摘要:

AbstractBackground: Despite many advances in blood conservation techniques, a significant proportion of patients undergoing primary coronary revascularization still require homologous transfusions. A comprehensive strategy to diminish perioperative blood loss was developed by integrating many individual components to create an improved blood conservation environment and was prospectively applied to 557 patients undergoing primary coronary artery bypass grafting (CABG) procedures performed in our medical center over a 14‐month period.Methods: The first 455 patients were treated with conventional, nonheparinbonded circuits (NHBCs) and full anticoagulation (activated clotting time [ACT]>480 sec). We wanted to test the hypothesis of whether “tip‐to‐tip” heparin‐bonded circuits (HBCs) used in conjunction with lower anticoagulation (ACT>280 sec) when added to our current blood conservation environment can further enhance clinical outcomes. We prospectively applied this technique to a consecutive group of patients (n = 102).Results: Compared to patients treated with NHBCs, patients treated with HBCs had a significantly lower mediastinal and pleural chest tube output in the first 24 hours (683 ± 561 mL vs 984 ± 616 mL, p<0.00001) were less likely to be transfused (52% vs 68.1%, p<0.01) and had a lower exposure to different blood donor units (4.1 ± 8.4 vs 9.3, ± 10.3, p<0.000003). There were no complications directly related to HBCs used in conjunction with lower anticoagulation. Morbidity and mortality rates were similar in both treatment groups.Conclusion: In summary, HBCs in conjunction with lower anticoagulation were safely applied in patients undergoing primary CABG with marked improvement in blood conservation, and should be considered for broad

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00018.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractWe present a case of a 34‐year‐old male with dilated cardiomyopathy in whom we performed a new surgical procedure; i.e., ventricular volume reduction to improve function. This initial human experience was preceded by a series of ten sheep in which we demonstrated that by enlarging the left ventricle (LV), the ejection fraction was reduced, and by restoring normal diameter, the LV function returned to nor

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00019.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00020.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground: Cardiomyoplasty surgery has been shown to be associated with damage and degeneration of the assisting skeletal muscle. The purpose of this study was to use ischemic (short‐term) and thermal (long‐term) preconditioning to protect the muscle during surgery and the subsequent ischemia.Methods: Three 10‐minute cycles of ischemia‐reperfusion were accomplished noninvasively on goat latissimus dorsi muscle (LDM) immediately prior to surgery. In another experiment, LDM was noninvasively heat shocked for 20 minutes at 42°C 24 hours prior to surgery. LDM damage was evaluated 5 days postsurgery using enzyme activities (β‐glucuronidase, β‐GLN; citrate synthase), hydroxyproline, morphology, and blood flow.Results: The lysosomal enzyme, β‐GLN, was significantly increased (43%, p<0.05) by surgical dissection and remained high in the ischemic preconditioned LDM (58%, p<0.05) and in the heat shocked LDM (57%, p<0.05).Conclusion: These findings show that these two protective protocols do not reduce the muscle damage that occurs during surgical preparation of the LDM fo

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00021.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00022.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractCommercially available cardioplegia delivery systems now allow for antegrade (aortic root, coronary ostia, saphenous vein graft) perfusion to occur either sequentially or simultaneous with retrograde (coronary sinus) perfusion. This study was designed to compare the total flow and local distribution of sequential versus simultaneous antegrade/retrograde cardioplegia delivery.Methods: Explanted human hearts diagnosed with idiopathic cardiomyopathy underwent a cold cardioplegic arrest and bicaval cardiectomy. Thirty‐seven degree centigrade blood cardioplegia containing colored microspheres was then delivered antegrade (red color) at a pressure of 80 mmHg or retrograde (blue color) at a pressure of 40 mmHg. In the sequential group (n = 6), cardioplegia was delivered antegrade and then retrograde for 2 minutes, respectively. For the simultaneous group (n = 6), cardioplegia was delivered both antegrade and retrograde for 2 minutes. The ventricular myocardium was then sampled at 12 representative sites to determine regional cardioplegic flow.Results: Mean total cardioplegia delivery/minute was 0.69 ± 0.62 mL/g per minute for sequential cardioplegia, and 0.46 ± 0.19 mL/g per minute for simultaneous cardioplegia (p>0.05, NS). At the 12 ventricular sites sampled, mean regional cardioplegic flow (mL/g per min) was in general slightly greater for sequential delivery. However, this was not statistically significant (p>0.05, NS).Conclusion: The data suggest that there may be a slight advantage in total cardioplegia delivery and regional cardioplegia delivery when using sequential rather than simultaneous cardioplegia delivery. However, this difference was not statistically significant and is likely not of clinical significance. Therefore, we would recommend using either sequential or simultaneous antegrade/retrograde cardioplegia based upon whichever technique facilitates the conduct of the individual operat

