Simonsenclausen7375

Mortality rates in group 1 and group 2 were 13.6% (n=3) and 10% (n=3), respectively (P=0.685). Postoperative new-onset cerebral events ratio was found in 5 (22.7%) in the femoral cannulation group and 6 (20%) in the axillary cannulation group (P=0.812). ARV471 in vivo CONCLUSION Both femoral and axillary arterial cannulation methods can be safely performed in patients with acute type A aortic dissection, provided that cerebral protection strategies should be considered in the first place. The method to be performed may vary depending on the patient's current medical condition or the surgeon's preference.OBJECTIVE To evaluate the efficacy and safety of a modified technique for totally thoracoscopic left atrial posterior wall and pulmonary vein isolation in patients with long-standing persistent atrial fibrillation. METHODS From April 2017 to December 2018, we included in this study 28 consecutive patients who underwent thoracoscopic left atrial posterior wall and pulmonary vein radiofrequency isolation combined with left atrial appendage resection. We used a device with irrigated electrodes (Medtronic Cardioblate Gemini-s). The original surgical technique "GALAXY" proposed by Doty in 2012 was modified. The number of ablations was significantly increased, and frequent position changing of the ablation device and change of device angulation were added. RESULTS Sinus rhythm was restored in all patients. There was no operative mortality, no myocardial infarction, and no stroke or transient ischemic attack. One patient required sternotomy and another survived left anterolateral thoracotomy due to bleeding. A 180-day follow-up (24-hour Holter monitoring) revealed no sign of recurrence of atrial fibrillation or other supraventricular arrhythmia in any patient. Mean follow-up was nine months (range 6-16 months). At the last follow-up, 26 patients (92,9%) were in sinus rhythm (24-hour Holter monitoring). CONCLUSION A frequent ablation device position changing during the surgery makes it possible to achieve complete left atrial posterior wall and pulmonary veins isolation.  An increased number of applications allows to avoid a false positive transmural damage assessment showed by impedance drop. Also, frequent position changing of the ablation device and increased number of applications do not affect the number of postoperative complications.OBJECTIVE To evaluate preoperative and postoperative body fluid distribution with a bioelectrical impedance analyzer in patients undergoing cardiopulmonary bypass. METHODS Fifteen adult patients undergoing cardiopulmonary bypass were included in this study. Total body fluid changes, basal metabolism rates, body fat masses, lean body masses, and total cell masses were recorded. The patients' values were measured before anesthesia, after anesthesia, after sternotomy, at the 5th, 30th, and 60th minutes of cardiopulmonary bypass, and on the 1st, 3rd, and 5th postoperative days. All values were compared with preoperative values. RESULTS Total body fluid changed significantly after cardiopulmonary bypass (P0.05). CONCLUSION Changes in body fluids during and after cardiopulmonary bypass are inevitable. The increase in total body weight shows that this fluid load shifts to the extracellular space during bypass and the fluid load in this area passes into the intravascular area in the early postoperative period. This may cause edema and dysfunction in the major organs. Therefore, the fluid balance should be adjusted very carefully, especially during the bypass phase and the early postoperative period.OBJECTIVE To compare two groups of patients - the coronary endarterectomy group, with patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy (CE), and the control group, with patients undergoing CABG without CE. We analyzed the rate of major outcomes (perioperative acute myocardial infarction [AMI], stroke, and mortality) and minor outcomes (time of cardiopulmonary bypass [CPB], time of aortic clamp, and postoperative length of hospital stay). We also determined the rates of early graft patency in patients undergoing CE. METHODS We reviewed a database of patients submitted to CABG, with or without associated CE, between January 2011 and June 2017. Twenty-five patients submitted to CE were compared with 201 patients submitted only to conventional surgery; the two groups presented similar preoperative characteristics and all the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II variables did not presented statistically significant difference. We considered statistically significant values of P less then 0.05. RESULTS There was no statistically significant difference in relation to time of post-surgical hospitalization (P=0.8139), incidence of perioperative AMI (P=0.2976), stroke (P=0,2976), and mortality rate (P=1.0000), but endarterectomy was associated with longer aortic clamping time (P=0.0004) and CPB time (P=0.0030). The rate of patency evaluated in patients submitted to endarterectomy (78,95%) was compatible with that described in the literature. CONCLUSION In this sample, coronary endarterectomy was associated with the rate of early graft patency similar to that of the literature, with morbidity and mortality rates similar to those of conventional surgery.INTRODUCTION Percutaneous coronary intervention (PCI) has been increasingly performed to treat coronary artery disease. The performance of multiple PCI has also been increasing. Consequently, the percentage of patients presenting for coronary artery bypass graft (CABG) surgery is reported to vary from 13 to 40%. The influence of previous PCI on CABG outcomes has been studied in single center, regional studies, registries and meta-analyses. Some reports showed a negative effect on mortality and morbidity in early or long-term follow-up, but others did not find this influence. METHODS AND RESULTS A cohort of 3007 patients consecutively operated for CABG, 261 of them with previous PCI, were included in this analysis. Comparison of the groups "previous PCI" and "primary CABG" was made in the original cohort and in a propensity score matched cohort of 261 patients. There were some differences in preoperative clinical characteristics in both types of cohort, even in the matched one. Outcomes were compared at 30 days, 1 year and 5 years of follow-up.