European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Mar 1997
Short-term and long-term neuropsychological consequences of cardiac surgery with extracorporeal circulation.
Cognitive dysfunction after extracorporeal circulation is a major continuing problem in modern cardiac surgery. We designed this prospective study to update the incidence of postoperative neuropsychological changes after routine cardiopulmonary bypass (CPB) and to identify perioperative variables associated with these complications. ⋯ We conclude that an important proportion of the cognitive impairment after cardiac surgery is likely to be due to nonspecific effects of surgery.
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Eur J Cardiothorac Surg · Mar 1997
Vocal cord dysfunction after cardiac surgery: an overlooked complication.
To evaluate the complication of vocal cord dysfunction following open heart surgery and its short- and long-term effects. ⋯ Vocal cord dysfunction can be an easily overlooked complication after open heart surgery. It can be the cause of respiratory insufficiency following tracheal extubation and may lead to reintubation and reventilation. The cause of the problem cannot always be traced but it may be due to direct trauma of the vocal cords during tracheal intubation, or trauma of the recurrent laryngeal nerve from the cuff of the endotracheal tube. A less likely possibility is that it may result from nerve injury due to central venous cannulation, or from cold. The condition may resolve within months, but, in rare cases, may lead to permanent morbidity.
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Eur J Cardiothorac Surg · Mar 1997
Randomized Controlled Trial Comparative Study Clinical TrialThe influence of risk on the results of warm heart surgery: a substudy of a randomized trial.
The Warm Heart Investigators Trial randomized isolated coronary bypass patients to cold or warm cardioplegia, and demonstrated that warm cardioplegia significantly reduced the prevalence of low output syndrome and myocardial infarction (as defined by CKMB enzyme release). This study was designed prospectively as a subanalysis of the original trial, to determine the effect of warm heart surgery on high risk patients, who were anticipated to derive the major benefit from warm cardioplegia. ⋯ Although our analysis confirms the overall benefits of warm cardioplegia, our unanticipated finding in high risk subjects may be explained by the fact that morbidity and mortality in that patient subgroup is caused not only by poor myocardial protection, but by other clinical and technical factors. Further studies are necessary to identify those patients who might benefit most from improved myocardial protection techniques.
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Eur J Cardiothorac Surg · Mar 1997
Randomized Controlled Trial Clinical TrialThe influence of acute preoperative plasmapheresis on coagulation tests, fibrinolysis, blood loss and transfusion requirements in cardiac surgery.
Withdrawal of autologous plasma and reinfusion after cardiopulmonary bypass (CPB) offers the opportunity of improving patients' haemostasis and reducing homologous blood consumption in cardiac surgery. The influence of acute, preoperative plasmapheresis (APP) on coagulation tests, fibrinolysis, blood loss and transfusion requirements was investigated in elective aortocoronary bypass patients. ⋯ The findings suggest that in elective cardiac surgery heparin cannot prevent generation of both thrombin and fibrin, born throughout CPB and postoperatively. The use of PRP withdrawn immediately preoperatively is an attractive technique to reduce allogeneic blood usage and preoperative blood loss, especially in patients in whom withdrawal of autologous whole blood cannot be performed.
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Eur J Cardiothorac Surg · Mar 1997
Case ReportsUnexpected complication of intra-aortic balloon counterpulsation via the ascending aorta: balloon migration.
A case of intraaortic balloon pump catheter migration after an ascending aortic insertion, occurring 16 h postoperatively in a 48 year old man after myocardial revascularization, is presented. The prevention and management of this rare but serious complication of intraaortic balloon pumping is reviewed.