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Abbasciano RG, Tomassini S, Roman MA, Rizzello A, Pathak S, Ramzi J, Lucarelli C, Layton G, Butt A, Lai F, Kumar T, Wozniak MJ, Murphy GJ. Effects of interventions targeting the systemic inflammatory response to cardiac surgery on clinical outcomes in adults. Cochrane Database Syst Rev 2023; 10:CD013584. [PMID: 37873947 PMCID: PMC10594589 DOI: 10.1002/14651858.cd013584.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Organ injury is a common and severe complication of cardiac surgery that contributes to the majority of deaths. There are no effective treatment or prevention strategies. It has been suggested that innate immune system activation may have a causal role in organ injury. A wide range of organ protection interventions targeting the innate immune response have been evaluated in randomised controlled trials (RCTs) in adult cardiac surgery patients, with inconsistent results in terms of effectiveness. OBJECTIVES The aim of the review was to summarise the results of RCTs of organ protection interventions targeting the innate immune response in adult cardiac surgery. The review considered whether the interventions had a treatment effect on inflammation, important clinical outcomes, or both. SEARCH METHODS CENTRAL, MEDLINE, Embase, conference proceedings and two trial registers were searched on October 2022 together with reference checking to identify additional studies. SELECTION CRITERIA RCTs comparing organ protection interventions targeting the innate immune response versus placebo or no treatment in adult patients undergoing cardiac surgery where the treatment effect on innate immune activation and on clinical outcomes of interest were reported. DATA COLLECTION AND ANALYSIS Searches, study selection, quality assessment, and data extractions were performed independently by pairs of authors. The primary inflammation outcomes were peak IL-6 and IL-8 concentrations in blood post-surgery. The primary clinical outcome was in-hospital or 30-day mortality. Treatment effects were expressed as risk ratios (RR) and standardised mean difference (SMD) with 95% confidence intervals (CI). Meta-analyses were performed using random effects models, and heterogeneity was assessed using I2. MAIN RESULTS A total of 40,255 participants from 328 RCTs were included in the synthesis. The effects of treatments on IL-6 (SMD -0.77, 95% CI -0.97 to -0.58, I2 = 92%) and IL-8 (SMD -0.92, 95% CI -1.20 to -0.65, I2 = 91%) were unclear due to heterogeneity. Heterogeneity for inflammation outcomes persisted across multiple sensitivity and moderator analyses. The pooled treatment effect for in-hospital or 30-day mortality was RR 0.78, 95% CI 0.68 to 0.91, I2 = 0%, suggesting a significant clinical benefit. There was little or no treatment effect on mortality when analyses were restricted to studies at low risk of bias. Post hoc analyses failed to demonstrate consistent treatment effects on inflammation and clinical outcomes. Levels of certainty for pooled treatment effects on the primary outcomes were very low. AUTHORS' CONCLUSIONS A systematic review of RCTs of organ protection interventions targeting innate immune system activation did not resolve uncertainty as to the effectiveness of these treatments, or the role of innate immunity in organ injury following cardiac surgery.
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Affiliation(s)
| | | | - Marius A Roman
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Angelica Rizzello
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Suraj Pathak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Joussi Ramzi
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Carla Lucarelli
- Department of Cardiac Surgery, University of Verona, Verona, Italy
| | - Georgia Layton
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ayesha Butt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Florence Lai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Tracy Kumar
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Marcin J Wozniak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Anastasiadis K, Antonitsis P, Murkin J, Serrick C, Gunaydin S, El-Essawi A, Bennett M, Erdoes G, Liebold A, Punjabi P, Theodoropoulos KC, Kiaii B, Wahba A, de Somer F, Bauer A, Kadner A, van Boven W, Argiriadou H, Deliopoulos A, Baker RΑ, Breitenbach I, Ince C, Starinieri P, Jenni H, Popov V, Moorjani N, Moscarelli M, Di Eusanio M, Cale A, Shapira O, Baufreton C, Condello I, Merkle F, Stehouwer M, Schmid C, Ranucci M, Angelini G, Carrel T. 2021 MiECTiS focused update on the 2016 position paper for the use of minimal invasive extracorporeal circulation in cardiac surgery. Perfusion 2023; 38:1360-1383. [PMID: 35961654 DOI: 10.1177/02676591221119002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The landmark 2016 Minimal Invasive Extracorporeal Technologies International Society (MiECTiS) position paper promoted the creation of a common language between cardiac surgeons, anesthesiologists and perfusionists which led to the development of a stable framework that paved the way for the advancement of minimal invasive perfusion and related technologies. The current expert consensus document offers an update in areas for which new evidence has emerged. In the light of published literature, modular minimal invasive extracorporeal circulation (MiECC) has been established as a safe and effective perfusion technique that increases biocompatibility and ultimately ensures perfusion safety in all adult cardiac surgical procedures, including re-operations, aortic arch and emergency surgery. Moreover, it was recognized that incorporation of MiECC strategies advances minimal invasive cardiac surgery (MICS) by combining reduced surgical trauma with minimal physiologic derangements. Minimal Invasive Extracorporeal Technologies International Society considers MiECC as a physiologically-based multidisciplinary strategy for performing cardiac surgery that is associated with significant evidence-based clinical benefit that has accrued over the years. Widespread adoption of this technology is thus strongly advocated to obtain additional healthcare benefit while advancing patient care.
