The Annals of thoracic surgery
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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.
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The minimally invasive limited lower sternotomy is a surgical approach for mitral valve operations with easy access to the left atrium. It confers the advantages of preservation of the sternocostal articulations and both internal thoracic arteries, with no need to enter either pleural cavity or resect the costal cartilages. It facilitates aortic and atrial cannulation for cardiopulmonary bypass, and allows easy access to the mitral valve through the left atrium.
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Conventional roller pump apulsatile cardiopulmonary bypass (CPB) was compared with computer-controlled pulsatile bypass, which was designed to recreate biological variability (return of beat-to-beat variability in rate and pressure with superimposed respiratory rhythms). The degree of jugular venous oxygen saturation (SjvO2) less than 50% during rewarming from hypothermic CPB was compared for the two bypass techniques. An SjvO2 less than 50% during rewarming from hypothermic CPB is correlated with cognitive dysfunction in humans. ⋯ Computer-controlled pulsatile CPB was associated with significantly greater SjvO2 during rewarming from hypothermic CPB. Both the mean and cumulative areas under the curve for SjvO2 less than 50% exceeded a ratio of 75:1 for apulsatile versus computer-controlled pulsatile CPB. These experiments suggest that cerebral oxygenation was better preserved during rewarming from moderate hypothermia with computer-controlled pulsatile CPB, which returned biologic variability to the flow pattern.