European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 2002
Comparative StudyShort-term and long-term neurocognitive outcome in on-pump versus off-pump CABG.
Neuropsychological dysfunctions are considered to be important complications of coronary artery bypass graft surgery (CABG). We examined the frequency of neuropsychological abnormalities occurring in patients undergoing CABG with (on-pump) and without (off-pump) cardiopulmonary bypass. ⋯ This study showed no short-term difference between the on-pump and off-pump CABG groups. The long-term cognitive outcome revealed more favorable results for the off-pump group. Although a preference to operate multiple vessel disease with classical cardiopulmonary bypass (CPB) has to be considered, the present study shows evidence for a different pattern of early decline and late recovery of cognitive functions in patients undergoing CABG with and without CPB.
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Eur J Cardiothorac Surg · Oct 2002
Lethal mesenteric ischaemia after cardiopulmonary bypass: a common complication?
The purpose of the study was twofold: (1) to identify the incidence of acute mesenteric ischaemia (A.M.Isc.) following cardiopulmonary bypass and (2) to identify factors associated with its development. ⋯ The incidence of acute mesenteric ischaemia is 0.49% of all cases undergoing CPB. A.M.Isc. is a common association with death following CPB (11%). It appears to be significantly associated with the presence of peripheral vascular disease, IABP use, the development of post-operative renal failure, operation type and priority, smoking, duration of CPB and cross-clamp time. Surprisingly, it was not linked to general risk factors for vascular disease.
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Eur J Cardiothorac Surg · Oct 2002
Lung volume reduction surgery--a comparison of the long term outcome of unilateral vs. bilateral approaches.
Bilateral lung volume reduction surgery (LVRS) is thought to be preferable to unilateral surgery due to greater initial benefit but the subsequent rate of decline may also be greater. We compared the long term physiological and health status outcome of LVRS performed on one or simultaneously on both lungs. ⋯ We have found no benefit from bilateral simultaneous LVRS and prefer unilateral LVRS because of the lower morbidity, resulting in earlier discharge, and slower decline in physiological benefit.
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Eur J Cardiothorac Surg · Sep 2002
Comparative StudyWarm retrograde blood cardioplegia saves more ischemic myocardium but may cause a functional impairment compared to cold crystalloid.
Ongoing ischemia, or even ischemia in progress, is regularly encountered in today's patients amenable to cardiac surgery. We set out to assess the effect of 'active resuscitation' during cardioplegia with warm continuous retrograde blood cardioplegia (WB) in a protocol simulating a clinical situation. ⋯ CC did reduce the size of the infarction by about 10% compared to control animals, whereas WB reduced the infarction by more than 50% of that seen after CC. Both modalities are, however, associated with a functional reduction during the first 60 min of reperfusion, WB being the worst.
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Eur J Cardiothorac Surg · Sep 2002
Six-year prospective audit of chest reopening after cardiac arrest.
To identify which patients benefit from chest reopening after cardiac arrest. ⋯ This study strongly confirms the benefit of chest reopening after cardiac arrest in the cardiac surgical ICU. Patients who arrest within 24 h of surgery and in whom reopening is instituted within 10 min are particularly likely to benefit. The value of chest reopening in arrests outside the ICU remains unresolved. All patients reopened on the ward died, suggesting that this practice should be discontinued. Early 'scoop and run' resulted in one solitary survivor though it should probably be restricted to patients who arrest within 72 h of surgery as surgically remediable problems are unlikely after this time.