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Affiliation(s)
- Kyriakos Anastasiadis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Polychronis Antonitsis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - John Murkin
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Cyril Serrick
- Department of Perfusion, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Serdar Gunaydin
- Department of Cardiovascular Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Aschraf El-Essawi
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Mark Bennett
- Department of Anesthesia, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andreas Liebold
- Department of Cardio-thoracic Surgery, University Hospital Ulm, Ulm, Germany
| | - Prakash Punjabi
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Bob Kiaii
- Division of Cardiothoracic Surgery, UC Davis Health, Sacramento, CA, USA
| | - Alexander Wahba
- Department of Cardio-Thoracic Surgery, St Olav's University Hospital, Trondheim, Norway and Department of Circulation and Medical Imaging, University of Science and Technology, Trondheim, Norway
| | - Filip de Somer
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Adrian Bauer
- Department of Cardiovascular Perfusion, MediClin Heart Center, Coswig, Saxony-Anhalt, Germany
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Switzerland
| | | | - Helena Argiriadou
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Deliopoulos
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Robert Α Baker
- Cardiothoracic Surgery Quality and Outcomes, and Perfusion, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
| | - Ingo Breitenbach
- Department of Thoracic and Cardiovascular Surgery, Braunschweig Clinic, Braunschweig, Germany
| | - Can Ince
- Department of Intensive Care, Laboratory of Translational Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Hansjoerg Jenni
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Switzerland
| | - Vadim Popov
- Department of Cardio-Vascular Surgery, Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, University of Cambridge, Cambridge, UK
| | - Marco Moscarelli
- Cardiac Surgery, Anthea Hospital Gvm Care & Research, Bari, Italy
| | - Marco Di Eusanio
- Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Alex Cale
- Department of Cardiac Surgery, Hull and East Yorkshire Hospitals NHS Trust, UK
| | - Oz Shapira
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ignazio Condello
- Cardiac Surgery, Anthea Hospital Gvm Care & Research, Bari, Italy
| | - Frank Merkle
- Academy for Perfusion, German Heart Institute Berlin, Berlin, Germany
| | - Marco Stehouwer
- Department of Clinical Perfusion, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianni Angelini
- Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, Bristol, UK
| | - Thierry Carrel
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
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3
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Maisat W, Yuki K. Narrative review of systemic inflammatory response mechanisms in cardiac surgery and immunomodulatory role of anesthetic agents. Ann Card Anaesth 2023; 26:133-142. [PMID: 37706376 PMCID: PMC10284469 DOI: 10.4103/aca.aca_147_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/05/2022] [Accepted: 12/18/2022] [Indexed: 09/15/2023] Open
Abstract
Although surgical techniques and perioperative care have made significant advances, perioperative mortality in cardiac surgery remains relatively high. Single- or multiple-organ failure remains the leading cause of postoperative mortality. Systemic inflammatory response syndrome (SIRS) is a common trigger for organ injury or dysfunction in surgical patients. Cardiac surgery involves major surgical dissection, the use of cardiopulmonary bypass (CPB), and frequent blood transfusions. Ischemia-reperfusion injury and contact activation from CPB are among the major triggers for SIRS. Blood transfusion can also induce proinflammatory responses. Here, we review the immunological mechanisms of organ injury and the role of anesthetic regimens in cardiac surgery.
