality, major adverse cardiovascular events, and heart failure. Results: During hospital stay, 26 patients died and 288 suffered major morbidity. After 3.6 years of follow-up, 56 patients had died, 105 had major adverse cardiovascular events, and 70 developed heart failure. Multivariate analysis revealed every 1 mg·L−1 increase of high-sensitive C-reactive protein was associated with increased odds ratio for early mortality (odds ratio = 2.50, p = 0.002), major morbidity (odds ratio = 1.38, p = 0.02), and hazard ratio for midterm mortality (hazard ratio = 1.68, p = 0.03), major adverse cardiovascular events (hazard ratio = 1.48, p = 0.04), and heart failure (hazard ratio = 1.88, p = 0.01). Preoperative high-sensitive C-reactive protein > 2.5 mg·L−1 predicted higher risks of early (hazard ratio = 2.69, p = 0.02) and midterm mortality (hazard ratio = 1.92, p = 0.02), major morbidity (hazard ratio = 1.46, p = 0.004), major adverse cardiovascular events (hazard ratio = 2.06, p < 0.001), and heart failure (hazard ratio = 1.71, p = 0.03). Conclusions: Elevated high-sensitive C-reactive protein (>2.5 mg·L−1) predicts poor early and midterm outcomes after coronary artery bypass.
Mitral stenosis after IMR ETlogix ring annuloplasty for ischemic regurgitation
Authors: Martín Carlos-Esteban , Castaño Mario , Gomez-Plana Jesús , Gualis Javier , Comendador Jose Manuel M , Iglesias Ignacio 
Published: May 2013

Objectives: Ring annuloplasty combined with coronary artery bypass grafting is the standard approach for treatment of patients with ischemic mitral regurgitation. We evaluated mitral valve hemodynamic performance and recurrence of mitral regurgitation after ring annuloplasty. Patients and methods: 40 consecutive patients (mean age, 70 ± 8 years) with chronic ischemic mitral regurgitation grade ≥2+ received annuloplasty with an IMR ETlogix ring. During follow-up (25.9 ± 15.5 months), 84% of surviving patients underwent exercise stress echocardiography to assess recurrence of mitral regurgitation and differences between rest and exercise mitral valve hemodynamic performance. Results: Hospital mortality was 10%. During follow-up, we found no significant differences between left ventricular ejection fraction or end-diastolic and end-systolic diameters pre- and postoperatively (41% vs. 45%, 59 vs. 56 mm, and 49 vs. 46 mm, respectively), but there was a significant increase in mitral mean gradient with exercise (3.3 ± 1.2 vs. 7.8 ± 4 mm Hg, p < 0.001). Two patients had mitral regurgitation ≥grade III–IV. Conclusions: Mitral annuloplasty with the IMR ETlogix ring provides effective correction of chronic ischemic mitral regurgitation, but this technique may induce functional mitral stenosis.
Is a cell saver necessary in off-pump coronary artery bypass surgery?
Authors: Tan Nguyen Luong , Corbineau Hervé , Phu Bui Duc , Verhoye Jean-Philippe 
Published: May 2013

Background: Off-pump coronary artery bypass surgery should have a significantly lower risk of postoperated bleeding than on-pump surgery. However, the use of a cell saver has been considered necessary, with significant additional cost incurred. Can we consider performing off-pump coronary artery bypass surgery without a cell saver? Patients and methods: A prospective observational study was performed in 68 consecutive patients operated on for 2- or 3-vessel coronary lesions by the off-pump technique. Results: The mean number of distal anastomoses was 2.7 ± 0.7. Both internal thoracic arteries were used in 45 patients, and sequential revascularization was performed in 27, with 140 (77.8%) arterial grafts. Cell savers were used in 21 (30.9%) patients. In these 21 patients, the mean volume retransfused after treatment was 315 ± 177 mL. Postoperatively, 11 (16.2%) patients were transfused with packed red blood cells, with a mean volume of 636 ± 234 mL per patient. The 2 factors identified as associated with a higher risk of autotransfusion were female sex and a lower preoperative hemoglobin. Conclusions: The use of a cell saver in off-pump surgery is useless in most cases. Careful surgical hemostasis is essential to limit hypovolemia.
Monitoring brain oxygen saturation during awake off-pump coronary artery bypass
Authors: Toda Arinobu , Watanabe Go , Matsumoto Isao , Tomita Shigeyuki , Yamaguchi Shojiro , Ohtake Hiroshi 
Published: May 2013

