The Annals of thoracic surgery
-
A surgery of 349 cardiac surgeons showed that during a six-year period, a pump oxygenator accident serious enough to cause patient injury or death occurred one per 1,000 procedures. A total of 264 deaths occurred as a direct results of an accident. ⋯ Low-level alarm systems were reported to be used by 42% of the respondents and activated clotting times were used by 63%. Rigorous use of alarm systems and heparin monitoring could reduce the incidence of pump-related accidents.
-
Innovation in the development of medical devices has been an important factor in the practive of health care in the United States. However, in a climate of increasing federal regulation, concern is expressed that such regulation can inhibit scientific creativity in the medical device industry. ⋯ Increasing regulation will divert research dollars from discovery efforts to regulatory maintenance. Surgeons can participate in the regulatory process by informing the public and the government on issues regarding safety and effectiveness of medical devices.
-
A protocol is presented that facilitates early extubation following pediatric cardiothoracic operations. A total of 197 consecutive patients were managed according to this protocol. Fifty percent of the patients were less than 3 years old. ⋯ There were 16 deaths among the 55 patients managed with mechanical ventilation. Carefully conducted early extubation provided specific advantages over routine postoperative mechanical ventilation. Modern techniques of anesthesia and surgical repair of congenital heart disease can decrease the requirement for postoperative mechanical ventilation and the potential for related complications.
-
A new intraaortic balloon is described that can be inserted percutaneously through a 12F sheath by the standard Seldinger technique. Insertion and removal are rapid, and the hemodynamics of balloon pumping are similar to our previous clinical experience with standard single- and dual-chambered intraaortic balloons. The initial clinical experience is detailed.
-
Optimal exposure greatly facilitates reconstructive mitral valve procedures. We describe an effective method for exposing this valve using a specially designed mitral valve retractor. This technique proved useful in 321 patients who underwent operation on the mitral valve.