The Annals of thoracic surgery
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Minimal access techniques with cardiopulmonary bypass use smaller cannula systems for management of cardiopulmonary bypass. To augment flow rates through the smaller cannula, the technique of vacuum-assisted venous drainage has been used. We describe a complication of vacuum-assisted venous drainage by inadvertent positive pressurization of the venous circuit resulting in a paradoxic air embolus across a patent atrial septal defect. Hazards of the current cardiopulmonary bypass systems and techniques for avoiding this potential complication are discussed.
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Comparative Study
Pentoxifylline reduces coronary leukocyte accumulation early in reperfusion after cold ischemia.
Ischemia/reperfusion injury can complicate recovery in cardiac operations. Ischemia induces endothelial dysfunction, which may contribute to leukocyte accumulation during reperfusion. Leukocyte-mediated injury may then occur. Using intravital microscopy we previously reported increased leukocyte retention in coronary capillaries and venules during early reperfusion during warm ischemia/reperfusion. In this study we investigated whether cold cardioplegic protection would limit leukocyte sequestration in coronary microvessels early in reperfusion. Pentoxifylline (PTX) has antiinflammatory effects and may limit endothelial dysfunction during ischemia/reperfusion. The effect of cardioplegia modification with PTX was also examined. ⋯ Cold cardioplegia did not prevent leukocyte retention in the coronary microcirculation early in reperfusion. PTX modification of cardioplegia significantly reduced leukocyte sequestration in coronary capillaries and venules. Preserving endothelial function during ischemia may limit leukocyte accumulation and ischemia/reperfusion injury after cardiac operation.
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Lung biopsies are frequently needed to diagnose diffuse interstitial lung diseases. Both limited thoracotomy (open lung biopsy) and thoracoscopy can be used for lung biopsies, but both procedures have traditionally required hospital admission. We report a series of patients that underwent outpatient open lung biopsy to show the safety and effectiveness of this practice. ⋯ Selected patients with a clinical diagnosis of diffuse interstitial lung disease can safely and effectively undergo diagnostic outpatient open lung biopsy. However, careful patient selection and attention to operative detail are essential.
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Acute type A dissection is associated with postoperative complications and a high mortality rate. This study was performed to determine the perioperative risk factors leading to hospital mortality in patients with acute type A aortic dissection. ⋯ Preoperative ST-T elevation and massive blood transfusion during operation were identified as significant independent risk factors for hospital mortality after operation for acute type A aortic dissection. Our findings should contribute to estimation of operative risk in individual patients.
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Cardiac surgery patients' hematocrits frequently fall to low levels during cardiopulmonary bypass. ⋯ Female patients and patients with smaller body surface area may be more hemodiluted than larger patients. Minimizing intraoperative anemia may result in improved outcomes for this subgroup of patients.