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Affiliation(s)
- Wiriya Maisat
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, USA
- Department of Anaesthesia, Harvard Medical School, Boston, USA
- Department of Immunology, Harvard Medical School, Boston, USA
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Koichi Yuki
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, USA
- Department of Anaesthesia, Harvard Medical School, Boston, USA
- Department of Immunology, Harvard Medical School, Boston, USA
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Van Praet KM, Kofler M, Meyer A, Sündermann SH, Hommel M, Falk V, Kempfert J. Single-Center Experience With a Self-Expandable Venous Cannula During Minimally Invasive Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:491-498. [PMID: 36314445 DOI: 10.1177/15569845221131534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Venous drainage is often problematic in minimally invasive cardiac surgery (MICS). Here, we describe our experience with a self-expandable stent cannula designed to optimize venous drainage. METHODS The smart canula® was used in 58 consecutive patients undergoing MICS for mitral valve disease (n = 40), left atrial myxoma (n = 3), left ventricular outflow tract obstruction (n = 1), and aortic valve replacement via a right anterior minithoracotomy (n = 14) procedures. The venous cannula was placed under transesophageal echocardiography guidance to reach the superior vena cava. Vacuum-assisted venous drainage (between -20 and -35 mm Hg) was used to reach a target flow index of 2.2 L/min/m² at a core temperature of 34 °C using a goal-directed perfusion strategy aimed at a minimum DO2 of 272 mL/min/m2. Cardiopulmonary bypass (CPB) parameters were recorded, and hemolysis-related parameters were analyzed on postoperative days 1 to 7. RESULTS Mean body surface area and median body mass index were 1.9 ± 0.2 m2 and 25.2 (23.4, 30.2) kg/m2. Mean CPB and median cross-clamping times were 107.7 ± 24.4 min and 64.5 (53, 75.8) min, and median CPB flow during cardioplegic arrest was 4 (3.6, 4.2) L/min (median cardiac index 2.1 [2, 2.2] L/min/m²). Venous drainage was considered sufficient by the surgeon in all cases, and insertion and removal were uncomplicated. Mean SvO2 during CPB was 80.2% ± 5.5%, and median peak lactate was 10 (8, 14) mg/dL, indicating sufficient perfusion. Mean venous negative drainage pressure during cross-clamping was 27.2 ± 12.3 mm Hg. Platelets dropped by 73.6 ± 37.5 K/µL, lactate dehydrogenase rose by 81.5 (44.3, 140.8) U/L, and leukocytes rose by 3.4 (2.2, 7.2) K/µL on postoperative day 1. CONCLUSIONS The venous smart canula® allows for optimal venous drainage at low negative drainage pressures, facilitating sufficient perfusion in MICS.
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Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany.,Berlin Institute of Health, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Matthias Hommel
- Institute for Anesthesiology, German Heart Center Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
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5
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Bari G, Érces D, Varga G, Szűcs S, Varga Z, Bogáts G, Boros M. Methane inhalation reduces the systemic inflammatory response in a large animal model of extracorporeal circulation. Eur J Cardiothorac Surg 2020; 56:135-142. [PMID: 30649294 DOI: 10.1093/ejcts/ezy453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Extracorporeal circulation induces cellular and humoral inflammatory reactions, thus possibly leading to detrimental secondary inflammatory responses. Previous data have demonstrated the bioactive potential of methane and confirmed its anti-inflammatory effects in model experiments. Our goal was to investigate the in vivo consequences of exogenous methane administration on extracorporeal circulation-induced inflammation. METHODS Two groups of anaesthetized Vietnamese minipigs (non-treated and methane treated, n = 5 each) were included. Standard central cannulation was performed, and extracorporeal circulation was maintained for 120 min without cardiac arrest or ischaemia, followed by an additional 120-min observation period with haemodynamic monitoring. In the methane-treated group, 2.5% v/v methane-normoxic air mixture was added to the oxygenator sweep gas. Blood samples through the central venous line and tissue biopsies from the heart, ileum and kidney were taken at the end point to determine the whole blood superoxide production (chemiluminometry) and the activity of xanthine-oxidoreductase and myeloperoxidase, with substrate-specific reactions. RESULTS Methane treatment resulted in significantly higher renal blood flow during the extracorporeal circulation period compared to the non-treated group (63.9 ± 16.4 vs 29.0 ± 9.3 ml/min). Whole blood superoxide production (548 ± 179 vs 1283 ± 193 Relative Light Unit (RLU)), ileal myeloperoxidase (2.23 ± 0.2 vs 3.26 ± 0.6 mU/(mg protein)) and cardiac (1.5 ± 0.6 vs 4.7 ± 2.5 pmol/min/mg), ileal (2.2 ± 0.6 vs 7.0 ± 3.4 pmol/min/mg) and renal (1.2 ± 0.8 vs 13.3 ± 8.0 pmol/min/mg) xanthine-oxidoreductase activity were significantly lower in the treated group. CONCLUSIONS The addition of bioactive gases, such as methane, through the oxygenator of the extracorporeal circuit represents a novel strategy to influence the inflammatory effects of extracorporeal perfusion in cardiac surgical procedures.
