European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Jan 1997
Emergency surgery for acute infective aortic valve endocarditis: performance of cryopreserved homografts and mode of failure.
To describe our experience in the surgical treatment of infective, native and prosthetic aortic valve endocarditis, using cryopreserved homograft valves. ⋯ Emergency aortic valve replacement with cryopreserved homografts for acute native or prosthetic aortic valve endocarditis has a low operative mortality. The late incidence of recurrent endocarditis or homograft failure up to 7 years is acceptable. Cryopreserved homografts are non-viable. The presence of T-cell lymphocytes in explanted homografts indicates that rejection may be possible.
-
Eur J Cardiothorac Surg · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative hemodynamics depend on cardiopulmonary bypass temperature: the potential role of endothelin-1.
There is a growing body of evidence that perfusion temperature during cardiopulmonary bypass (CPB) influences postoperative systemic vascular resistance (SVR). The reason for this is not clear. Extracorporeal circulation can provoke raised plasma levels of endothelin-1 (ET-1), a very potent vasoconstrictor peptide produced by endothelial cells. We therefore analysed the effect of CPB temperature on postoperative vascular resistance and plasma concentrations of ET-1. ⋯ These results suggests that the hemodynamic differences after normothermic and hypothermic CPB might be mediated, at least in part, by temperature dependent changes in ET-1 plasma levels.
-
Eur J Cardiothorac Surg · Jan 1997
Spontaneous cardioversion and mitral valve repair: a role for surgical cardioversion (Cox-maze)?
The objectives of this study are to describe: (1) The incidence of change in pre-operative rhythm (cardioversion) with mitral valve repair early and at 1 year's review after surgery (late). (2) The characteristics of those patients who remain in atrial fibrillation (AF) or sinus rhythm (SR) at late follow up. (3) The characteristics of those patients whose rhythm is seen to change (cardiovert) from SR to AF, or AF to SR and to remain so at 1 year. In this way it is hoped to more clearly define those patients who would benefit from the combination of mitral valve repair and surgical cardioversion (Cox-maze procedure). ⋯ Immediately prior to surgery the presence of AF was associated with a tendency to larger left atrial size, older age and a greater LVESD. Cardioversion was common for both patients in AF (46%) and SR (25%) early following conservative mitral surgery. The prevalence of late cardioversion was of a similar order in both those originally in AF (21%) and SR (17%). The maintenance of, or cardioversion to SR seemed to be characterised only by the LVESD. This analysis captures many of the problems of retrospective review. A multi-centre, prospective study is proposed to achieve the aim of an accurate formula predicting long standing cardioversion with mitral valve surgery.
-
Eur J Cardiothorac Surg · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialComplement and neutrophil activation during cardiopulmonary bypass: a randomized comparison of hypothermic and normothermic circulation.
Activation of both complement and neutrophils has been demonstrated to be involved in many pathological reactions following cardiopulmonary bypass (CPB). The aim of the present study is to evaluate the effect of normothermic and hypothermic CPB on both complement and neutrophil activation. ⋯ In conclusion, our study clearly demonstrates that warm CPB is associated with an increased ability to activate complement and neutrophils in patients undergoing coronary surgery.
-
Eur J Cardiothorac Surg · Jan 1997
Aprotinin and deep hypothermic circulatory arrest: there are no benefits even when appropriate amounts of heparin are given.
To evaluate retrospectively the effect of 'high-dose' aprotinin on blood losses, donor blood requirements and morbid events on patients undergoing ascending aorta and/or aortic arch procedures with the employ of deep hypothermic circulatory arrest (HCA). ⋯ Even when appropriate amounts of heparin are administered, 'high-dose' aprotinin probably is not an effective blood-sparing drug in deep HCA. Aprotinin should be employed cautiously in this clinical setting because of its possible correlation with an increased rate of postoperative morbid events.