European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 1993
Comparative StudyRelationship between hemodynamics and blood volume changes after cardiopulmonary bypass during coronary artery bypass grafting.
The blood volume and central hemodynamics were assessed in 22 patients undergoing coronary artery bypass grafting before and after cardiopulmonary bypass. Patients were divided into two groups according to their blood volume after cardiopulmonary bypass. In group A (n = 10) the patients were hypovolemic and in group B (n = 12) the patients were hypervolemic after cardiopulmonary bypass. ⋯ There was a correlation between the changes in cardiac index and changes in total blood volume (r = 0.57; P < 0.01). Patients in neither group suffered from hypoxia. We conclude that extreme hemodilution after cardiopulmonary bypass must be normovolemic, and the pulmonary capillary wedge pressure or right atrial pressure as a guide for blood volume evaluation after termination of cardiopulmonary bypass may be misleading.
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Eur J Cardiothorac Surg · Jan 1993
Meta Analysis Comparative StudyOptimal antithrombotic therapy following aortocoronary bypass: a meta-analysis.
To evaluate the role of antithrombotic therapy, on preserving graft patency, we performed a meta-analysis of randomized clinical trials involving aspirin (ASA), dipyridamole (D), anticoagulants (AC) and placebo or nontreatment controls (P). Manual literature searches were performed supplemented by computerized MEDLINE listings complete to July 1991. Saphenous vein graft occlusion was determined by angiography (patients with > or = 1 distal anastomotic occlusion). ⋯ Early postoperative treatment (< or = 6 h) strongly influenced graft occlusion while preoperative administration provided no additional benefit. No mortality advantage was identified for any antithrombotic therapy. Aspirin or anticoagulants enhance saphenous vein graft patency following aortocoronary bypass surgery, and a combination thereof deserves further investigation in a trial large enough to detect the effects of these treatments with respect to clinical events.
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Eur J Cardiothorac Surg · Jan 1993
Randomized Controlled Trial Comparative Study Clinical TrialArrhythmia prophylaxis after coronary artery surgery. A randomised controlled trial of intravenous magnesium chloride.
One hundred and thirty patients undergoing elective myocardial revascularisation were randomised to receive an intravenous infusion containing either 50 mmol magnesium chloride or placebo during the first 48 h following surgery. Magnesium was given to 66 patients and a placebo infusion to 64 patients. Postoperative serum magnesium concentrations fell in the placebo group (from 0.83 +/- 0.06 to 0.79 +/- 0.11 mmol/l) but were elevated in the magnesium group (from 0.82 +/- 0.05 to 1.2 +/- 0.25 mmol/l). ⋯ Three patients in the magnesium group had an episode of ventricular fibrillation and three patients in the placebo group had frequent ventricular ectopics. There was one death in the magnesium group associated with a perioperative myocardial infarction. This study shows that intravenous magnesium supplements reduce the incidence of supraventricular arrhythmias following coronary artery surgery.
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Eur J Cardiothorac Surg · Jan 1993
Editorial ReviewOrgan dysfunction and cardiopulmonary bypass: the role of complement and complement regulatory proteins.
Cardiopulmonary bypass-induced organ dysfunction remains a clinical problem in certain groups of patients. Although the pathogenesis is multifactorial, it is likely that a panendothelial injury consequent upon widespread humoral and cellular activation is a major contributor to this process. The biologically active products of complement activation are certainly capable of inducing many of the features of the post-perfusion syndrome. ⋯ Haworth, Personal Communication) whilst pre-existing sepsis could clearly induce a degree of endothelial dysfunction. A further possibility is that the inflammatory response in these patients is already "primed". Some patients with heart failure have been shown to have elevated circulating TNF.(ABSTRACT TRUNCATED AT 400 WORDS)
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Eur J Cardiothorac Surg · Jan 1993
Randomized Controlled Trial Clinical TrialAlterations of cell-mediated immune response following cardiac surgery.
Nosocomial infections in patients following cardiac surgery are frequently associated with opportunistic microorganisms indicating a dysregulation of cell-mediated immune response. The objective of this prospective randomized trial, therefore, was to investigate the mechanisms of dysregulation and the counterregulatory effects of immunomodulation. Twenty patients underwent conventional postoperative therapy, another 20 patients received indomethacin, which inhibits synthesis of the down-regulating mediator prostaglandin E2, and a further 20 patients were given thymopentin in addition to indomethacin, thereby augmenting activation and differentiation of the T-lymphocytes. ⋯ Conversely, with combined indomethacin and thymopentin treatment restoration of cellular distribution as well as protection of IL-2 synthesis could be achieved. These results indicate a quantitative and functional impairment of the forward regulation of cell-mediated immunity. It was shown for the first time that combined indomethacin and thymopentin treatment could successfully counteract these immunomechanistic alterations.