The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Apr 1999
Randomized Controlled Trial Comparative Study Clinical TrialReducing the post-pump syndrome by using heparin-coated circuits, steroids, or aprotinin.
Cardiopulmonary bypass (CPB) induces a systemic inflammatory response called 'post-pump syndrome'. As a part of a complex interaction between white cells and vascular endothelium, proinflammatory cytokines IL-6 and IL-8 are part of a phased immune response that is also balanced by anti-inflammatory cytokines such as IL-10. We compared the influence of heparin-coated circuits, steroids, and aprotinin on these cytokines, looking for ways to reduce the syndrome. ⋯ The results show a similar reduction of the inflammatory cytokine release (IL-6 and IL-8 as markers) using early steroid application and aprotinin in high dosage. Heparin coating reduces IL-6 and increases IL-10 release, whereas IL-8 is not affected. Further studies should investigate the effects of a combined application for reducing inflammatory cytokine release and the post-pump syndrome.
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Mannitol is widely used in all fields of medicine, due to its beneficial actions on the kidney and brain. Mannitol has been extensively used in cardiac surgery since its infancy, and remains in common usage to day. ⋯ As with virtually all treatments in medicine and surgery its use is not immune from side effects. The medical literature on mannitol over the past 30 years is considered.
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Thorac Cardiovasc Surg · Feb 1999
Comparative StudyCoronary bypass grafting without cardiopulmonary bypass--technical considerations, clinical results, and follow-up.
Coronary bypass surgery can be performed less invasively by avoiding cardiopulmonary bypass (CPB). We present our early 'off pump' coronary bypass surgery experience in combination with a minithoracotomy or sternotomy. ⋯ Coronary bypass surgery without using cardiopulmonary bypass is safe to achieve good early and mid-term results. MIDCAB is a minimally invasive technique. Experienced surgeons should be ready to compete with PTCA techniques.
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Thorac Cardiovasc Surg · Feb 1999
Comparative StudySurgical therapy of fulminant pulmonary embolism: early and late results.
Pulmonary embolectomy remains the only option for patients with fulminant pulmonary embolism and failure or contraindication of thrombolysis even today. Increasing prevalence of heparin-induced thrombocytopenia type II (HIT) adds a new significant problem, which was investigated in a retrospective study. ⋯ Pulmonary embolectomy on cardiopulmonary bypass remains an adequate therapy in patients with failure of or contraindication to thrombolysis, and HIT is not a contraindication.
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Extracorporeal membrane oxygenation (ECMO) has been used clinically for more than 10 years in pulmonary and cardiopulmonary failure. Intravascular devices were developed and introduced. But, due to lack of efficiency, they did not gain clinical acceptance. ⋯ Further technical improvements are evolving like sophisticated pump control systems to reduce negative inlet pressure or pulsatile pump flow. Therefore ECMO devices have become safer and less invasive. Pharmacological cotherapy will both shift the inclusion criteria for ECMO and improve ECMO efficacy and safety.