The Annals of thoracic surgery
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Randomized Controlled Trial Clinical Trial
Influence of high- and low-dose aprotinin on activation of hemostasis in open heart operations.
The protease inhibitor aprotinin reduces hemostatic activation and blood loss after cardiac operations. The aim of the present study was to investigate the influence of two different aprotinin doses on hemostatic activation and to identify the most effective dose to reduce the postoperative bleeding tendency. ⋯ A high-dose aprotinin regimen was significantly more effective than a low-dose regimen in attenuating fibrinolysis and reducing the bleeding tendency and allogeneic blood requirements, but not in reducing F(1+2) prothrombin fragments. High-dose aprotinin therapy appears to be superior to low-dose therapy.
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A recent study found that a higher-perfusate hematocrit was associated with improved neurologic recovery after deep hypothermic circulatory arrest. The current study examined the relative contributions of oxygen delivery and colloid oncotic pressure to this result, as well as the efficacy of different colloidal agents and modified ultrafiltration. ⋯ Both higher hematocrit and higher colloid oncotic pressure with pentafraction improve cerebral recovery after deep hypothermic circulatory arrest. The higher hematocrit improves cerebral oxygen delivery but does not reduce total body edema. Modified ultrafiltration after cardiopulmonary bypass is less effective than having a higher initial prime hematocrit or colloid oncotic pressure.
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A technique for aortic valve replacement is described in which the aortic valve is exposed through a partial sternotomy without transecting ("T'ing" off) the sternum. Aortic valve replacement can be performed with standard aortic and right atrial cannulation.
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Clinical Trial
Comprehensive multimodality blood conservation: 100 consecutive CABG operations without transfusion.
Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open heart surgical procedures. We hypothesized that a comprehensive multimodality blood conservation program applied algorithmically on the basis of bleeding and transfusion risk would provide a maximum, cost-effective, and safe reduction in postoperative bleeding and allogeneic blood transfusion. ⋯ Comprehensive risk factor-based application of multiple blood conservation measures in an optimized, integrated, and algorithmic manner can significantly decrease bleeding and need of allogeneic transfusion in coronary artery bypass grafting in a safe and cost-effective manner.
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In patients undergoing coronary artery bypass grafting there are two possible causes of myocardial injury: (1) global ischemic myocardial injury during aortic cross-clamping and subsequent reperfusion, and (2) postoperative myocardial infarction. We studied the use of cardiac marker proteins to specifically and separately detect such injury. ⋯ Perioperative myocardial injury can be diagnosed from the release of cardiac marker proteins into plasma already at 0.5 hours after the start of reperfusion. For early assessment of postoperative myocardial infarction, fatty acid-binding protein is a more suitable plasma marker than are creatine kinase, creatine kinase-MB, or myoglobin.