The Annals of thoracic surgery
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Comparative Study
Use of verapamil and nitroglycerin solution in preparation of radial artery for coronary grafting.
The radial artery (RA) has been used as an alternative arterial graft for coronary artery bypass grafting. This artery has been reported to be spastic; therefore, use of spasmolytic drugs (vasodilators) during the preparation of the RA is recommended. The combination of calcium antagonists and nitroglycerin (verapamil plus nitroglycerin, VG solution) has been suggested to be effective in other bypass grafts. This study was designed to investigate (1) the effect of the VG solution during preparation of the RA for coronary artery bypass grafting and (2) whether the effect would last for a prolonged period after topical use. ⋯ The present study suggests that the combination of verapamil and nitroglycerin may provide a rapid onset, a complete relaxation, and a long-lasting vasorelaxant effect when used to prepare the RA for grafting. This study adds a new method to prevent RA spasm during coronary artery bypass grafting.
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Comparative Study Clinical Trial
Steroid administration in heart and heart-lung transplantation: is the timing adequate?
The release of cytokines after cardiopulmonary bypass may play an important role in postoperative morbidity. The release of proinflammatory cytokines, such as tumor necrosis factor alpha, interleukin (IL)-6 and IL-8, is even greater in patients undergoing heart transplantation (HTx) than coronary artery grafting. We tested the hypothesis that in HTx patients the earlier administration of steroids, before rather than after cardiopulmonary bypass as usual, can reduce the inflammatory response. ⋯ Earlier steroid administration in the immunosuppressive protocol for HTx or HLTx may be preferable to reduce the inflammatory response to cardiopulmonary bypass, as reflected by a lower production of tumor necrosis factor alpha and IL-8, and a greater release of IL-10.
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Compartment syndrome of the lower leg is an occasional complication of prolonged ischemia and reperfusion. Compartment syndrome of the thigh is a less well-recognized complication. We present 2 patients with compartment syndrome of the ipsilateral thigh after femoral arterial and venous cannulation for cardiopulmonary bypass. Early diagnosis and urgent decompressive fasciotomy may limit the extent of local tissue damage and subsequent myonephropathic syndrome.
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Extracorporeal membrane oxygenation circuits have recently been introduced for extracorporeal life support (ECLS) in adult patients in cardiogenic shock and have been shown to provide excellent oxygenation and hemodynamic support. Heparin coating of the extracorporeal circuit provides a more biocompatible surface, which has been shown to minimize early surface-induced complement activation and platelet dysfunction and hence may improve patient survival. This report reviews our experience with extracorporeal membrane oxygenation to treat postcardiotomy cardiogenic shock using minimal to no systemic heparinization in 23 patients. ⋯ Extracorporeal life support using an extracorporeal membrane oxygenation system provides excellent cardiac support with similar hospital survival rates as centrifugal mechanical support. Extracorporeal life support has complications unique to itself, but with time, these are likely to be overcome. Women and patients with persistent left ventricular dilatation are less likely to be weaned.
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The present era of medicine is concerned to a large measure with cost containment and the advent of managed care. For these reasons the concept of reducing hospital stays with a concomitant reduction in hospital cost is very attractive. The role of fast track is to ensure that we are not placing the patient at any additional risk and in fact are improving recovery and patient well-being. ⋯ A fast-track protocol allows faster recovery and earlier discharge from both the intensive care unit and the hospital without apparent increased risk. Complicated patients can also be fast tracked, and the desire to do so may actually expedite recovery.