The Annals of thoracic surgery
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Comparative Study
Venous air in the bypass circuit: a source of arterial line emboli exacerbated by vacuum-assisted drainage.
Arterial emboli cause neurocognitive deficits in cardiac surgical patients. Carotid artery emboli, detected ultrasonically, have been observed after venous air entrainment into the cardiopulmonary bypass circuit. We investigated in vitro the extent to which venous air affected emboli detected in the arterial line downstream from a 40-microm filter. ⋯ Entrained venous air during cardiopulmonary bypass is a potential hazard, particularly during vacuum-assisted venous drainage. Every effort should be made to avoid venous air entrainment.
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Randomized Controlled Trial Comparative Study Clinical Trial
Coagulofibrinolysis during heparin-coated cardiopulmonary bypass with reduced heparinization.
We examined the safety of reduced systemic heparinization during heparin-coated cardiopulmonary bypass by measuring coagulofibrinolitic indices, including fibrinopeptide A, which directly reflects fibrinogenesis. ⋯ Reduced systemic heparinization combined with a heparin-coated cardiopulmonary bypass circuit is biochemically and clinically safe but does not reduce postoperative bleeding.
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Two patients with intraoperative dissection of the entire left atrium after mitral valve repair are presented. Intraoperative transesophageal echocardiography detected left atrial dissection with formation of a large cavity compressing the left atrium. The false lumen was opened and widely connected to the right atrium to perform the decompression. This technique permits the runoff into the low pressure system in case of persisting hemorrhage from the unknown entry, and eliminates the risk of systemic embolization from the cavity.
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Substitution of the nitric oxide (NO) pathway reduces ischemia/reperfusion injury after lung transplantation. 8-Br-cGMP is a membrane-permeable analogue of cGMP, the second messenger of NO. In this study, we evaluated the effect of administration of 8-Br-cGMP in the flush solution on early graft function. ⋯ In this large animal model of lung allograft ischemia/reperfusion injury, 8-Br-cGMP as additive to the flush solution improves posttransplant lung edema, lipid peroxidation, and neutrophil migration to the allograft. This effect is not attributable to improved flush by vasodilation, as we compared 8-Br-cGMP with PGE1 given before flush in control animals.
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Randomized Controlled Trial Clinical Trial
Heparin-coated circuits reduce myocardial injury in heart or heart-lung transplantation: a prospective, randomized study.
The effects of heparin-coated (HC) circuits have been primarily investigated in routine cardiac operations with limited duration of cardiopulmonary bypass (CPB) and ischemia. Their benefits have not been conclusively proven but could be more significant when CPB and ischemic times are longer, such as during heart transplantation (HTx) or heart-lung transplantation (HLTx). ⋯ The use of HC circuit limits both pro- and anti-inflammatory responses to CPB. It may also reduce myocardial injury after prolonged duration of CPB and ischemia.