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Affiliation(s)
- Gábor Bari
- Department of Cardiac Surgery, University of Szeged, Szeged, Hungary
| | - Dániel Érces
- Institute for Surgical Research, University of Szeged, Szeged, Hungary
| | - Gabriella Varga
- Institute for Surgical Research, University of Szeged, Szeged, Hungary
| | - Szilárd Szűcs
- Institute for Surgical Research, University of Szeged, Szeged, Hungary
| | - Zoltán Varga
- Institute for Surgical Research, University of Szeged, Szeged, Hungary
| | - Gábor Bogáts
- Department of Cardiac Surgery, University of Szeged, Szeged, Hungary
| | - Mihály Boros
- Institute for Surgical Research, University of Szeged, Szeged, Hungary
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Abstract
Because of a severe dysregulation of the host response to infection, septic shock may induce a profound imbalance between oxygen consumption and delivery, which in some cases may be refractory to conventional support measures. In this setting, extracorporeal membrane oxygenation (ECMO) may help to restore this ratio. Indeed, in neonates and children, this technique is already established as a valid salvage therapy. In spite of the rapid growth in the use of ECMO in recent years, the evidence of its benefits in adult patients is weak, particularly in cases of refractory septic shock. Nevertheless, several case series have reported good outcomes in selected cases with specific management. Here we explore the links between sepsis and ECMO, starting with the basic biology underlying the two entities. We then review the published literature on the use of extracorporeal support in adult patients with septic shock and finally conclude with a review of the key points of management that can optimize the results after this critical situation.
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7
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Ali JM, Kovzel M, McPhilimey E, Colah S, De Silva R, Moorjani N. Minimally invasive extracorporeal circulation is a cost-effective alternative to conventional extracorporeal circulation for coronary artery bypass grafting: propensity matched analysis. Perfusion 2020; 36:154-160. [PMID: 32522075 DOI: 10.1177/0267659120929180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Minimally invasive extracorporeal circulation has developed with the aim of reducing the impact of the adverse effects associated with conventional extracorporeal circulation. The aim of this study was to compare outcomes for patients undergoing coronary artery bypass grafting using minimally invasive extracorporeal circulation with those performed using conventional extracorporeal circulation. METHODS A retrospective analysis was performed of patients undergoing minimally invasive extracorporeal circulation coronary artery bypass grafting at a single centre. 2:1 propensity matching was performed to identify control patients undergoing conventional extracorporeal circulation coronary artery bypass grafting. Outcomes were compared using univariate analysis. RESULTS A total of 354 patients were included in the study, with 118 patients undergoing minimally invasive extracorporeal circulation coronary artery bypass grafting. Patients were well matched on baseline characteristics. The mean logistic EuroSCORE was 3.95 ± 4.20. Operative times (3.31 ± 1.52 vs. 3.56 ± 0.73, p = 0.03) were significantly shorter in minimally invasive extracorporeal circulation cases. Patients who underwent surgery with minimally invasive extracorporeal circulation had significantly less 12-hour blood loss (322.3 ± 13.2 mL vs. 380.8 ± 15.2 mL, p < 0.01). Correspondingly, a significantly lower proportion of patients were transfused (25.8% vs. 36%, p = 0.04), and the mean number of red blood cells transfused was lower (0.45 ± 0.95 vs. 0.97 ± 2.13, p = 0.01). Similarly, the number of coagulation products administered was lower (0.161 ± 0.05 vs. 0.40 ± 0.09, p = 0.05). There was a significantly lower incidence of acute kidney injury (11.0% vs. 19.9%, p = 0.03). Minimally invasive extracorporeal circulation was associated with a £679.50 cost saving per patient. DISCUSSION Minimally invasive extracorporeal circulation for coronary artery bypass grafting is associated with a reduced requirement for blood transfusion, reduced incidence of acute kidney injury and a significant cost saving. Minimally invasive extracorporeal circulation should be considered as an adjunct for all patients undergoing coronary artery bypass grafting.
