The Annals of thoracic surgery
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Blood conservation has become an important issue in cardiac surgery. This study was undertaken to determine if the need of blood transfusion could be predicted from preoperative patient variables. ⋯ These data demonstrate that readily available patient variables can predict patients at risk for transfusion. Routine use of aprotinin and other adjustments of cardiopulmonary bypass should be considered to reduce transfusion in high-risk patients.
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Right-sided circulatory failure remains a significant source of morbidity and mortality for both cardiac transplant and left ventricular assist device recipients. ⋯ Right ventricular assist devices work most effectively if implanted early enough to avoid significant, potentially irreversible end-organ injury. We liberally employ continuous arteriovenous hemodialysis, minimize the use of heparin immediately postoperatively, keep patients sedated, and continue RVAD support until the patient displays signs of hemodynamic and end-organ recovery as heralded by (1) a decrease in central venous pressure and, more importantly, a decrease in pulmonary artery diastolic pressure, (2) an increase in urine output, and (3) a decrease in serum transaminase levels.
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Coronary artery bypass grafting without cardiopulmonary bypass is now an accepted technique of myocardial revascularization. We herein report our total experience with this procedure. ⋯ We conclude that the continuing use of coronary artery bypass grafting without cardiopulmonary bypass is justified and that, with proper selection of patients, the procedure is safe and cost-effective.
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The data presented are a brief summary of The International Registry for Mechanical Ventricular Assist Pumps and Artificial Hearts and a summary of the personal experience of the Minnesota Thoracic Associates at the Minneapolis Heart Institute with the use of the Sams centrifugal pump from May 1985 to September 1994. ⋯ It is our belief that when considering the cost analysis of temporary devices, one must conclude that a more economical approach for the treatment of end-stage cardiac disease would be aggressive development of a permanent ventricular assist device.
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Controversy still exists as to whether patients with previous stroke are at increased risk for neurologic complications after heart operations. ⋯ This analysis identifies a group of patients at high risk for neurologic sequelae and confirms the vulnerability of the previously injured brain to cardiopulmonary bypass, as evidenced by reappearance or exacerbation of focal deficits in such patients.