The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Aug 1997
Randomized Controlled Trial Comparative Study Clinical TrialRight ventricle is protected better by warm continuous than by cold intermittent retrograde blood cardioplegia in patients with obstructed right coronary artery.
Preservation of the right-ventricular (RV) myocardium is a clinical challenge especially in patients with occluded right coronary artery, in whom antegrade cardioplegia cannot reach areas distal to the stenosis. Retrograde administration of cardioplegia has been thought to overcome the problem, but it has been blamed for inadequate distribution to the RV and possibly poorer functional recovery of this ventricle. Adapting the hypothesis that warm blood cardioplegia may offer better distribution and a more effective supply of oxygen to the arrested heart, we compared RV function in a randomised trial in patients with significant right and left coronary artery disease, after either warm continuous (warm group, n = 15) or intermittent cold (cold group, n = 14) retrograde blood cardioplegia. ⋯ Creatine kinase cardiac isoenzyme release was greater in the cold group (p < 0.01). The relationship between left-ventricular stroke work and corresponding preload did not differ between the groups. It can be concluded that recovery of RV function after coronary surgery was better in terms of ejection fraction and preload-related stroke work with warm continuous cardioplegia than with intermittent cold cardioplegia, this along with lower cardiac enzyme release suggesting better RV protection.
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Thorac Cardiovasc Surg · Jun 1997
Heart surgery in patients aged eighty years and above: determinants of morbidity and mortality.
Escalating medical costs, limitation of resources and the necessity to provide cost-effective medical care have created a need for systematic risk stratification and cost-benefit analyses in the background of an ongoing discussion. Results of heart surgery in octogenarians have been evaluated in a prospective single-center, study since 1990. 101 consecutive patients (55/ 101 = 54.5% female) aged 80 years and above (median: 81 years; interquartile range [IQR]: 80.0-82.5, total range [TR]: 80-92 years) undergoing open heart surgery at our institution between January 1990 and March 1996 were included into this prospective study. Prior to surgery, most patients were severely symptomatic being in functional NYHA classes either III (56.4%) or IV (31.7%). 61/101 (60.4%) patients underwent isolated coronary artery bypass grafting (CABG), 23 (22.8%) had aortic valve replacement (AVR), 14 patients (13.9%) had CABG combined with AVR or double valve replacement and 3 (3.0%) had mitral valve repair. ⋯ After hospital discharge, 67/93 patients (82.8%) were in NYHA functional class I or II. Cardiac surgery in very elderly patients can be performed with acceptable operative risk and a favorable long-term outcome. The individual patient risk-profile including significant co-morbid conditions and severity of the heart disease predicts not only survival but the extent of perioperative morbidity.
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Thorac Cardiovasc Surg · Apr 1997
Vascular complications related to intraaortic balloon counterpulsation: an analysis of ten years experience.
We have performed a retrospective review of our experience with the intraaortic balloon counterpulsation pump (IABP) during the last decade, to identify aspects of risk factors, complications, and management that affect peripheral vascular morbidity and mortality. Data from 472 patients who had the IABP inserted during the ten-year period from December 1985 to December 1995 were retrospectively reviewed. Risk factors, implantation techniques, complications, and significant variables were evaluated. ⋯ Adequate implantation and surgical explantation techniques are essential to reduce the IABP-related morbidity; 4. Identification of subclinical disease may aid in the management of subsequent acute limb ischemia; 5. The presence of peripheral vascular disease and diabetes mellitus are associated with higher ischemic complication rates.
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Thorac Cardiovasc Surg · Apr 1997
Randomized Controlled Trial Clinical TrialThe effect of preoperative intra-aortic balloon pump support in patients with coronary artery disease, poor left-ventricular function (LVEF < 40%), and hypertensive LV hypertrophy.
Poor left-ventricular function, hypertension, and left-ventricular hypertrophy in patients with coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG) are associated with increased operative risks. Between June 1994 and March 1996, 33 patients undergoing CABG, were randomized into 2 groups. One group (IABP group, n = 19) received IABP treatment on average for 2 hours prior to CPB, the other group (control group, n = 14) had no preoperative IABP, Cardiac performance was measured pre- and postoperatively by Swan-Ganz catheter. ⋯ Preoperative IABP treatment in hypertensive patients with CAD, low LVEF and LV hypertrophy who are undergoing CABG is beneficial. An improved cardiac performance pre- and postoperatively was associated with a lower rate of hospital mortality and less postoperative morbidity, as well as shorter ICU stay. The treatment is cost-beneficial.
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Thorac Cardiovasc Surg · Feb 1997
Videothoracoscopy in the diagnosis and treatment of malignant pleural mesothelioma with associated pleural effusions.
Between 1985 and 1994 46 of 662 patients examined by thoracoscopy for secondary malignant pleural effusion were diagnosed to have diffuse malignant pleural mesothelioma. Mean patient age was 59 years, with a male: female ratio of 5:1. The right hemithorax was more frequently involved than the left (55% versus 45%). ⋯ Survival after one, two, and 5 years was 37.5%, 12.5%, and 5%, respectively. The characteristics of mesothelioma and pleural effusion evident in thoracoscopy and their diagnostic relevance are discussed. We suggest talc instillation as the sole therapeutic maneuver in evolutioned cases, since the literature and our own experience indicate that survival is not significantly prolonged by more aggressive surgical approaches.