BACKGROUND Even extremely high-doses of the potent opioid, sufentanil, cannot reliably suppress stress responses to intense surgical stimuli such as sternotomy. The chemically related opioid remifentanil with its different pharmacokinetics and binding affinities for delta- and kappa-opioid receptors might be more effective in attenuating these responses. METHODS ASA I-III patients scheduled f...

Leptin is a hormone that regulates food intake. During inflammatory status, leptin may contribute to the anorexia and cachexia of infection. Pulmonary endarterectomy was used as a model of non-infectious cytokine network hyperstimulation. Leptin and soluble leptin receptor (SLR) were compared with evolution of cortisol and inflammatory cytokines in twenty-two patients with chronic thromboemboli...

OBJECTIVE Aortic valve replacement has been approached by standard sternotomy. We described a technique of aortic valve replacement where the aortic valve is exposed through a hemi-sternotomy. Good exposure is obtained for aortic valve surgery with standard aortic and right atrial cannulation to establish cardiopulmonary bypass (CPB). METHODS From October 1996 to April 1997, 19 consecutive ao...

IMPORTANCE The value of robotically assisted surgery for mitral valve disease is questioned because the high cost of care associated with robotic technology may outweigh its clinical benefits. OBJECTIVE To investigate conditions under which benefits of robotically assisted surgery mitigate high technology costs. DESIGN, SETTING, AND PARTICIPANTS Clinical cohort study at a large multispecial...

We have read with interest the report of Legarra et al. [1] regarding the use of an inferior median sternotomy incision in patients with a tracheostomy. We have been able to take advantage of their technique’s description to solve a legal problem. A case of death by hanging was considered adequate for multiorgan transplantation including the heart. In Spain, donation of organs for transplantati...

OBJECTIVES The aim of this study was to analyse early postoperative outcomes and 2-year survival after aortic valve replacement (AVR) through a ministernotomy with a sutureless bioprosthesis implantation compared with a full sternotomy with implantation of a stented bioprosthesis. METHODS Patients who underwent primary isolated non-emergent AVR at six European centres were included in the stu...

BACKGROUND AND OBJECTIVE The aim of this randomized, prospective and double blinded study is to investigate effects of different esmolol use on hemodynamic response of laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft surgery. METHODS After approval of local ethics committee and patients' written informed consent, 45 patients were randomized into three group...

Disruption of cervical esophagogastric anastomosis after retrosternal stomach transposition remains a dangerous complication. We report a case of cervical gastric disruption after retrosternal gastric transposition in a 36-year-old man that required sternotomy for reanastomosis. After sternotomy, gastric mobilization was possible, in order to gain sufficient length for a new cervical esophagoga...

BACKGROUND We hypothesize that composite in-hospital surgical complications are lower in obese patients who undergo minimally invasive valve surgery for aortic and (or) mitral valve disease, when compared with the standard median sternotomy approach. METHODS We retrospectively reviewed 2,288 heart operations done at our institution between January 3, 2005 and January 10, 2010, and identified ...

INTRODUCTION Straight sternotomy is the most common access for open heart surgery. Techniques have been proposed for maximizing sternal stability in high-risk patients. This trend implies a growing need for newer surgical techniques. The aim of this experimental study in the sheep model is to evaluate median vs. S shaped sternotomy the feasibility of using a special device to accelerate the ste...