The Annals of thoracic surgery
-
The indications for prolonged cardiopulmonary support or extracorporeal membrane oxygenation are expanding. A potential serious complication of these techniques is distal limb ischemia. ⋯ We describe a simple method of providing distal limb perfusion using ordinary pressure tubing and a standard cordis catheter. This technique is capable of reproducing normal superficial femoral artery blood flow.
-
From 1972 to 1977, a treatment protocol was developed at our institution for patients with suspected penetrating intrapericardial wounds. It consists of immediate transport to the operating room, pericardial decompression by subxiphoid pericardial window under local or light general anesthesia in patients in stable condition, and median sternotomy and operative repair with limited use of cardiopulmonary bypass. ⋯ Approach to a trauma victim must be systematic. We believe one treatment protocol for patients with suspected penetrating intrapericardial wounds is effective.
-
The known complications of prosthetic valve replacement in patients with an ascending aortic aneurysm and secondary aortic regurgitation who frequently have a morphologically normal aortic valve have prompted interest in valve-sparing aneurysm repair procedures. The aim of this study was to define the echocardiographic criteria for identifying suitable candidates for ascending aortic aneurysm repair that spares the aortic valve. We also examined the perioperative and intermediate-term results of this innovative procedure. ⋯ In selected patients undergoing ascending aortic aneurysm repair who have normal aortic leaflets but secondary aortic regurgitation, the native valve can be spared through this novel operation. The aortic annulus size is reduced significantly, thereby effectively eliminating hemodynamically significant aortic regurgitation. The intermediate-term results are promising, but the long-term durability of this type of repair needs to be determined.
-
The purpose of this retrospective study is to determine the possible predictors of successful cardiac recovery using extracorporeal membrane oxygenation (ECMO) and the practical limits of ECMO support. ⋯ Postcardiotomy residual defects are a contraindication to ECMO. If children with residual defects are excluded, successful weaning from ECMO can be achieved in almost 70%, with almost all recovery occurring with the first 6 days of ECMO.
-
Randomized Controlled Trial Clinical Trial
Pretreatment with antioxidants and allopurinol diminishes cardiac onset events in coronary artery bypass grafting.
Oxygen-derived free radicals constitute one part of the etiologic factors for cardiac onset harmful events. Allopurinol is able to reduce the generation of free radicals. Vitamins E and C scavenge radicals after their formation. ⋯ Group 3 had fewer perioperative infarctions and less creatine kinase-MB release than the respective controls (group 4). Plasma levels of vitamins E and C, urate, and total free radical trapping ability were considered to support the theory about the role of free radicals in reperfusion injury. Especially the unstable patients, but also patients with stable coronary artery disease requiring coronary artery bypass grafting benefit from perioperative allopurinol and vitamin E and C treatment.