摘要:

AbstractBackground:The objective of this study was to determine the significant differences in preoperative and operative characteristics, and postoperative outcomes in patients having coronary artery bypass grafting (CABG) who are smokers and in those who are not smokers.Methods: Data were collected prospectively in all (2916) patients having their first CABG. The patients were cared for in a regional medical center by private physicians. No operations were denied because of smoking status. Smokers differed from nonsmokers in several characteristics.Results: Analysis of morbidity and mortality showed no instance in which smokers fared worse than nonsmokers. Stepwise logistic regression analysis showed that smoking was not predictive of mortality. Smoking was not predictive of morbidity except that it was predictive of less probability of need for intra‐aortic balloon pump (7.5% in non‐smokers and 4.7% in smokers). We then created groups of smokers and nonsmokers that were individually matched for age and sex. Analysis of the matched groups of smokers and nonsmokers showed that there was no significant difference in the incidence or magnitude of preoperative and operative factors except that recent myocardial infarction was more common in smokers. Nonsmokers had greater weight, body mass index (obesity), and ejection fraction. There was no difference in smokers and nonsmokers in mortality or morbidity at the 99% confidence level.Conclusion: We conclude that there is no need to delay CABG for the patients who are smok

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00067.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.tb00068.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground: Reinfusion of mediastinal shed blood after cardiac surgery has been used in some centers to reduce exposure to homologous blood transfusions. The method has not been widely applied mostly because some studies have failed to demonstrate a significant benefit.Methods: A group of 675 consecutive patients undergoing first‐time, isolated coronary artery bypass surgery (CABG) was studied. Prospective data was collected on the first 375 patients receiving autotransfusion (ATS) of mediastinal shed blood. The charts of 338 patients immediately preceding the institution of the ATS program at our institution (NO ATS group) were retrospectively reviewed. Transfusion of homologous blood products and rate of re‐exploration for bleeding were closely monitored.Results: The two groups were identical. The net blood loss was significantly less in the ATS group than in the NO ATS group (1013 ± 431 cc vs 1371 ± 631 cc, p<0.0001). Rate of exploration for postoperative bleeding was 1.5% in the ATS group and 5.0% in the NO ATS group (p<0.01). In the ATS group, 51.9% of patients were not exposed to any homologous blood product (vs 17.8% in the NO ATS group, p<0.0001). The ATS patients received on the average 2.9 ± 7.2 units of blood products versus 6.4 ± 9.7 units in the NO ATS group (p<0.0001).Conclusion: Reinfusion of mediastinal shed blood significantly reduces exposure to homologous blood transfusions and rate of re‐exploration. The ATS system reduces the number of re‐explorations for coagulopathy‐related postoperati

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00069.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground: Cardiopulmonary bypass (CPB) causes an inflammatory response and remarkably depresses the oxygenation capacity of the lung in pediatric patients with pulmonary hypertension. Although a heparin‐coated circuit is more biocompatible than an uncoated circuit, the beneficial effect of a heparin‐coated circuit on the postoperative lung function in the pediatric patients remains unknown.Methods: Sixty patients younger than 3‐years‐old undergoing heart operations for ventricular septal defect were divided into three groups: group I = children (n = 11) without pulmonary hypertension who underwent CPB with an uncoated oxygenator; group II = children (n = 32) with pulmonary hypertension who underwent CPB with an uncoated oxygenator; and group III = children (n = 17) with pulmonary hypertension who underwent CPB with a heparin‐coated oxygenator. A respiratory index (RI) was used to assess the oxygenation capacity of the lung.Results: RI in group II was significantly higher than in group I and intubation time in group II was significantly longer than in group I. There was a positive correlation between preoperative pulmonary‐systemic blood pressure ratio and RI at 3 hours post‐CPB. Three and six hours post‐CPB, RI in group III was significantly lower than in group II, but there was no significant difference in RI between both groups at 12 hours post‐CPB.Conclusions: Pulmonary hypertensive pediatric patients were vulnerable to postperfusion lung injury. Beneficial effects of a heparin‐coated oxygenator in a CPB circuit was limited to the early hours post‐CPB and the postoperative clinical course was not modified by the heparin‐coating o

