The Annals of thoracic surgery
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Randomized Controlled Trial Clinical Trial
Reduction of allogeneic blood transfusions after open heart operations by lowering cardiopulmonary bypass prime volume.
Despite recent advances in blood conservation techniques, up to 30% to 80% of patients undergoing open heart operations require allogeneic blood transfusions. A prospective, randomized study was performed to test the effect of lowering cardiopulmonary bypass prime volume (as an additional component of an integrated blood conservation strategy) on clinical outcome and allogeneic blood transfusion. ⋯ Lowering cardiopulmonary bypass prime volume resulted in a significant decrease in allogeneic blood product use. Because postoperative 24-hour chest tube drainage was similar in both groups, and hematocrit during bypass was higher in the RP group, the reduction in allogeneic blood transfusions appears to be related to a decrease in prime-induced hemodilution. This technique is effective, simple, and safe. It therefore should be strongly considered for patients undergoing operations using normothermic or near-normothermic cardiopulmonary bypass who are at high risk for allogeneic blood transfusion.
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Randomized Controlled Trial Comparative Study Clinical Trial
High-dose epsilon-aminocaproic acid versus aprotinin: antifibrinolytic efficacy in first-time coronary operations.
The antifibrinolytic efficacy of a high-dose regimen of epsilon-aminocaproic acid (epsilon-ACA) was compared with aprotinin in first-time coronary operations. ⋯ In first-time coronary operations, higher postoperative hematocrit and less shed blood retransfusion constitute only subtle advantages of aprotinin over high-dose epsilon-ACA.
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Central nervous system dysfunction after cardiopulmonary bypass is frequent and can be caused by inadequate cerebral perfusion and oxygenation. ⋯ Because cerebral autoregulation is impaired during cardiopulmonary bypass, phenylephrine is effective in increasing the cerebral blood flow and may contribute to the prevention of postoperative neurologic dysfunction, especially in patients who have a low jugular venous bulb oxygen saturation.
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Safe transition from cardiopulmonary bypass to the HeartMate left ventricular assist device without periods of low output, air emboli, or injury to the right ventricle is vital to its successful implantation. A right atrial-to-left ventricular shunt has been developed to purge quickly and completely all air from the system and prevent its reentry, as well as to assist the right ventricle during the transition from cardiopulmonary bypass to the HeartMate. ⋯ The extracorporeal membrane oxygenation right atrial-to-left ventricular shunt is simple and inexpensive to construct. It provides for a smoother and safer transition from cardiopulmonary bypass to the HeartMate left ventricular assist device.
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Randomized Controlled Trial Clinical Trial
Prospective, randomized clinical study of ischemic preconditioning as an adjunct to intermittent cold blood cardioplegia.
Ischemic preconditioning has been shown to be beneficial to myocardial preservation in a variety of models. This study was performed to determine whether ischemic preconditioning can ameliorate the postischemic myocardial dysfunction often seen in patients undergoing open heart operations. ⋯ Ischemic preconditioning significantly improves heart function in clinical cardiac operations, decreases the need for inotropic support, and could be an important adjunct to myoprotective strategies.