The Annals of thoracic surgery
-
Perfusion of the coronary circulation with hypoxemic blood from the left ventricle has been postulated to cause myocardial dysfunction during venoarterial extracorporeal membrane oxygenation for respiratory support. ⋯ Hypoxemic cardiac output from the left ventricle during venoarterial extracorporeal membrane oxygenation is associated with depression of left ventricular systolic function in this animal model. Current use of venoarterial extracorporeal membrane oxygenation for respiratory support may not provide adequate oxygen supply to the myocardium.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of epsilon aminocaproic acid and low-dose aprotinin in cardiopulmonary bypass: efficiency, safety and cost.
In this study we compared the clinical efficiency, safety, and economic benefit of low-dose aprotinin with epsilon aminocaproic acid (EACA) in reducing bleeding after cardiopulmonary bypass operation. ⋯ Low-dose aprotinin and EACA showed similar effects on the reduction of intraoperative and postoperative bleeding. The lower cost of EACA with no change in safety outcome suggests it is the preferred treatment.
-
As experience has grown with the use of mechanical circulatory support systems in patients with cardiogenic shock, many anecdotes have been noted where myocardial recovery occurred and devices could be removed with reasonable residual cardiovascular performance and resolution of the shock syndrome. Indeed, when first used, ventricular assist devices were inserted to bridge patients unable to be separated from cardiopulmonary bypass to eventual recovery. ⋯ There are many explanations for this, but principally, benefit is related to amelioration of circulatory insufficiency with attenuation of perturbed humoral networks and reduction of myocardial wall stress. It is important to understand how ventricular assist device implantation in select advanced heart failure patients might precipitate recovery of depressed myocardial function.
-
Clinical Trial
Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery.
The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. ⋯ Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.
-
Recently, Tardiff and colleagues have suggested that the presence of the apolipoprotein E, epsilon4 allele was associated with increased likelihood of cognitive decline after coronary artery bypass grafting. The objective of the current study was to replicate this earlier work using an increased sample size. The increased sample also enabled an analysis by individual genotype in cognitive decline after coronary artery bypass grafting. ⋯ This study suggests that the epsilon4 allele is not associated with cognitive decline in the weeks after coronary artery bypass grafting.