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Affiliation(s)
- Jason M Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Maksym Kovzel
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Eve McPhilimey
- Department of Clinical Perfusion, Royal Papworth Hospital, Cambridge, UK
| | - Simon Colah
- Department of Clinical Perfusion, Royal Papworth Hospital, Cambridge, UK
| | - Ravi De Silva
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
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8
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Jiang Q, Wang Z, Guo J, Yu T, Zhang X, Hu S. Retrospective Comparison of Endoscopic Versus Open Procedure for Mitral Valve Disease. J INVEST SURG 2020; 34:1000-1006. [PMID: 32064986 DOI: 10.1080/08941939.2020.1726531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We investigated whether the totally video-assisted thoracoscopic mitral valve surgery provides superior clinical outcomes and less inflammatory injury reaction compared with conventional sternotomy. METHODS A total of 504 consecutive patients admitted for mitral valve surgery from May 2014 through May 2019 in a single center were retrospectively analyzed according to two distinct procedure approach: the totally video-assisted thoracoscopic approach (group A, n = 127) and standard median sternotomy (group B, n = 377). The primary end point was the durations of cardiopulmonary bypass, aortic cross-clamping, the ventilation time and intensive care unit of stay; the secondary endpoints included inflammation indexes like high sensitivity C-reactive protein, neutrophil-lymphocyte ratio and metabolic injury parameters cardiac Troponin and lactate. RESULTS There was only one in-hospital death due to diffuse intravascular coagulation in group A, but similar complications such as repair failure, re-thoracotomy and stroke in both groups. The durations of cardiopulmonary bypass and aortic cross-clamping were significantly longer in group A. In contrast, ventilation time and intensive care unit of stay were shortened compared with these in group B. In addition, postoperative equivalent lactate clearance but lower high sensitivity C-reactive protein, neutrophil-lymphocyte ratio and cardiac Troponin level was in group A than those in group B within postoperative 24 hours(P < 0.05). CONCLUSIONS The analysis of present study indicated despite relatively longer cardiopulmonary bypass time, the totally thoracoscopic mitral valve procedure seemed to be favorable with regard to the extent of inflammatory reaction, cardiac injury and postoperative recovery compared with conventional median sternotomy.
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Affiliation(s)
- Qin Jiang
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, China
| | - Zhilan Wang
- Department of Gastroenterology, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, China
| | - Jing Guo
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, China
| | - Tao Yu
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, China
| | - Xiaoshen Zhang
- Department of Cardiac Surgery, Affiliated Hospital of University of Jinan, Guangzhou, China
| | - Shengshou Hu
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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9
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The Preventive Role of Selenium in Inflammatory Response During Coronary Artery Bypass Graft Surgery: A Randomized, Controlled Clinical Trial. Jundishapur J Nat Pharm Prod 2019. [DOI: 10.5812/jjnpp.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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10
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Hai Y, Chen N, Wu W, Wang Z, Lin F, Guo C, Liu C, Li W, Liu L. High postoperative monocyte indicates inferior Clinicopathological characteristics and worse prognosis in lung adenocarcinoma or squamous cell carcinoma after lobectomy. BMC Cancer 2018; 18:1011. [PMID: 30348119 PMCID: PMC6196434 DOI: 10.1186/s12885-018-4909-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 10/08/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Peripheral monocyte count is an assessable parameter. Recently, evidence suggested an elevated preoperative monocyte counts predicting poor prognosis in malignancies. The aim of this study was to determine the prognostic effect of early postoperative blood monocyte count in patients with lung adenocarcinoma or squamous cell carcinoma following lobectomy. METHODS We retrospectively reviewed patients with operated lung adenocarcinoma or squamous cell carcinoma from 2006 to 2011 in Western China Lung Cancer database. Univariate analysis on disease-free survival (DFS) and overall survival (OS) was performed using the Kaplan-Meier and log-rank tests, and multivariate analysis was conducted using the Cox proportional hazards regression