Objective: To evaluate the changes in cerebral blood flow during awake off-pump coronary artery bypass grafting and compare with the changes during off-pump coronary artery bypass grafting under general anesthesia, using continuous monitoring of regional cerebral oxygen saturation. Methods: The study population comprised 3 groups of patients who had undergone off-pump coronary artery bypass grafting with thoracic epidural anesthesia, general anesthesia, or a combination of the two. Regional brain oxygen saturation, determined with a near-infrared oxygen monitor, and mean arterial pressure during surgery were calculated and compared among the 3 groups. Results: Patients who had undergone awake off-pump coronary artery bypass grafting with thoracic epidural anesthesia had a significantly higher cerebrovascular impairment ratio, and the EuroSCORE was high. No significant differences were observed among the 3 groups in terms of the relationship between mean arterial pressure during surgery and regional brain oxygen saturation. It is suggested that there were no differences in cerebral blood flow and mean arterial pressure changes among the 3 groups. Conclusions: Awake off-pump coronary artery bypass grafting is a safe surgical technique for patients with history of cerebral infarction or impaired cerebral blood flow. Awake off-pump coronary artery bypass grafting is a less invasive procedure that allows efficient management of intraoperative cerebral blood flow, and can be equally effective as a percutaneous coronary intervention.
Postpneumonectomy bronchial stump recurrence and bronchopleural fistula
Authors: Cariati Andrea , Piromalli Elisa , Taviani Mario 
Published: May 2013

Objective: To reduce the incidence of postpneumonectomy local recurrence, and to prevent the onset of bronchopleural fistula. Background: A long bronchial stump with a short tumor-free bronchial margin has been found to be associated with a higher incidence of local recurrence, and with the development of bronchopleural fistula in some cases. Methods: 134 patients underwent pneumonectomy for non-small-cell lung cancer in 2 institutions. Bronchial stump length was measured intra- and postoperatively. Results: 30-day postoperative mortality was 2.9%. There were 3 postoperative bronchopleural fistulas after right pneumonectomy (3/61) and one after left pneumonectomy (1/73; p = 0.2; fistula was more frequent in the long-stump group), which were successfully treated with carina sutures in 75% of cases. The overall incidence of local recurrence was strongly related to the presence of tumoral microinvasion in the resection margin (100%). Conclusion: To prevent postpneumonectomy bronchial stump complications, it might be useful to use carina closure instead of bronchial closure. Carina closure can reduce local recurrence, significantly reduce the fistulization rate, and eliminate the stump diverticulum. Reduction of the length of the bronchial stump can be achieved using a TA Roticulator linear stapler.
Does use of cell saver decrease the inflammatory response in cardiac surgery?
Authors: Prieto Maria A , Guash Sara , Mendez Jose C , Munoz Cecilia , Planas Antonio , Reyes Guillermo 
Published: May 2013

