The Annals of thoracic surgery
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Comparative Study
Influence of ascending versus descending balloon counterpulsation on bypass graft blood flow.
Mechanical circulatory assistance is frequently needed in postcardiotomy patients to support the failing heart. A balloon catheter called SupraCor (ABIOMED Cardiovascular, Inc, Danvers, MA) has been developed and is similar to the existing intraaortic balloon pump with the exception of placement in the ascending versus the descending thoracic aorta. This investigation compared the effects of SupraCor versus standard intraaortic balloon pump on internal mammary artery and venous conduit bypass graft blood flow. ⋯ The results demonstrate that counterpulsation with an ascending aortic balloon significantly increases coronary bypass graft flow in both internal mammary artery and venous conduits. In contrast, counterpulsation with a descending aortic balloon did not alter coronary bypass graft flow.
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Randomized Controlled Trial Clinical Trial
Prophylactic tranexamic acid and epsilon-aminocaproic acid for primary myocardial revascularization.
The efficacy of prophylactic epsilon-aminocaproic acid and tranexamic acid to reduce transfusions after primary myocardial revascularization was evaluated in a teaching hospital context. ⋯ We conclude that either high-dose tranexamic acid or epsilon-aminocaproic acid effectively reduces transfusions in patients undergoing primary, elective myocardial revascularization.
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Randomized Controlled Trial Clinical Trial
Effect of anticoagulation protocol on outcome in patients undergoing CABG with heparin-bonded cardiopulmonary bypass circuits.
We have demonstrated that the use of heparin-bonded cardiopulmonary bypass circuits (HBCs) combined with a lower anticoagulation protocol as an adjunct to an integrated blood conservation strategy decreases the incidence and magnitude of homologous transfusion and improves clinical outcome in patients undergoing primary coronary artery bypass grafting. It is not known whether it is the lower anticoagulation protocol that influences outcome in patients treated with HBCs. Furthermore, the thrombogenic risk of using lower anticoagulation with HBCs still is debated. ⋯ This study definitively demonstrates that, when used appropriately, patients who are treated with HBCs and a lower anticoagulation protocol have a lower incidence and magnitude of homologous transfusion and are not at any added risk for clinical, hematologic (thrombin-antithrombin complex and fragment 1.2 measurements), or microscopic (transcranial Doppler analyses) thromboembolic complications or for neurologic or neuropsychologic deficits.
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We hypothesized that small amounts of thrombin desensitize the platelet thrombin receptor during cardiopulmonary bypass (CPB), resulting in postoperative platelet dysfunction and bleeding. ⋯ Our results show that (1) platelet activation, aggregation, and adhesion to leukocytes induced by TRAP are reduced after CPB, (2) decreased thrombin receptor responsiveness is associated with excessive postoperative blood loss, and (3) because the aggregation and activation responses are different for TRAP and thrombin, there may be a second thrombin receptor on platelets that is protected from damage during CPB. These results imply that prevention of the CPB-induced effects on the thrombin receptor will lessen postoperative morbidity associated with blood transfusion.
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Case Reports
Echocardiography allows safer venous cannulation during excision of large right atrial masses.
Excision of large right atrial masses requires bicaval cannulation and cardiopulmonary bypass. Safe venous cannulation can be accomplished only by knowing the exact intracavitary location and extension of the mass to avoid fragmentation. Transthoracic echocardiography and intraoperative transesophageal echocardiography, although helpful, cannot always define the exact intracavitary relationships of the tumor. ⋯ We propose the routine use of both intraoperative transesophageal and epicardial echocardiography in guiding venous cannulation for safe excision of large right atrial masses.