model. RESULTS There were 433 patients enrolled in our analysis. High postoperative elevated monocyte was associated with male gender (P < 0.001), positive smoking history (P = 0.005), and higher N stage (P = 0.002) and higher tumor stage (P = 0.026). Two-tailed log-rank test indicated patients with an early postoperative elevated monocyte count predicted a poor DFS and OS overall (P < 0.001, P < 0.001, respectively) as well as in subgroup analysis, and further presented as a promising independent prognostic factor for both DFS and OS (HR = 2.991, 95%CI: 2.243-3.988, P < 0.001; HR = 2.705, 95%CI: 1.977-3.700, P < 0.001, respectively) on multivariate analysis. However, no significance was detected for preoperative monocyte in multivariate analysis. CONCLUSIONS Elevated early postoperative peripheral monocyte count was an independent prognostic factor of poor prognosis and inferior clinicopathological features for patients with operable lung adenocarcinoma or squamous cell carcinoma by lobectomy.
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Affiliation(s)
- Yang Hai
- 0000 0001 0807 1581grid.13291.38Department of Thoracic Surgery, West China Hospital, Sichuan University, Address: No. 37, Guoxue Alley, Chengdu, 610041 Sichuan China
- West China School of Medicine, Sichuan University, Chengdu, 610041 China
| | - Nan Chen
- 0000 0001 0807 1581grid.13291.38Department of Thoracic Surgery, West China Hospital, Sichuan University, Address: No. 37, Guoxue Alley, Chengdu, 610041 Sichuan China
- West China School of Medicine, Sichuan University, Chengdu, 610041 China
| | - Wenwen Wu
- West China School of Medicine, Sichuan University, Chengdu, 610041 China
| | - Zihuai Wang
- West China School of Medicine, Sichuan University, Chengdu, 610041 China
| | - Feng Lin
- 0000 0001 0807 1581grid.13291.38Department of Thoracic Surgery, West China Hospital, Sichuan University, Address: No. 37, Guoxue Alley, Chengdu, 610041 Sichuan China
| | - Chenglin Guo
- 0000 0001 0807 1581grid.13291.38Department of Thoracic Surgery, West China Hospital, Sichuan University, Address: No. 37, Guoxue Alley, Chengdu, 610041 Sichuan China
| | - Chengwu Liu
- 0000 0001 0807 1581grid.13291.38Department of Thoracic Surgery, West China Hospital, Sichuan University, Address: No. 37, Guoxue Alley, Chengdu, 610041 Sichuan China
| | - Weimin Li
- 0000 0001 0807 1581grid.13291.38Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- 0000 0001 0807 1581grid.13291.38Department of Thoracic Surgery, West China Hospital, Sichuan University, Address: No. 37, Guoxue Alley, Chengdu, 610041 Sichuan China
- West China School of Medicine, Sichuan University, Chengdu, 610041 China
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11
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Kokki H, Maaroos M, Ellam S, Halonen J, Ojanperä I, Ranta M, Ranta VP, Tolonen A, Lindberg O, Viitala M, Hartikainen J. How do different extracorporeal circulation systems affect metoprolol bioavailability in coronary artery bypass surgery patients. Eur J Clin Pharmacol 2018. [PMID: 29523917 DOI: 10.1007/s00228-018-2437-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Cardiac surgery and conventional extracorporeal circulation (CECC) impair the bioavailability of drugs administered by mouth. It is not known whether miniaturized ECC (MECC) or off-pump surgery (OPCAB) affect the bioavailability in similar manner. We evaluated the metoprolol bioavailability in patients undergoing CABG surgery with CECC, MECC, or having OPCAB. METHODS Thirty patients, ten in each group, aged 44-79 years, scheduled for CABG surgery were administered 50 mg metoprolol by mouth on the preoperative day at 8-10 a.m. and 8 p.m., 2 h before surgery, and thereafter daily at 8 a.m. and 8 p.m. Blood samples were collected up to 12 h after the morning dose on the preoperative day and on first and third postoperative days. Metoprolol concentration in plasma was analyzed using liquid chromatography-mass spectrometry. RESULTS The absorption of metoprolol was markedly reduced on the first postoperative day in all three groups, but recovered to the preoperative level on the third postoperative day. The geometric means (90% confidence interval) of AUC0-12 on the first and third postoperative days versus the preoperative day were 44 (26-74)% and 109 (86-139)% in the CECC-group, 28 (16-50)% and 79 (59-105)% in the MECC-group, and 26 (12-56)% and 96 (77-119)% in the OPCAB-group, respectively. Two patients in the CECC-group and two in the MECC-group developed atrial fibrillation (AF). The bioavailability and the drug concentrations of metoprolol in patients developing AF did not differ from those who remained in sinus rhythm. CONCLUSION The bioavailability of metoprolol by mouth was markedly reduced in the early phase after CABG with no difference between the CECC-, MECC-, and OPCAB-groups.