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00023.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractThis article summarizes the case histories of six infants who had isolated secundum‐type atrial septal defects (ASDs) and presented with failure to thrive in the first year of life. Patients underwent operative closure of their ASD with the expectation that this would improve their feeding and growth pattern. Five of the six children demonstrated little or no improvement in symptoms following operation. Each of these five patients have subsequently shown signs of developmental delay. Our experience with this group suggests that failure to thrive associated with a secundum ASD will frequently have a noncardiac basi

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00024.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractObjectives and Background: The purpose of this study was to document our initial experience with patients 90 years of age and older and to determine whether cardiac surgery is justified in this age group. Cardiac surgery in octogenarians has proven to be a successful and worthwhile procedure. A small group of nonagenarians with severe coronary artery disease (CAD) and aortic valve disease refractory to medical therapy have been considered for surgery.Methods: Fourteen patients aged 90 or more underwent cardiac surgery for symptomatic CAD or aortic valvular disease refractory to medical therapy. Eight patients underwent isolated coronary artery bypass grafting (CABG) and six patients underwent aortic valve replacement (AVR). All patients were in NYHA Class IV preoperatively.Results: Hospital mortality occurred in one patient (7%). Hospital morbidity occurred in 10 patients (71%) and included 7 cardiac, 5 neurological, 1 gastrointestinal, 1 infectious, and 1 pulmonary event. All survivors left the hospital symptomatically improved. The mean length of stay was 26 days. Four CABG patients went on to die at a mean of 2 years and 2 months, and 3 remain alive at a mean of 2 years and 4 months. Three AVR patients expired at a mean of 3 years and 4 months, and 3 remain alive at 4 years and 1 month.Conclusions: Cardiac surgery in carefully selected nonagenarians is justified and can be performed with acceptable results.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00025.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground and Aims: Chronic renal failure (CRF) is known to increase the morbidity and mortality in patients undergoing cardiac operations. Successful outcome of coronary artery bypass grafting (CABG) in some patients with CRF has been reported, but remains controversial.Methods: Forty‐four patients with CRF who underwent CABG were examined. Two groups were analyzed. Group I consisted of 13 patients with end‐stage renal disease on hemodialysis. Group II consisted of 31 patients with a creatinine ± 1.6 gm/dL for a minimum of 6 months, but were not on dialysis. There were 36 male and 8 female patients, with a mean age of 71 years.Results: The hospital mortality was 10 patients (23%) with 4 (31%) hospital deaths in Group I, and 6 (19%) in Group II. There was major morbidity in 35 (80%) patients. In Group II there were 8 (26%) patients who required permanent postoperative dialysis. A control group of 547 patients 70 years of age who underwent CABG had 30 hospital mortalities (5%) and 75 morbidities (13%). The average length of stay was 27 days. Fifteen patients died at a mean of 34 months after being discharged from the hospital. Nineteen of the original 44 patients remain alive at a mean of 32 months. The total mortality at 6 years and 4 months was 57%.Conclusions: Older and sicker patients with CRF who undergo CABG are at an exceptionally high risk for mortality and morbidity. For CRF patients not on dialysis with a creatinine 2.5 gm/dL, there is a strong likelihood of permanent postoperative dialysis. Long‐term follow‐up shows survival to be well below their non‐CRF co

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00026.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00027.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY