The Annals of thoracic surgery
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An interesting observation, ie, the coracoclavicular line (from the lower border of the coracoid process to the upper border of the medial head of the clavicle) was parallel to the subclavian vein catheter in bedside chest roentgenograms (anteroposterior view), prompted us to use this subclavian approach. After supine positioning of the patient with the arm alongside the body and the left shoulder elevated 10 to 15 degrees, the puncture point was selected 1.5 cm away from the point where the coracoclavicular line crossed inferior border of the clavicle on the skin. ⋯ In 205 attempts in adult patients, 95.6% patients had successful cannulation in first attempt without significant complication. This technique appears to be promising as it is based on observation and is guided by constant landmarks and precise direction.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized study of right ventricular function with intermittent warm or cold cardioplegia.
Transient right ventricular dysfunction has been previously documented after bypass operations despite adequate myocardial protection with intermittent antegrade cold blood cardioplegia. Recently warm blood cardioplegia has been interrupted during construction of distal anastomoses to improve visualization. The effects of intermittent antegrade warm blood cardioplegia, and the resultant periods of right ventricular normothermic ischemia, on postoperative right ventricular function are unknown. ⋯ Despite intermittent normothermic ischemia of half the cross-clamp time, patients receiving warm cardioplegia maintained right ventricular hemodynamics after bypass grafting.
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Two types of ventricular assist systems have been approved for use by the Japanese government. ⋯ From these data, the Toyobo pump and the Zeon pump are useful for short-term support for acute, profound heart failure. The Toyobo pump also may provide sufficient support as a bridge to transplantation for the medium term.
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New volume requirements for coronary artery bypass grafting are being imposed on cardiac surgeons by hospitals, managed care groups, and others. The rationale for this is unclear. The available literature as well as additional sources relating volume and outcomes in cardiac surgery were extensively reviewed and reexamined. ⋯ Each cardiothoracic surgeon should participate in a national database that permits comparison of his or her outcomes on a risk-adjusted basis with other surgeons. Until conclusive data become available that link volume to outcome, volume should not be used as a criterion for credentialing of cardiac surgeons by hospitals, managed care groups, or others. Instead, each surgeon should be evaluated on his or her individual results.