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Affiliation(s)
- Hannu Kokki
- School of Medicine, University of Eastern Finland, Kuopio, Finland. .,Department of Anaesthesia and Operative Services, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland.
| | - Martin Maaroos
- Heart Centre, Kuopio University Hospital, Kuopio, Finland
| | - Sten Ellam
- Department of Anaesthesia and Operative Services, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland
| | - Jari Halonen
- School of Medicine, University of Eastern Finland, Kuopio, Finland.,Heart Centre, Kuopio University Hospital, Kuopio, Finland
| | - Ilkka Ojanperä
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Merja Ranta
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Veli-Pekka Ranta
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | | | | | - Juha Hartikainen
- School of Medicine, University of Eastern Finland, Kuopio, Finland.,Heart Centre, Kuopio University Hospital, Kuopio, Finland
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12
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Yang M, Xiao LB, Gao ZS, Zhou JW. Clinical Effect and Prognosis of Off-Pump Minimally Invasive Direct Coronary Artery Bypass. Med Sci Monit 2017; 23:1123-1128. [PMID: 28257412 PMCID: PMC5347985 DOI: 10.12659/msm.902940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Coronary artery bypass grafting (CABG) is a common procedure to circumvent the obstruction of coronary arteries when stents are unsuitable. CABG is a very traumatic surgery that requires redirecting blood flow to an external pump. Thus, this procedure has many risks during and after surgery, and minimizing these risks would greatly benefit the patients. Material/Methods We selected 126 patients with coronary artery syndrome and who were unsuitable for stent percutaneous coronary intervention. The observation group received minimally invasive direct coronary artery bypass (MIDCAB), while the control group was treated with off-pump CABG. Results Blood markers and echocardiography before and after treatment improved equally in both groups. Neither group exhibited obvious adverse reactions, or liver and kidney function damage. However, surgical bleeding and postoperative observation days were significantly reduced in the MIDCAB group. Death and cardiac shock at the end of follow-up were significantly lower in the MIDCAB group. Conclusions Overall, the clinical benefits of MIDCAB and OP-CABG were similar, but MIDCAB significantly reduced postoperative hospital stay and intraoperative blood transfusion, and improved clinical prognosis.
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Affiliation(s)
- Ming Yang
- Department of Cardiothoracic Surgery, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
| | - Lian-Bo Xiao
- Department of Cardiothoracic Surgery, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
| | - Zhi-Sheng Gao
- Department of Cardiovascular Internal Four, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
| | - Ji-Wu Zhou
- Department of Cardiothoracic Surgery, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
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Paparella D, Parolari A, Rotunno C, Vincent J, Myasoedova V, Guida P, De Palo M, Margari V, Devereaux PJ, Lamy A, Alamanni F, Yusuf S, Whitlock R. The Effects of Steroids on Coagulation Dysfunction Induced by Cardiopulmonary Bypass: A Steroids in Cardiac Surgery (SIRS) Trial Substudy. Semin Thorac Cardiovasc Surg 2017; 29:35-44. [DOI: 10.1053/j.semtcvs.2017.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 11/11/2022]
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Nguyen B, Reeves B, Angelini G, Haskard D, Evans P. Reply. Ann Thorac Surg 2016; 102:1765-1766. [PMID: 27772582 DOI: 10.1016/j.athoracsur.2016.04.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 04/20/2016] [Accepted: 04/25/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Bao Nguyen
- Cardiovascular Sciences Unit, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Barnaby Reeves
- Bristol Heart Institute and Clinical Trials & Evaluation Unit, University of Bristol, Bristol, United Kingdom
| | - Gianni Angelini
- Bristol Heart Institute and Clinical Trials & Evaluation Unit, University of Bristol, Bristol, United Kingdom; Department of Cardiothoracic Surgery, Imperial College, London, United Kingdom
| | - Dorian Haskard
- Cardiovascular Sciences Unit, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Paul Evans
- Department of Cardiovascular Science, University of Sheffield, Sheffield, S10 2RX, United Kingdom.
