The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Jun 2001
Randomized Controlled Trial Comparative Study Clinical TrialClinical use of heparin-coated cardiopulmonary bypass in coronary artery bypass grafting.
Clinical handling, risk and benefit of a heparin-coated cardiopulmonary bypass system combined with reduced systemic heparinization in coronary bypass surgery was investigated in a prospective, randomized clinical study. 243 patients (Pts.) were divided into 3 groups: group A (n = 83) had a standard uncoated extracorporeal circulation (ECC) set, and systemic heparin was administered in an initial dose of 400 IE/kg body weight. During ECC activated clotting time (ACT) was kept > or = 480 sec. Group B (n = 77) had the same ECC set completely coated with low-molecular-weight heparin; i.v. heparin was given in the same dose as in group A, ACT was kept at the same level. ⋯ This circulatory technique was also associated with a distinctly lower need for postoperative blood replacement. We conclude that heparin-coated extracorporeal circulation combined with either full-dose or reduced systemic heparinization can be used effectively with the same standard equipment and procedures as in uncoated technology. Combination with low-dose i.v. heparin leads to significantly decreased blood loss and less need for blood replacement.
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Thorac Cardiovasc Surg · Jun 2001
Randomized Controlled Trial Comparative Study Clinical TrialSerum S-100beta protein release in coronary artery bypass grafting: laminar versus pulsatile flow.
Cerebral injury after Cardiopulmonary bypass (CPB) is still a serious and unpredictable complication. The S-100beta serum marker has been suggested as potentially useful in the detection of cerebral injury during and after CPB. Direct comparisons of whether laminar or pulsatile pump flow in CABG leads to higher S-100beta values and which type might be more neuroprotective have not been made so far. ⋯ The results indicate that pulsatile flow might have a more neuroprotective effect than laminar flow as S-100beta values were lower.
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Thorac Cardiovasc Surg · Jun 2001
Case ReportsParaplegia as an unusual manifestation of aortic coarctation.
In this report, we present an unusual case of a 20-year-old man whose first symptom of aortic coarctation was sudden paraplegia due to spinal epidural hemorrhage caused by rupture of an aneurysmal collateral vessel. Now, one year after surgical correction of coarctation, the patient has had no cardiac or neurological problems. To our knowledge, this is the only clearly documented case of such an aortic coarctation complication.