References of "Larbuisson, Robert"
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See detailEpargne sanguine : aspects préopératoires
LARBUISSON, Robert ULg

Scientific conference (2013, May 24)

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See detailEpargne sanguine en chirurgie cardiaque : Etude rétrospective des pratiques
ERPICUM, Marie ULg; DEFRAIGNE, Jean ULg; LARBUISSON, Robert ULg

Report (2013)

Cette étude rétrospective s’inscrit dans le cadre des recherches de la thèse de doctorat sur l’épargne sanguine à travers l’itinéraire clinique du patient opéré cardiaque. Son objectif est de dresser un ... [more ▼]

Cette étude rétrospective s’inscrit dans le cadre des recherches de la thèse de doctorat sur l’épargne sanguine à travers l’itinéraire clinique du patient opéré cardiaque. Son objectif est de dresser un état des lieux de la prise en charge des patients opérés cardiaques au CHU de Liège, des pratiques d’épargne sanguine qui y sont employées et de leur impact sur le recours à la transfusion, les durées de séjour et la mortalité. Cet audit devrait permettre de 1) mettre en évidence les éléments pouvant être améliorés dans l’organisation actuelle de la prise en charge de ces patients afin de concourir aux objectifs d’épargne sanguine 2) servir de base à l’élaboration d’un itinéraire clinique du patient opéré cardiaque. [less ▲]

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See detailUtilisation du système CardioPAT® en postopératoire de chirurgie cardiaque
ERPICUM, Marie ULg; FLECHE, Jérôme; SENARD, Marc ULg et al

Report (2013)

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See detailMultimodality blood conservation strategy in cardiac surgery with cardiopulmonary bypass: the CHU of Liege experience
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, November 20)

This study presents the transfusion rates of cardiac surgery patients and describes the in-house strategy of blood conservation applied in a single centre

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See detailPostoperative bleeding and autotransfusion
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, November 20)

Bleeding in the postoperative period of cardiac surgery is not rare. Mediastinal bleedings could potentially be saved with a cell salvage device. This practice may contribute to decreased allogeneic ... [more ▼]

Bleeding in the postoperative period of cardiac surgery is not rare. Mediastinal bleedings could potentially be saved with a cell salvage device. This practice may contribute to decreased allogeneic transfusion. This study explores the effectiveness of a chest drainage system combined with a cell salvage option during the postoperative period of cardiac surgery in patients at high risk of bleeding [less ▲]

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See detailL'épargne sanguine: un enjeu actuel
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

in Revue Médicale de Liège (2012), 67(11), 593-596

In view of the demographic evolution, the progress of quality requirements and the shortage of donors, a deficiency of blood components is to be feared in the coming years.. This implies the development ... [more ▼]

In view of the demographic evolution, the progress of quality requirements and the shortage of donors, a deficiency of blood components is to be feared in the coming years.. This implies the development of a blood conservation strategy, the revision of transfusion practices and the implementation of preventive measures to limit transfusion requirements. Each department caring for patients at high transfusion risk should assess and rationalize its transfusion practices in a structured multidisciplinary way [less ▲]

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See detailMultimodality blood conservation strategy in cardiac surgery with cardiopulmonary bypass : the CHU of Liège experience
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, September 29)

Introduction: The aim of this study is to analyze the transfusion rates of cardiac surgery patients in a single centre following an in-house strategy of blood conservation. Methods: The data of all adult ... [more ▼]

Introduction: The aim of this study is to analyze the transfusion rates of cardiac surgery patients in a single centre following an in-house strategy of blood conservation. Methods: The data of all adult patients undergoing normothermic cardiac surgery with cardiopulmonary bypass (CPB) over a 1 year period were retrospectively collected (n=491). Management protocols were described. The transfusion rates of allogeneic blood components were recorded: red blood cells (RBC), fresh frozen plasma (FFP) and platelets (PT), as well as the number of units transfused. The timing of transfusion was categorized: during CPB (peroperative period), within the first 48 postoperative hours after wean out CPB (early postoperative period) and during the hospitalisation from surgery until discharge (hospitalisation). The hematocrit values were recorded during CPB, 10 minutes after wean out CPB, after the first 48 postoperative hours and at discharge from hospital. Results: Two hundred and forty-eight patients (50%) received an allogeneic blood component transfusion during hospitalisation. One hundred and twenty-one patients (25%) received RBC during the operative period; the median of units transfused was 2(1-2).The lowest hematocrit value during CPB was 21(19-24) % in median. A cell salvage device was used in each case: the median volume of washed red blood cells transfused was 678(512-891) mL. The median hematocrit value after CPB was 23(21-25) %. One hundred and sixty-five patients (34%) were transfused in the early postoperative period: 27% received RBC, 18% received FFP and 18% received PT. The median of units transfused was 2(1-3) for RBC, 4(2-6) for FFP and 1(1-2) for PT. The median hematocrit value after 48 hours was 32(29-34) % and 32(30-35) % at discharge. Conclusion: The transfusion rates observed in this series are relatively high compared with the literature. Improvements will be made in our practice and protocols management in order to decrease the need of transfusion. This detailed audit of the transfusion practices in our cardiac surgery centre would be helpful to value the effectiveness of further improvements. [less ▲]

