Methods: We reviewed the outcomes of 450 patients who underwent redo mitral valve surgery via a right thoracotomy from 1996 to 2011 at the University of Michigan. Of these, 134 patients underwent redo mitral valve surgery with ventricular fibrillation, and 316 patients underwent beating heart surgery. Although operative eras were consecutive, patients’ age, risk factors, New York Heart Association, and preoperative left ventricular ejection fraction were not significantly different. Core temperature on cardiopulmonary bypass buy GDC-0449 for beating heart surgery was 32 degrees C versus 26 degrees C for ventricular
fibrillation.
Results: Patients undergoing beating heart surgery had shorter periods of cardiopulmonary bypass: 81 +/- 9 minutes versus 113 +/- 36 minutes. Beating heart surgery required less blood products than ventricular fibrillation: 1.65 +/- 2 units versus 3.8 +/- 5 units packed red blood cells, 0.6 +/- CUDC-907 cost 1.2 units versus 1.8 +/- 4 units fresh-frozen plasma, and 1.02 +/- 4 versus 7.5 +/- 17 platelet packs (all P < .01). Conversely, patients receiving ventricular fibrillation required longer postoperative ventilation: 34 +/- 101 hours versus 15.5 +/- 27 hours (P < .01). The 30-day mortality was similar for both (6.5% for beating heart and 7.4% for ventricular fibrillation), and postoperative length of stay
was the same at 7 days. Stroke rate was 2.6% for patients undergoing beating heart surgery and 3% for patients receiving ventricular fibrillation. Significant operative complications were uncommon; there was no catastrophic hemorrhage, and only 2 patients receiving ventricular fibrillation and 2 patients undergoing beating heart surgery required reexploration.
Conclusions: As reoperative cardiac surgery
continues to increase, techniques that safely facilitate operation while improving outcome should be adopted. As an operative alternative, redo right thoracotomy mitral valve surgery on the beating heart is associated with shorter bypass time, less transfusion requirements, shorter postoperative ventilation, and lower mortality. This safe and effective approach should be considered for this complex operation. (J BAY 11-7082 manufacturer Thorac Cardiovasc Surg 2012;144:334-9)”
“Although abductor pollicis brevis (APB) and flexor pollicis longus (FPL) share a common peripheral nerve supply, these muscles subserve different functions and may be differently affected in neurode-generative disease such as amyotrophic lateral sclerosis (ALS). As a consequence, differences in cortical excitability may potentially develop in relation to these functional differences. Cortical excitability was assessed using the threshold tracking transcranial magnetic stimulation (TMS) technique in 15 healthy controls with motor responses recorded over the APB and FPL using surface electrode recordings.