European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Minimally invasive direct coronary artery bypass (MIDCAB) is performed under direct vision without sternotomy or cardiopulmonary bypass. The technique is used in reoperative patients through various incisions to revascularize one or two areas of the heart. The internal mammary artery, gastroepiploic artery, radial artery, or saphenous vein are used as graft conduits. ⋯ Reoperative MIDCAB grafting avoids the risks of resternotomy, aortic manipulation, and cardiopulmonary bypass. The techniques yield an early patency rate of 94%, which includes eight patients who had postoperative catheter-based interventions. Reoperative MIDCAB grafting had lower rates of supraventricular arrhythmia and transfusion when compared with conventional coronary artery bypass grafting, but did not offer an advantage for mortality, stroke or myocardial infarction. This 3-year experience suggests that while reoperative MIDCAB grafting can effectively revascularize focal areas of the heart, patients should be carefully selected to minimize operative risk.
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Eur J Cardiothorac Surg · May 1998
Randomized Controlled Trial Clinical TrialWarm blood hyperkalaemic reperfusion ('hot shot') prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery.
A significant metabolic derangement occurs in the ischaemic-reperfused heart of patients undergoing coronary artery bypass surgery using cold blood cardioplegia. The aim of the present study was to investigate whether this effect could be reversed by complementing cold blood cardioplegia with a short terminal exposure of warm blood hyperkalaemic cardioplegia ('hot shot'). ⋯ The data suggest that warm blood hyperkalaemic reperfusion hot shot prevents myocardial metabolic derangement seen during coronary artery surgery.
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Eur J Cardiothorac Surg · May 1998
Effects of angiotensin converting enzyme inhibition on systemic vascular resistance and vasoconstrictor requirements during hypothermic cardiopulmonary bypass.
We proposed that angiotensin converting enzyme (ACE) inhibitor therapy would alter systemic vascular resistance (SVR) during rewarming and increase the requirement for vasoactive drugs in the immediate post-bypass period. ⋯ Preoperative ACE inhibitor therapy decreases SVR during the rewarming phase of CPB and increases post-bypass vasoactive drug requirements.
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Eur J Cardiothorac Surg · May 1998
Central venous pressure, pulmonary capillary wedge pressure and intrathoracic blood volumes as preload indicators in cardiac surgery patients.
Monitoring of cardiac preload is mainly performed by measurement of central venous and pulmonary capillary wedge pressure in combination with assessment of cardiac output, applying the pulmonary arterial thermal dilution technique. However, the filling pressures are negatively influenced by mechanical ventilation and the pulmonary artery catheter is criticized because of its inherent risks. Measurement of right atria, right ventricular, global end diastolic and intrathoracic blood volume index by arterial thermal dye dilution utilizing the COLD-system may represent an alternative. ⋯ Central venous pressure, capillary wedge pressure, right atrial and right ventricular end diastolic volumes are no suitable preload parameters in cardiac surgery intensive care, compared to intrathoracic and global end diastolic blood volumes. The latter show a higher clinical value and can be obtained by less invasive methods, as no pulmonary artery catheter is required.
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Eur J Cardiothorac Surg · May 1998
Randomized Controlled Trial Clinical TrialSuperiority of centrifugal pump over roller pump in paediatric cardiac surgery: prospective randomised trial.
The merits of centrifugal pump in adult cardiopulmonary bypass are well established. This study compares the effects of the Medtronic Biomedicus centrifugal pump with conventionally used roller pump in routine cardiopulmonary bypass in infants and children. ⋯ The centrifugal pump as compared to roller pump results in less blood trauma, reduced platelet activation and less pronounced inflammatory response. There is also an improved renal response during and after bypass. This is translated clinically into reduced requirement for ventilation, shorter intensive care and hospital stays. These results strongly favour the use of centrifugal pump in routine paediatric cardiac surgery.