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See detailPostoperative bleeding and autotransfusion
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, September 29)

Introduction: Bleeding in the postoperative period of cardiac surgery is not infrequent. Mediastinal bleeding is usually collected in a chest drainage system and discarded. Nevertheless, this blood could ... [more ▼]

Introduction: Bleeding in the postoperative period of cardiac surgery is not infrequent. Mediastinal bleeding is usually collected in a chest drainage system and discarded. Nevertheless, this blood could potentially be managed with a cell salvage device during the first six postoperative hours. This practice is generally performed only in case of a surgical re-exploration for massive bleeding and may contribute to decreased allogeneic transfusion. But in case of postoperative coagulopathy requiring medical treatment, re-exploration is usually postponed and consequently, collected blood is discarded. Therefore, chest drainage systems combined with a cell salvage option could optimize the management of blood losses and transfusions in the postoperative period, regardless of any surgical re-exploration. The aim of this study is to assess the effectiveness of such a system during the postoperative period of cardiac surgery, in patient at high risk of bleeding. Method : During a 6 months period, the CardioPAT® (Haemonetics) device was used in all cardiac surgery patients at high risk of postoperative bleeding. The following data were prospectively collected: hemoglobin level, bleeding volume, volume of autologous washed red blood cell transfused by the CardioPAT® (WRBC), volume of allogeneic red blood cell (RBC), fresh frozen plasma (FFP) or platelets (PT) transfused and surgical re-exploration. Results : The CardioPAT® was used in 16 patients during the target period. Mean postoperative bleeding volume was 338±337mL after 1 hour and 820±727mL after 6 hours. The cell salvage option was used in 9 (56%) cases and mean WRBC transfused volume was 153±212mL. One patient required surgical re-exploration. All patients transfused by WRBC received previously an allogeneic transfusion (RBC, FFP and/or PT). The hemoglobin level of blood collected in the CardioPAT® device impacted on the delay and the blood volume required for WRBC availability; lower was the hemoglobin level, larger was the volume of blood required to obtain a concentrate of WRBC. Consequently, patients with a very low hemoglobin level were anyway transfused with RBC. Conclusion : The CardioPAT® device can reduce allogeneic blood transfusion after cardiac surgery in patients at high risk of bleeding. It gives time to treat coagulopathy, leading to a decrease of surgical re-exploration. However, a device with a larger reservoir and with a flexible processing speed would be more accurate in case of major haemorrhage. Systematic utilisation of this device at the time of FFP and/or PT transfusion is a safe but expensive strategy. It seems more accurate to use this device in a permissive bleeding strategy, waiting for the spontaneous coagulation recovery of the patient, in the first postoperative hours. [less ▲]

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See detailAbout the diagnosis of acute transfusion-related reaction during cardiopulmonary bypass
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Conference (2012, September 29)

Many advances have been realized in the field of blood safety during the last decade: donors’ selection, leukoreduction of packed red blood cells and platelet concentrates, genomic screening of blood ... [more ▼]

Many advances have been realized in the field of blood safety during the last decade: donors’ selection, leukoreduction of packed red blood cells and platelet concentrates, genomic screening of blood-borne diseases, viral and bacterial inactivation process,... However, transfusion of blood components remains unsafe. Therefore, detecting and reporting transfusion-related complications are still essential means for both the patients’ management and the public health approach, since these measures help to adjust preventive measures to be applied in a haemovigilance purpose. Most acute transfusion-related complications occur within minutes or hours after transfusion and require urgent medical care; delayed transfusion reactions may also develop days, even months later, implying a longer follow-up. Transfusion of red blood cells is not infrequent during cardiac surgery with cardiopulmonary bypass. Symptoms of acute transfusion-related reactions include hypotension, diffuse bleeding, hemoglobinuria and oliguria. These symptoms are identical to those that can be observed during a complicated cardiopulmonary bypass. Consequently, identification of acute transfusion-related reactions in this particular situation is quite difficult and probably leads to an under-reporting of their occurrence. In this paper, we explore how to track acute transfusion-related reactions during cardiopulmonary bypass. Any suspicion of such reactions must leads to investigations, in order to confirm the diagnosis. Their detection would allow to better focus their specific treatment and further their notification in a global blood safety policy. [less ▲]