Background: The role of a cell-saver device in the inflammatory response to cardiac surgery has not been well documented. We hypothesized that the use of a cell saver may reduce proinflammatory cytokine concentrations in patients undergoing cardiac surgery. Methods: 57 patients presenting for first-time nonemergency cardiac surgery were prospectively randomized to control or cell salvage groups. Blood samples for inflammatory marker assays were collected from the arterial line on induction of anesthesia, at the end of cardiopulmonary bypass, 1 h after surgery, and 24 h after surgery. Plasma proinflammatory cytokines were analyzed using a sandwich solid-phase enzyme-linked immunosorbent assay. Results: The highest cytokine levels were observed 1 h after surgery. When comparing serum interleukin levels in both patient groups during the different perioperative periods, we found a higher interleukin-8 concentration 24 h after the procedure, and higher concentrations of the p40 subunit of interleukin-12 at 1 h and 24 h postoperatively. The concentrations of interleukin-6 and p40 were greater in blood stored by the cardiotomy suction system than in blood processed by the cell saver ( p = 0.01 in both cases). The interleukin-8 concentration was higher in the blood processed by the cell saver ( p = 0.03). No significant differences were observed in interleukin-1 and interferon gamma levels in blood from both systems. Clinical outcomes were similar in both groups. Conclusions: Our results suggest that cell salvage in low-risk patients undergoing their first elective cardiac procedure does not decrease the inflammatory response after surgery.
Coronary surgery in patients with low ejection fraction: mid-term results
Authors: Ergüneş Kazim , Yurekli Ismail , Lafcı Banu , Gokalp Orhan , Akyuz Muhammed , Yetkin Ufuk , Yilik Levent , Gurbuz Ali 
Published: May 2013

Background: The aim of this study was to investigate the effect of preoperative low ejection fraction (≤30%) on postoperative morbidity and mortality in patients undergoing isolated on-pump coronary artery bypass grafting. We also investigated the effect of pre- and perioperative factors on survival. Methods: Between January 2002 and December 2009, 103 (6.2%) patients with an ejection fraction ≤30% and 1554 (93.8%) with an ejection fraction >30% underwent coronary artery bypass grafting. Results: In multivariate logistic regression analysis, cardiopulmonary bypass time, operation time, prolonged inotropic support, and intensive care unit stay were independent predictors of mortality in patients with low ejection fraction. Intensive care unit and hospital stays were significantly longer in these patients, and the postoperative mortality rate was significantly higher. Advanced age (≥70 years) influenced mortality during the follow-up of patients with low ejection fraction. Midterm survival was significantly reduced in patients with ejection fraction ≤30%. Smoking, prolonged inotropic support, and prolonged ventilatory support were independent predictors of midterm survival in patients with ejection fraction ≤30%. Conclusion: On-pump coronary artery bypass grafting can be performed in patients with ejection fraction ≤30%, with reasonable mortality and morbidity rates.
Prognostic factors in malignant pleural mesothelioma: role of talc pleurodesis
Authors: Al-Alao Bassel Suffian , Parissis Haralabos , Rychlik Igor J , Graham Alastair , McGuigan Jim 
Published: May 2013

Objective: To examine baseline characteristics associated with survival in patients with malignant pleural mesothelioma. Methods: 122 patients with histologically proven malignant pleural mesothelioma during the period 2000–2010 were studied. Survival was evaluated by the Kaplan-Meier method with the logrank test. Cox regression analysis was used to estimate the hazard ratios for possible prognostic factors. Results: 105 (86%) patients had complete survival follow-up; 91 died and 14 (13.3%) were alive at the end of the observation period starting from the day of diagnosis. The median survival was 286 days (95% confidence interval: 212–359). Talc pleurodesis was performed in 59 patients, and 17 had surgical interventions (2 chest wall resections, 2 extrapleural pneumonectomies, and 13 decortications). Chemotherapy was used in 41 patients, port-site radiation in 68, and combined therapy in 26. Cox regression analysis identified talc pleurodesis ( p = 0.04), chemotherapy ( p < 0.001), port-site radiation ( p < 0.001), and combined chemotherapy and port-site radiation ( p < 0.006) as favorable prognostic factors after adjusting for age, sex, histologic subtype, smoking, and performance status. Conclusions: Surgical intervention including decortications and extrapleural pneumonectomy had no effect on survival in this series. Chemotherapy and radiation to port sites independently and in combination were associated with improved overall survival in malignant pleural mesothelioma patients. Talc pleurodesis was an independent determinant of survival, but further studies are warranted.
Relationship of venous blood gas with cervical esophagogastric anastomotic leak
Authors: Mohajeri Gholamraza , Tabatabaei Abas , Hashemi Mozafar , Bistgani Mohammad Moazeni 
Published: May 2013

