The Annals of thoracic surgery
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Between 1990 and 1992, 346 consecutive patients underwent coronary artery bypass procedures. Ninety-eight patients (group A) from 1990 served as historical controls, and 248 patients (group B) from 1991 to 1992 served as a prospective, consecutive cohort for statistical comparison. The two groups varied in the type of myocardial protection used: intermittent cold crystalloid cardioplegia was used in group A and continuous warm blood cardioplegia in group B. (Two patients in group A received intermittent cold blood cardioplegia, and these 2 patients are grouped with the crystalloid group for the sake of convenience. ⋯ Group B patients were less likely to have development of complex postoperative arrhythmias. Ventricular fibrillation at unclamping was noticeably rare (2.0% in group B versus 84% in group A; p < 0.05). The average group B heart resumed sinus rhythm 72 seconds after declamping.(ABSTRACT TRUNCATED AT 250 WORDS)
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Biography Historical Article
In memoriam: Nina S. Braunwald, 1928-1992.
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Gastrointestinal damage occurs in 0.6% to 2% of patients after cardiopulmonary bypass (CPB), and carries a mortality of 12% to 67%. The incidence of subclinical gastrointestinal damage may be much greater. We examined the effects of nonpulsatile, hypothermic CPB on intestinal absorption and permeability in 41 patients. ⋯ The permeation of 3-O-methyl-D-glucose and D-xylose returned to normal levels 5 days after CPB, but that of L-rhamnose remained significantly below pre-CPB values at 6.6% +/- 0.5% (p = 0.004). However, the permeation of lactulose increased after CPB (from 0.35% +/- 0.04% to 0.59% +/- 0.1%; p = 0.018), and the lactulose/L-rhamnose gut permeability ratio increased markedly (from 0.045 +/- 0.04 to 0.36 +/- 0.08; normal = 0.06 to 0.08; p = 0.004). Patients who had a CPB time of 100 minutes or more had a greater increase in gut permeability (p = 0.049).(ABSTRACT TRUNCATED AT 250 WORDS)
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Many lung transplant programs consider ventilator dependence as a contraindication for transplantation. Among 54 patients in whom bilateral lung transplantations for cystic fibrosis were performed by the Joint Marseille-Montreal Lung Transplant Program, 10 were ventilator dependent. Three of them died in the early postoperative period (30%): 2 as a result of cerebral anoxia and sepsis, 1 of Pseudomonas cepacia pneumonia. ⋯ Obliterative bronchiolitis developed in 66% of patients at risk (2 of 6 patients surviving more than 6 months). We conclude that transplantation in mechanically ventilated patients with cystic fibrosis is not associated with an increase in morbidity or mortality after bilateral lung transplantation. Long-term survival, as in patients who undergo transplantation while spontaneously breathing, is limited by the development of obliterative bronchiolitis.