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See detailCardiac paraganglioma : diagnostic work up and review of the literature.
Sooknunden, Marvyn ULg; HAMOIR, Etienne ULg; de Leval, Laurence ULg et al

in Acta Chirurgica Belgica (2012), 112

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See detailValve aortique percutanée
ERPICUM, Marie ULg; DEFRAIGNE, Jean ULg; LANCELLOTTI, Patrizio ULg et al

in Urgences & Accueil (2010), 11(40), 6-8

Transcatheter aortic valve implantation (TAVI) is increasingly performed and represents a relatively safe alternative treatment for high risk patients denied to surgical aortic valve replacement. TAVI is ... [more ▼]

Transcatheter aortic valve implantation (TAVI) is increasingly performed and represents a relatively safe alternative treatment for high risk patients denied to surgical aortic valve replacement. TAVI is performed at the University Hospital of Liege since July 2008 with the Medtronic CoreValve Revalving® system by femoral or subclavian access. This paper exposed the technique of TAVI and the nursing care required after this procedure. [less ▲]

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See detailPancreatic cellular injury after cardiac surgery with cardiopulmonary bypass: Frequency, time course and risk factors
Nys, Monique ULg; Venneman, Ingrid ULg; Deby-Dupont, G. et al

in Shock (Augusta, Ga.) (2007), 27(5), 474-481

Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We ... [more ▼]

Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We defined PCI as the simultaneous presence of abnormal values of pancreatic isoamylase and immunoreactive trypsin (IRT). The frequency and time evolution of PCI were assessed in this condition using assays for specific exocrine pancreatic enzymes. Correlations with inflammatory markers were searched for preoperative risk factors. One hundred ninety-three patients submitted to cardiac surgery were enrolled prospectively. Blood IRT, amylase, pancreatic isoamylase, lipase, and markers of inflammation (alpha1-protease inhibitor, alpha2-macroglobulin, myeloperoxidase) were measured preoperatively and postoperatively until day 8. The postoperative increase in plasma levels of pancreatic enzymes and urinary IRT was biphasic in all patients: early after surgery and later (from day 4 to 8 after surgery). One hundred thirty-three patients (69%) experienced PCI, with mean IRT, isoamylase, and alpha1-protease inhibitor values higher for each sample than that in patients without PCI. By multiple regression analysis, we found preoperative values of plasma IRT >or=40 ng/mL, amylase >or=42 IU/mL, and pancreatic isoamylase >or=20 IU/L associated with a higher incidence of postsurgery PCI (P < 0.005). In the PCI patients, a significant correlation was found between the 4 pancreatic enzymes and urinary IRT, total calcium, myeloperoxidase, alpha1-protease inhibitor, and alpha2-macroglobulin. These data support a high prevalence of postoperative PCI after cardiac surgery with cardiopulmonary bypass, typically biphasic and clinically silent, especially when pancreatic enzymes were elevated preoperatively. [less ▲]

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See detailDescription and Evaluation of a Simplified Technique for Replacement of the Ascending Aorta and Proximal Arch in Degenerative Aneurysmal Disease
Radermecker, M. A.; Nasser, A.; Fontaine, R et al

in Acta Chirurgica Belgica (2007), 107(6), 733-8

The distal extension of ascending aorta pathology often requires prosthetic grafting into the proximal arch. In order to perform optimal distal anastomosis, an open technique under a short period of ... [more ▼]

The distal extension of ascending aorta pathology often requires prosthetic grafting into the proximal arch. In order to perform optimal distal anastomosis, an open technique under a short period of circulatory arrest (CA) was adopted. For this purpose we evaluated prospectively a simplified technique for surgery and perfusion. The aneurysmal aorta was directly cannulated to cool down the patient to 26 degrees C. Under CA and retrograde cerebral perfusion, the diseased aorta and aortic cannulation site were resected. After completion of the distal anastomosis, antegrade rewarming was performed via recannulation of the AAo graft (side branch graft) whilst surgery was proceeded on the root and/or aortic valve. This technique clearly addresses the safety of cannulation into the aneurismal aorta. The issues of cerebral and visceral protection during CA and antegrade reperfusion and rewarming have been analysed prospectively in eight patients operated on over a period of 6 months. Our preliminary results indicate that this technique of arterial cannulation and CA at 26 degrees C for the management of degenerative AAo disease involving the proximal arch appears safe both in terms of cerebral and systemic (visceral, muscular) protection. By this way, the complications related to deep hypothermia and prolonged cardiopulmonary bypass are avoided. This assumption may be only valid for a CA period less than 30 min. This preliminary study is limited by its small size and heterogeneity of the pathologies. However, the simplicity, surgical ease, rapidity and efficacy conveyed by this technique warrant further consideration and evaluation. [less ▲]

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See detailActualites therapeutiques en anesthesie-reanimation: cap sur l'hopital de jour
Hick, Gaëtane ULg; Kirsch, Murielle ULg; Janssens, Marc ULg et al

in Revue Médicale de Liège (2007), 62(5-6, May-Jun), 272-6

The one day clinic possesses its own structure and organisation; patient management is also specific. Preoperative visit and assessment are programmed at least 48 hours before anesthesia. Preoperative ... [more ▼]

The one day clinic possesses its own structure and organisation; patient management is also specific. Preoperative visit and assessment are programmed at least 48 hours before anesthesia. Preoperative examinations and choice of anesthetic technique (sedation associated with local anesthesia or not, general anesthesia, locoregional anesthesia, or hypnosedation) are discussed and determined depending upon medical history, clinical examination, and type of procedure. General recommandations, instructions about fasting, interruption of some therapies, and introduction of new medication(s) are explained orally and also provided in a written document. New anesthetics and analgesics allow quick awakening and recovery of vital functions, and subsequently rapid hospital discharge. Prevention and aggressive treatment of postoperative nausea and vomiting are also a major concern in our anesthesic management of ambulatory patient. [less ▲]

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See detailThe use of pre-operative intrathecal morphine for analgesia following coronary artery bypass surgery
Roediger, Laurence ULg; Joris, Jean ULg; Senard, Marc ULg et al

in Anaesthesia (2006), 61(9), 838-844

With the emergence of rapid extubation protocols following cardiac surgery, providing adequate analgesia in the early postoperative period is important. This prospective randomised double-blind study ... [more ▼]

With the emergence of rapid extubation protocols following cardiac surgery, providing adequate analgesia in the early postoperative period is important. This prospective randomised double-blind study investigated the benefits of pre-operative intrathecal administration of low dose morphine in patients undergoing coronary artery bypass graft surgery. Postoperative analgesia, pulmonary function, stress response and postoperative recovery profile were assessed. Thirty patients were allocated into two groups, receiving either 500 mug of morphine intrathecally prior to anaesthesia and intravenous patient-controlled analgesia with morphine postoperatively following tracheal extubation, or only postoperative intravenous patient-controlled analgesia. In the intrathecal group, the total consumption of intravenous morphine following surgery was significantly reduced by 40% and patients reported lower pain scores at rest, during the first 24 h following extubation. Peak expiratory flow rate was greater and postoperative catecholamine release was significantly lower. Patients in the control group had a higher incidence of reduced respiratory rate following extubation. [less ▲]

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See detailNew approaches and old controversies to postoperative pain control following cardiac surgery
Roediger, Laurence ULg; Larbuisson, Robert ULg; Lamy, Maurice ULg

in European Journal of Anaesthesiology (2006), 23(7), 539-550

Objective: To evaluate the effect of postoperative pain control in cardiac surgical patients on morbidity, mortality and other outcome measures. Background: New approaches in pain control have been ... [more ▼]

Objective: To evaluate the effect of postoperative pain control in cardiac surgical patients on morbidity, mortality and other outcome measures. Background: New approaches in pain control have been introduced over the past decade. The impact of these interventions, either alone or in combination, on perioperative outcome was evaluated in cardiac surgical patients. Methods: We searched Medline for the period of 1980 to the present using the key terms analgesics, opioid, non-steroidal anti-inflammatory drugs, cardiac surgery, regional analgesia, spinal, epidural, fast-track cardiac anaesthesia, fast-track cardiac surgery, myocardial ischaemia, myocardial infarction, postoperative care, accelerated care programmes, postoperative complications, and we examined and discussed the articles that were identified to be included in this review. Results: Pain management in cardiac surgery is becoming more important with the establishment of minimally invasive direct coronary artery bypass surgery and fast-track management of conventional cardiac surgery patients. Advances have been made in this area and encompass specific techniques, such as central neuraxial blockade or selective nerve blocks, and drugs (opioids, sedative-hypnotics and non-steroidal anti-inflammatory drugs). Ideally, these therapies provide not only patient comfort but also mitigate untoward cardiovascular responses, pulmonary responses, and other inflammatory and secondary sympathetic responses. The introduction of these newer approaches to perioperative care has reduced morbidity, but not mortality, in cardiac surgical patients. Conclusions: Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of cardiac surgery, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Reorganization of the perioperative team (anaesthesiologists, surgeons, nurses and physical therapists) will be essential to achieve successful fast-track cardiac surgical programmes. Developments and improvements of multimodal interventions within the context of 'fast-track' cardiac surgery programmes represents the major challenge for the medical professionals working to achieve a 'pain and risk free' perioperative course. [less ▲]

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See detailOxygen carriers in cardiac surgery
Larbuisson, Robert ULg; Deby, Ginette ULg; Lamy, Maurice ULg

in Transfusion Alternatives in Transfusion Medicine (2005), 7(1), 42-57

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See detailComparison of the effects of propofol and pentobarbital on left ventricular adaptation to an increased afterload
Kolh, Philippe ULg; Lambermont, Bernard ULg; Ghuysen, Alexandre ULg et al

in Journal of Cardiovascular Pharmacology (2004), 44(3), 294-301

The purpose of this study was to compare the hemodynamic effects of pentobarbital and propofol and their effects on cardiovascular adaptation to an abrupt increase in left ventricular afterload ... [more ▼]

The purpose of this study was to compare the hemodynamic effects of pentobarbital and propofol and their effects on cardiovascular adaptation to an abrupt increase in left ventricular afterload. Experiments were performed in 12 open-chest pigs instrumented for measurement of aortic pressure and flow, and left ventricular pressure and volume. In one group (n = 6), anesthesia was obtained with sodium pentobarbital (3 mg x kg(-1) x h(-1)), and, in the second group B (n = 6), with propofol (10 mg x kg(-1) x h(-1)). Both groups received sufentanil (0.5 microg x kg(-1) x h(-1)) and pancuronium bromide (0.1 mg x kg(-1)). Left ventricular function was assessed by the slope of end-systolic pressure-volume relationship and stroke work. After baseline recordings, left ventricular afterload was increased by aortic banding. The cardiovascular adaptations triggered by the aortic banding, such as tachycardia, vasoconstriction, and augmentation of myocardial contractility were prevented with propofol, suggesting interference with the baroreflex. Increase in left ventricular afterload decreased mechanical efficiency, regardless of anesthetic agent. These results showed that pentobarbital at 3 mg x kg(-1) x h(-1) has less deleterious hemodynamic effects than propofol at 10 mg x kg(-1) x h(-1). [less ▲]

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See detailActualites en anesthésie-réanimation en chirurgie cardiaque adulte
Roediger, Laurence ULg; Larbuisson, Robert ULg; Senard, Marc ULg et al

in Revue Médicale de Liège (2004), 59(1), 35-45

Anesthetic techniques and treatment of cardiac surgery patients have considerably evolved over the past twenty years. The demand for cardiac surgical procedures is increasing. This demand coincides with a ... [more ▼]

Anesthetic techniques and treatment of cardiac surgery patients have considerably evolved over the past twenty years. The demand for cardiac surgical procedures is increasing. This demand coincides with a change in the profile of patients presenting for surgery, requiring modification in perioperative management strategies. Several new anesthetics, related drugs, and technologies have become available in recent years that inevitably have made new approaches with patient management possible. In parallel to these new developments, there have appeared real opportunities to apply novel physiologic and pharmacologic concepts that may redefine our clinical practice. Fast-tracking, which emphasizes the major role of anesthetic management in postoperative outcome, is one such line of investigation. Fast-tracking was first introduced in an attempt to decrease the time to tracheal extubation and reduce expensive time in intensive care unit areas. Large doses of opioids have been clearly identified as a factor in delaying weaning from mechanical ventilatory support after cardiac surgery. Thus, early investigations emphasized the importance of limiting the dose of potent opioid analgesics during the intraoperative period to achieve early recovery. Supplementation with hypnotic drugs allows reduction of the opioid dose, enabling earlier extubation without compromising hemodynamic stability. Fast track cardiac anesthesia (FTCA) is becoming an accepted practice for perioperative management of cardiac surgical patients. FTCA is a key component to successful conduction of fast-track cardiac surgery. Also, analgesia management in cardiac surgery is becoming more important with the establishment of minimally invasive direct coronary artery bypass surgery and fast track management of conventional cardiac surgery patients. [less ▲]

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