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15
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Son KH, Park CH, Park KY, Choi CH. Which Variables Should be Considered as Confounders of p38-Mitogen Activated Protein Kinase Activation Measurements? Ann Thorac Surg 2016; 102:1764-1765. [PMID: 27772580 DOI: 10.1016/j.athoracsur.2016.03.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 03/29/2016] [Accepted: 03/31/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Kuk Hui Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University, 21 Namdong-daero 774 beon-gi l, Namdong-gu, Incheon 405-760, Korea
| | - Chul Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University, 21 Namdong-daero 774 beon-gi l, Namdong-gu, Incheon 405-760, Korea
| | - Kook Yang Park
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University, 21 Namdong-daero 774 beon-gi l, Namdong-gu, Incheon 405-760, Korea
| | - Chang Hu Choi
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University, 21 Namdong-daero 774 beon-gi l, Namdong-gu, Incheon 405-760, Korea.
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Holmannova D, Kolackova M, Mandak J, Kunes P, Holubcova Z, Holubec T, Krejsek J. Effects of conventional CPB and mini-CPB on neutrophils CD162, CD166 and CD195 expression. Perfusion 2016; 32:141-150. [PMID: 27625334 DOI: 10.1177/0267659116669586] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Cardiac surgery is known to trigger a systemic inflammatory response. While the use of conventional cardiopulmonary bypass (CPB) results in profound inflammation, modified mini-CPB is considered less harmful. We evaluated the impact of cardiac surgery on the expression of CD162, CD166, CD195 molecules and their association with the type of CPB used. METHODS AND RESULTS Twenty-four patients were enrolled in our study. Twelve of them were operated using conventional CPB while the other twelve patients underwent surgery with mini-CPB. Blood samples were analysed by flow cytometry. We observed a significant increase in median fluorescence intensity of CD162 and CD195 that peaked instantly after surgery and normalized to the baseline value on the 1st day post surgery, whereas CD166 was initially down-regulated and its median fluorescence intensity (MFI) value increased to the baseline in the next few days. CONCLUSION We observed immediate changes in the expression of CD162, CD166, and CD195 molecules on the neutrophils after surgery in both study groups of patients. The intensity of the observed changes was significantly greater in the group of patients who underwent conventional CPB compared to patients who underwent mini-CPB cardiac surgery.
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Affiliation(s)
- Drahomira Holmannova
- 1 Department of Clinical Immunology, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Martina Kolackova
- 1 Department of Clinical Immunology, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Jiri Mandak
- 2 Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Pavel Kunes
- 2 Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Zdenka Holubcova
- 2 Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Tomas Holubec
- 3 Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jan Krejsek
- 1 Department of Clinical Immunology, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
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Abstract
INTRODUCTION Cardiopulmonary bypass has undoubtedly been the cornerstone in the rapid development of cardiac surgery, allowing even the performance of procedures beyond the scope of cardiothoracic surgery. Its use however, is associated with significant complications that arise from the mechanical effects of the circuit on circulating blood components as well as the contact of blood with non-endothelial surfaces. Miniature cardiopulmonary bypass systems have been developed in an attempt to minimize these complications. Areas covered: Herein clinical outcomes from the most recent studies in adult cardiac surgery are discussed. The main benefits of miniaturisation as well as potential areas of further application are described. Expert commentary: Data is critically appraised in the context of current guidelines. Finally the need for further basic science in addition to large multi-centre randomized controlled trial data is highlighted.
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Affiliation(s)
- Ioannis Dimarakis
- a Department of Cardiothoracic Surgery , Wythenshawe Hospital , Manchester , UK
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