Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2009
Comparative StudySelective antegrade cerebral perfusion at two different temperatures compared to hypothermic circulatory arrest--an experimental study in the pig with microdialysis.
Hypothermic arrest and selective antegrade cerebral perfusion (SACP) is widely used during aortic arch surgery. The microdialysis technique monitors biomarkers of cellular metabolism and cellular integrity over time. In this study, the cerebral changes during hypothermic circulatory arrest (HCA) at 20 degrees C and HCA with SACP at two different temperatures, 20 and 28 degrees C, were monitored. ⋯ The largest increase of glycerol was found in the group with tepid cerebral perfusion (28 degrees C) and the HCA group (P<0.05). This study supports the use of SACP over arrest. It also suggests that cerebral metabolism and cellular membrane integrity may be better preserved with SACP at 20 degrees C compared to 28 degrees C.
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Interact Cardiovasc Thorac Surg · Jun 2009
Clinical application of an ultrasonic scalpel to divide pulmonary vessels based on laboratory evidence.
The Harmonic Ace ultrasonic scalpel (Ethicon Endo-Surgery, Inc, Cincinnati, Ohio), has been widely used in endoscopic surgery to divide systemic vessels, but not pulmonary vessels. We describe our initial clinical experience of using it for pulmonary vessel division. The Harmonic Ace was used to divide pulmonary vessels 5 mm or less in diameter, secured with a proximal single ligation, in 20 patients who underwent video-assisted major lung resection between September 2007 and April 2008. ⋯ There was no postoperative bleeding. In the pig model, the bursting pressure of sealed pulmonary arteries (PA) was >75 mmHg. Pulmonary vessels can be safely divided using the Harmonic Ace with proximal single ligation unless multiple or large pulmonary vessels are held within the blade jaw.
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Interact Cardiovasc Thorac Surg · Jun 2009
Comparative StudyClinical and hemodynamic factors associated with the outcome of early extubation attempts after right heart bypass surgery.
Fast-track anesthesia with early extubation (EE) is playing an increasingly important role in pediatric cardiac surgery. We examined the pre- and intra-operative factors contributing to successful EE, and outcomes after right heart bypass surgery (RHB). We retrospectively reviewed the medical records of 71 consecutive children (median age=14 months) admitted over a 4-year period to the pediatric intensive care unit (PICU) of our university-based hospital, after RHB. ⋯ EE was correlated with fewer postoperative respiratory complications (OR: 0.09; 95% CI, 0.02-0.57; P=0.01) and shorter stay in the PICU (OR: 0.88; 95% CI, 0.76-1.03; P=0.12). Our data suggest that EE after RHB could be facilitated in patients with a preserved cardiac function and lower pulmonary vascular resistance. EE could be followed by fewer postoperative pulmonary complications.