Perfusion
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A correlation between perfusion modality and vascular dilation induced by endothelial nitric oxide (NO) release has been pointed out in the literature; nevertheless, only a few studies deal with the analysis of patients treated by cardiac surgery. The aim of this work is to analyze endothelial NO release in patients undergoing cardiac surgery under continuous flow cardiopulmonary bypass (CPB) or pulsatile perfusion. Pulsatile devices approved for clinical CPB do not accurately reproduce the physiological flow waveform provided by the left ventricle while, on the other hand, it is important to analyze pulsatile perfusion under both physiological flow waveform and pulsatile flow CPB. ⋯ A significant difference in the intraoperative nitrite concentration was also observed between the groups (p=0.006). Nitrosylhemoglobin concentration, although not instrumentally detectable, resulted as negligible with respect to the other NO metabolites. Despite the small number of patients belonging to each group, this significant reduction of NO(2)(-) concentration under continuous flow CPB revealed a strong dependence on endothelial NO release and plasma nitrite concentration on perfusion modality.
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Clopidogrel (Plavix) is an inhibitor of ADP-induced platelet aggregation, acting by direct inhibition of adenosine diphosphate (ADP) binding to its receptor and of the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex. A common recommendation for coronary artery bypass surgery is to stop clopidogrel five to seven days before surgery.(1) Patients taking clopidogrel within five days of surgery are more likely to show an increase in post-operative bleeding, an increase need for blood products, and an increased chance for secondary operations to control bleeding. This paper presents an option which appears to decrease the adverse effects of clopidogrel for patients undergoing coronary artery bypass surgery within one to four days of stopping the use of clopidogrel. ⋯ No other donor blood products were required. Post-operative bleeding was minimal, and the need for a secondary operation due to bleeding was eliminated. The average stay in the cardiovascular intensive care unit(CICU) was 2.8 days, with an average hospital stay of 7.25 days.