Objective: this study investigated the relationship between various parameters of venous blood gas analysis of gastric fundus veins and cervical esophagogastric anastomotic leaks after transhiatal esophagectomy. Background: decreased tissue perfusion is one of the causes of anastomotic leak. There are various methods used to assess gastric conduit perfusion, with different results, and we lack a reliable method. Method: this descriptive study, performed from March 2008 to October 2010, consisted of 45 patients with esophageal cancer who underwent transhiatal esophagectomy. After gastrolysis, blood samples were taken from a gastric fundus vein and submitted for venous blood gas analysis. The cervical wounds were examined 5 days postoperatively. The patients were divided into 2 groups based on the presence of leakage, and mean values of the venous blood gas analysis were compared. Results: we observed significant differences in mean pH, PCO2, and O2 saturation between the 2 groups ( p = 0.04, p = 0.03, and p = 0.04, respectively). Conclusion: venous blood gas analysis of gastric fundus veins appears to be a feasible and fast method for intraoperative assessment of microperfusion in the gastric fundus.
Eleven-year experience in thoracoscopic excision of bronchogenic cyst
Authors: Panchanatheeswaran Karthik , Dutta Roman , Singh Khumallambam Ibomcha , Kumar Arvind 
Published: May 2013

Objectives: bronchogenic cysts are uncommon congenital cystic lesions. Most are incidentally detected and require surgical excision for histological diagnosis, symptom relief, and to prevent complications. Video-assisted thoracoscopic resection is preferable in suitable patients. In this study, we reviewed the clinical presentation, diagnosis, and thoracoscopic treatment of bronchogenic cysts. Methods: from January 2001 to December 2011, 14 patients with bronchogenic cyst underwent thoracoscopic surgery for excision of the cyst. Their mean age was 24 years. Twelve patients were symptomatic (85.71%). Results: the average maximum diameter of the cysts was 6.7 cm. The most common location of the cyst was the mediastinum ( n = 10, 71.4%). All bronchogenic cysts were completely excised. In 7 cases, the procedure was converted to thoracotomy. The mean hospital stay following thoracoscopic surgery was 4 days. There was no recurrence on follow-up. Conclusions: thoracoscopic excision of a bronchogenic cyst should be considered the first-line therapeutic option. Proper preoperative case selection can prevent conversion to thoracotomy due to major pleural adhesions. There should be a low threshold for conversion to thoracotomy if complete excision of the cyst is not possible, because this is the main goal of treatment to prevent recurrence.
Surgical treatment of early stage small cell lung cancer
Authors: Ploenes Till , Osei-Agyemang Thomas , Krohn Alexander , Kayser Gian , Burger Meike , Passlick Bernward 
Published: May 2013

Background: Chemotherapy with radiation has to be considered the standard therapy for limited-stage small cell lung cancer but surgical resection is possible in a small subgroup in which it may improve survival. Surgery is not recommended as the standard treatment, but a few small studies have demonstrated a benefit of surgery in highly selected cases of limited-stage small cell lung cancer. Methods: We conducted a retrospective study of 29 patients with limited-stage small cell lung cancer undergoing surgical resection in our department. There were 7 (24%) women and 22 (76%) men with a median age of 62 years (range, 46–82 years). Medical history, histology and survival status were extracted from the medical database of the University Medical Center Freiburg. Results: The median overall survival was 20.7 months. In 15 patients who received neoadjuvant treatment, the median survival was 89.4 months. Karnofsky performance status and neoadjuvant chemotherapy had a significant influence on median survival ( p < 0.0004). Conclusions: We concluded that surgical resection can be beneficial in a highly selected group of patients as a part of a multidisciplinary approach. In addition, surgical resection is safe with acceptable mortality and morbidity.