Journal of cardiac surgery
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Blood transfusion with cardiac surgery accounts for 20% of transfusions in the United States. The effect of perioperative transfusion on cardiac surgery outcomes is unknown. We hypothesized that cardiac surgery with perioperative blood transfusion was associated with worse outcomes. ⋯ Identification and management of risk factors associated with transfusion may reduce the transfusion requirement, minimize perioperative complications and improve outcomes. Bloodless cardiac surgery is associated with a decreased morbidity and mortality.
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Randomized Controlled Trial
Evaluation by cardiac troponin I: the effect of ischemic preconditioning as an adjunct to intermittent blood cardioplegia on coronary artery bypass grafting.
Ischemic preconditioning (IPC) is commonly regarded as having a powerful internal protective effect on the organs. The mechanism of IPC is not clear yet, and the controversy over the benefits and protocol of IPC still continues. In this study, we used the sensitive and specific biochemical marker: cardiac troponin-I (CTnI) to evaluate whether IPC as an adjunct to intermittent cold blood cardioplegia (CBC) could reduce myocardial injury, as opposed to simple CBC during coronary artery bypass grafting (CABG). ⋯ Compared to the simple CBC in lower-risk CABG patients, IPC as an adjunct to CBC reduced CTnI release, improved heart function after surgery, and shortened the time of recovery in CAD patients.
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The systemic inflammatory response after coronary artery bypass grafting using cardiopulmonary bypass (CPB) contributes substantially to postoperative organ dysfunction and coagulation disorders. Important features of this inflammatory reaction include the activation of complement and leukocytes, the release of proinflammatory cytokines, alterations in the metabolism of nitric oxide, and an increase in the production of oxygen-free radicals, which in some cases may lead to oxidant stress injury. ⋯ The development and application of off-pump coronary artery bypass (OPCAB) technology has largely been driven by this theme of avoiding systemic inflammatory reaction to decrease the incidence and/or severity of adverse outcomes. This review article discusses the influence of cardiopulmonary bypass on systemic inflammation and attempts to evaluate the current best available evidence on the impact of OPCAB on systemic inflammation.