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00070.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground and Aim: Coronary artery disease (CAD) and coronary artery bypass grafting (CABG) in young patients are different than their older counterparts. The purpose of this study is to more fully define the issues of CABG in patients in their third decade of life.Methods: The medical records from all patients under forty years of age undergoing CABG at Allegheny University Hospital, Hahnemann Division, Philadelphia, PA from July 1990 to June 1995 were examined. Surgical outcome, psychosocial, and sexual issues were examined. Lipid analyses were compared perioperatively.Results: There were 43 male and 9 female patients. The mean age was 35 years (23 to 39 years). Risk factors included 43 (83%) patients with a history of smoking, 34 (65%) with familial hypercholesterolemia, 25 (48%) with a family history of CAD, 23 (44%) with hypertension, and 11 (21%) with diabetes. The mean preoperative serum cholesterol was 241 mg/dL. There were no hospital mortalities. Morbidities were found in 18 (35%) patients, including 9 (17%) cardiac, 5 (10%) pulmonary, 3 (6%) infectious, and 1 (2%) renal. In follow‐up, three cardiac‐related mortalities occurred within five years of surgery. Sixteen patients were readmitted to a hospital for cardiac related causes. Thirty‐two (62%) patients failed to return to work, twenty‐five (48%) failed to engage in regular exercise, and twenty‐four resumed smoking. Psychosocial changes were found postoperatively in thirty (58%) patients. Eight (15%) patients admitted to sexual changes following surgery. Postoperative lipid profiles were minimally altered from preoperative values.Conclusions: Surgical revascularization is successful in alleviating symptoms with minimal risk. Postoperatively, a number of cardiac related events occurred. A significant number of patients resume smoking, fail to engage in regular exercise, fail to resume work, and fail to take prescribed lipid‐lowering agents. Psychosocial and sexual dysfunctions ar

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00071.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractAcute kinking of coronary bypass grafts and postoperative hemorrhage due to oozing from the anastomotic suture lines are uncommon but devastating complications of myocardial revascularization. Routine draping of arterial and venous coronary bypass grafts just prior to sternal closure by use of thrombin‐soaked oxidized regenerated cellulose may help to avoid these potentially lethal complications. This practice appears to be devoid of any immediate or long‐term sequela to the pati

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00072.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground: In the repair of total anomalous pulmonary venous return (TAPVR) under cardiopulmonary bypass, esmolol, ultra short acting beta blocker, was applied to obtain low heart rate and weak ventricular contraction under mild hypothermic cardiopulmonary bypass.Methods: Five infants aged from 14 to 158 days with an average of 70 days, underwent a primary or palliative repair of TAPVR. The type of anomalous return was supracardiac type (2), infracardiac (2), and intracardiac (1). A primary repair was done in three for isolated TAPVR with bypass time of 65 to 76 minutes, and a palliative repair for two with complex anomalies with bypass time of 64 and 87 minutes.Results: There was one operative death from cerebral bleeding in an infant with complex TAPVR who underwent simultaneous pulmonary banding.Conclusion: This strategy seems to be applicable in pediatric cardiac surgery when aortic cross‐clamping is better to be avoided and the surgery is mainly limited to the atrial leve

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00073.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.tb00074.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractPulmonary regurgitation (PR) following nonvalved reconstruction of the right ventricular outflow tract is usually well tolerated. However, a small percentage of patients develop progressive right ventricular dilatation and failure due to long‐standing PR. When this group of patients becomes refractory to medical management, pulmonic valve replacement (PVR) may offer symptomatic relief and hemodynamic improvement. From a cumulative experience, the pulmonary homograft may be the optimal choice for PVR due to its very low transvalvular gradient assuring optimal hemodynamics, the absence of anticoagulation‐re‐lated and thromboembolic complications, and the excellent mid‐term results when compared to other valved conduit, including the aortic homograft. We report our experience in two patients who have been operated upon at the BWH between March and August 1995 for severe pulmonary valve insufficiency and right heart failure, who received cryopreserved pulmonary homografts. We also describe our technique of PVR using a pulmonary homograft as an or‐thotopic root re

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00075.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground: Supraventricular arrhythmias continue to complicate the postoperative course of patients undergoing myocardial revascularization. The aim of the study was to identify factors associated with atrial fibrillation (AF) and to determine the efficacy of postoperative magnesium sulphate (MgSO4) replacement on the incidence of AF after coronary artery bypass grafting (CABG) operation.Methods: Fifty patients undergoing CABG were studied prespectively. Consenting patients with good left ventricular function and without any documented arrhythmias were randomly divided into two groups of 25 patients each in a double‐blind fashion. The clinical characteristics of both groups were similar. In the study group, 200 mEq MgSO4was given for the first 5 postoperative days, in the control group, placebo was given instead of MgSO4.Results: Five (20%) patients in the control group and one (4%) patient in the MgSO4group experienced AF. There was no significant relationship between the development of AF and the following variables: age; sex; diabetes mellitus; hypertension; previous myocardial infarction; smoking; extension of coronary artery disease; aortic cross‐clamp time; number of grafts; cardiopulmonary bypass time; postoperative pericarditis; and anemia.Conclusion: The use of MgSO4in early postoperative period is effective in reducing the incidence of AF after CABG in patients with good ventricular funct

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1996.tb00076.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY