Clinical impact of del Nido cardioplegia in adult cardiac surgery: A prospective randomized trial.

OBJECTIVE: The study objective was to assess the benefits of del Nido cardioplegia compared with cold blood cardioplegia solution in terms of myocardial protection during adult cardiac surgery. METHODS: A total of 474 adult patients undergoing coronary artery bypass grafting, heart valve surgery, thoracic aortic surgery, or combined procedures were randomized to the del Nido cardioplegia group (n = 234) or the cold blood cardioplegia solution group (n = 240) after provided informed consent. The primary end points assessed inotropic support requirements, severe cardiovascular events, and troponin trend within the first 48 hours of intensive care unit stay. Reperfusion arrhythmias, aortic crossclamp and cardiopulmonary bypass times, and other clinical perioperative variables were considered as secondary end points. RESULTS: No statistically significant differences were found regarding postoperative inotropic support requirements or the incidence of severe cardiovascular events. The del Nido cardioplegia group showed a higher return to spontaneous sinus rhythm (P< .001), a lower number of defibrillation attempts (P< .001), and an earlier peak troponin value in the postoperative period. Peak blood glucose levels and intravenous insulin requirements were significantly lower in the del Nido cardioplegia group. We found no significant differences regarding aortic crossclamp or cardiopulmonary bypass time. We did observe a lower incidence of postoperative stroke in the del Nido cardioplegia group (2.6% vs 6.7%; P= .035). CONCLUSIONS: del Nido cardioplegia can be used safely and with comparable outcomes compared with traditional cardioplegia solutions. Additional advantages over glycemic control, reperfusion arrhythmias, and its comfortable redosing interval make del Nido an interesting alternative for myocardial protection in adult cardiac surgery. A significant decrease in postoperative stroke will require further research to shed light on the results of this study. VIDEO ABSTRACT.

Femtosecond laser induced surface swelling in poly-methyl methacrylate.

We show that surface swelling is the first step in the interaction of a single femtosecond laser pulse with PMMA. This is followed by perforation of the swollen structure and material ejection. The size of the swelling and the perforated hole increases with pulse energy. After certain energy the swelling disappears and the interaction is dominated by the ablated hole. This behaviour is independent of laser polarization. The threshold energy at which the hole size coincides with size of swelling is 1.5 times that of the threshold for surface swelling. 2D molecular dynamics simulations show surface swelling at low pulse energies along with void formation below the surface within the interaction region. Simulations show that at higher energies, the voids coalesce and grow, and the interaction is dominated by material ejection.

Fabrication of microlens arrays in polycarbonate with nanojoule energy femtosecond laser pulses.

We report fabrication of smooth microlens arrays by focusing a nanojoule energy, high repetition rate femtosecond laser oscillator inside a polycarbonate sample. Heat accumulation at the laser focal point and subsequent material expansion leads to localized swelling at the sample surface that behaves as a microlens. By changing the depth of the laser focus in the sample, the focal length of the microlens can be controlled and varies from 40 to 80 µm while maintaining a high numerical aperture of ~0.6. This fabrication technique is a single step, controllable, and economical process that can produce arrays of optically smooth microlenses.

Mechanism for spherical dome and microvoid formation in polycarbonate using nanojoule femtosecond laser pulses.

Spherical domes are created on the surface of polycarbonate samples, and microvoids are formed within the bulk using only a femtosecond oscillator with pulse energy of just 0.47 nJ. Size of spherical domes and shape of microvoids are controlled by changing the laser focus inside the material. Their formation is explained by a combination of heat accumulation and dome formation dynamics, where the dome acts as a microlens shifting the laser focus within the sample. The technique described here provides a simple avenue for fabricating smooth microlens arrays of various sizes and opens the possibility for direct fabrication of complex three-dimensional microfluidic channels in transparent materials.

Spontaneous and sequential transitions of a Gaussian beam into diffraction rings, single ring and circular array of filaments in a photopolymer.

A Gaussian beam propagating in a photopolymer undergoes self-phase modulation to form diffraction rings and then transforms into a single ring, which in turn ruptures into a necklace of stable self-trapped multimode filaments. The transitions of the beam between the three distinct nonlinear forms only occur at intensities where the beam-induced refractive index profile in the medium slowly evolves from a Gaussian to a flattened Gaussian.