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 1995
Comparative StudySurgery for acute ascending aortic dissection: closed versus open distal aortic repair.
One hundred twelve consecutive patients with acute ascending aortic dissection and submitted to immediate surgery were retrospectively analyzed with regard to perioperative mortality and morbidity. The patients were divided into two groups according to whether distal aortic repair was carried out by the open procedure (using deep hypothermic circulatory arrest, group A: 68 patients) or by the closed technique (without circulatory arrest, group B: 44 patients). Patients' ages ranged from 24 to 78 years (mean 57.4 years). ⋯ The trend towards a higher mortality in group A mainly reflected the more severe and complex anatomical characteristics and could not be attributed to the circulatory arrest per se. The period of deep hypothermic circulatory arrest in the survivors (25 min) was similar to that of the group with lethal outcome (32 min). Among the non-lethal complications, however, group A patients more frequently showed clinical signs consistent with cerebral injury: apart from the transient symptoms suggestive in reversible diffuse cerebral damage, five patients in group A had a permanent focal neurological deficit (versus one patient in group B).(ABSTRACT TRUNCATED AT 250 WORDS)
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Eur J Cardiothorac Surg · Jan 1995
Comparative StudyInterrupted warm blood cardioplegia for coronary artery bypass grafting.
Continuous warm blood cardioplegia has been used with good clinical outcome in both antegrade and retrograde delivery. However, the continuous delivery of cardioplegia is sometimes interrupted for adequate visualization and flow is not constant with heart manipulation during operation. We studied the effects of interrupted antegrade delivery of warm blood cardioplegia on myocardial metabolism and clinical results after surgery. ⋯ After removal of the aortic cross-clamp, the heart returned to sinus rhythm spontaneously in 90% of the patients with warm cardioplegia and 15.4% of those with a cold heart (P < 0.01). Postoperatively, there was no significant CK-MB or MDA release in either group except for one patient with perioperative myocardial infarction. After operation inotropic support was required for two and one patient in the warm and cold groups, respectively, although there were significantly more patients with poor left ventricular function in the warm, than in the cold, group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Eur J Cardiothorac Surg · Jan 1995
Hospital morbidity and mortality after myocardial revascularisation surgery: current changes in risk factors.
To identify the operating risks for mortality and morbidity in patients undergoing aortocoronary bypass surgery, the data of 514 myocardial revascularisation procedures performed consecutively between January 1991 and December 1992 were analysed; 73.2% of the patients had associated diseases and 59.3% had suffered one or more previous myocardial infarctions. The mean ejection fraction of the population as a whole was 52.2 +/- 13. In 10.5% of the cases there was severe left ventricular (LV) function impairment with a mean ejection fraction (EF) of 30.2 +/- 4.4 (range 20-35). ⋯ Perioperative acute myocardial infarction occurred in 5.4% of the patients (CL 4.4-6.4), in three cases resulting in death [10.7% (CL 4.8-15.8)]. Fourteen of the acute myocardial infarctions (AMI) occurred in the 42 patients undergoing emergency surgery for acute coronary occlusion (33.3%). A percentage of 18.7% of the 493 surviving patients suffered a postoperative complication.(ABSTRACT TRUNCATED AT 250 WORDS)
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Eur J Cardiothorac Surg · Jan 1995
Comparative Study Clinical TrialConsistent non-pharmacologic blood conservation in primary and reoperative coronary artery bypass grafting.
Because much interest has been focused on blood conservation using different drugs and complicated blood cell processing devices, we analyzed our results with the use of a non-pharmacologic, simple and inexpensive program for blood salvage in 2326 patients undergoing myocardial revascularization. The material was divided into two groups: patients undergoing a primary coronary bypass operation (Group P, n = 2298) and a smaller subset of patients undergoing repeat coronary bypass operation (Group R, n = 28). At least one internal mammary artery was grafted in 99% of the patients, with supplemental saphenous vein grafts. ⋯ In Group R, 1 patient (3.6%) received packed red cells and no patients were given other homologous blood products, compared to 33 patients (1.4%) given red cells and 35 patients (1.5%) given plasma transfusion in Group P (NS). Thus, in total, 2257 patients (97.0%) were not exposed to any homologous blood products during hospitalization. Total hemoglobin loss was significantly higher in Group R, resulting in a mean hemoglobin concentration at discharge of 109 +/- 13 g/l, compared to 121 +/- 14 g/l in Group P (P = 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)
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Eur J Cardiothorac Surg · Jan 1995
Surgical management of ventricular septal defect with aortic valve prolapse: clinical considerations and results.
Aortic valve prolapse is found in over 5% of children with ventricular septal defect (VSD). Although this association occurs mostly with doubly committed subarterial VSDs, in this study the predominant type of VSD was perimembranous. In order to determine the need and timing for surgery and whether the anatomical features of septal defect may influence clinical management and outcome in this lesion, we reviewed our experience with 28 consecutive patients, operated on for VSD with prolapsed aortic valve cusp, with or without aortic regurgitation. ⋯ Sixteen patients having mild or trivial aortic regurgitation underwent closure of the VSD only, and 12 patients underwent VSD closure with aortic valvuloplasty. Valvuloplasty was required more often in doubly committed VSDs (66%) and in the perimembranous type without associated anomalies (100%), and significantly less often in the presence of RVOT obstruction, subaortic membrane or both (22%). At follow-up (up to 5 years, mean 18 months), the grade of aortic regurgitation was unchanged in 11 and decreased in 5 patients undergoing closure of the VSD only.(ABSTRACT TRUNCATED AT 250 WORDS)