The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Feb 2002
Randomized Controlled Trial Clinical TrialCardiopulmonary bypass copolymer surface modification reduces neither blood loss nor transfusions in coronary artery surgery.
Surface-modifying additives (SMA) have been suggested for improving cardiopulmonary bypass (CPB) circuit biocompatibility, potentially minimizing inflammatory complications and bleeding associated with CPB. The purpose of this prospective, randomized clinical study was to compare a novel copolymer surface-modified CPB circuit (SMARXT; COBE Cardiovascular) against the unmodified circuit. ⋯ Our results show that the surface-modified CPB circuit decreased neither blood loss nor transfusions despite slightly better platelet function preservation compared to the unmodified circuit. This type of CPB circuit surface modification does not appear to improve clinical outcome in low-risk coronary artery surgery patients.
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Thorac Cardiovasc Surg · Feb 2002
Comparative StudyMid-term results of aortic valve preservation: remodelling vs. reimplantation.
Valve-preserving root replacement has become an accepted alternative to composite replacement both in dissection and in aneurysmal disease. We retrospectively analysed 5-year results comparing root remodelling and reimplantation procedures. ⋯ Five-year results are comparable and encouraging for remodelling and reimplantation procedures. If the initial valve function and geometry is adequate, the chance of secondary failure beyond the first year is minimal.
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Thorac Cardiovasc Surg · Feb 2002
The effects of L-carnitine on spinal cord ischemia/reperfusion injury in rabbits.
Paraplegia after distal aortic aneurysm repair remains a persistent clinical problem. We hypothesized that the tolerance of the spinal cord to an ischemic period could be improved with hypothermic Ringer's Lactate containing L-Carnitine. ⋯ In this model, the infusion of hypothermic Ringer's Lactate contained L-carnitine provided sufficient spinal cord protection against ischemia. Clinically, this may be a useful adjunct for prevention of paraplegia during surgery of the descending aorta.
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Thorac Cardiovasc Surg · Dec 2001
Comparative StudyEffect of cardiopulmonary bypass on myocardial function, damage and inflammation after cardiac surgery in newborns and children.
Postoperative measurement of cardiac troponin I, creatine kinase and procalcitonin reflects myocardial damage and systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children. Pulse-contour cardiac output technique is a less invasive tool for determining postoperative cardiac function. ⋯ In summary, perioperative measurement of cTnI, CK and PCT reflects myocardial damage and systemic inflammatory response and allows an improved peri- and postoperative management. PiCCO technique is an excellent, less invasive tool to determine postoperative cardiac function.
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Thorac Cardiovasc Surg · Dec 2001
Comparative StudyPostoperative evaluation of radial artery grafts for coronary artery bypass grafting by transit-time Doppler flow measurements.
Due to the histological configuration of the vessel wall, the radial artery is prone to spasm as a result of handling or harvesting. Therefore, certain degrees of arterial wall spasm are unpreventable, even with appropriate pharmacologic treatment, while using the radial artery as a bypass graft in CABG. Consequently, the radial artery is only reluctantly used compared to saphenous vein grafts in CABG. In our clinical experience, the radial artery, if harvested carefully, has proved to be an excellent bypass graft. This investigation was undertaken to study the differences in blood flow measured directly after extracorporeal circulation in radial artery grafts and venous grafts. Both grafts were compared to the left internal mammarian artery anastomosed to the LAD. ⋯ Radial artery grafts compared to saphenous vein grafts do not show significant differences early after operation in mean blood flow or pulsatility index. Further studies are needed to evaluate long-term performance of radial arteries as coronary bypass grafts and to compare the radial artery to the right mammarian artery and the standard saphenous vein graft.