Journal of cardiac surgery
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The continued need to minimize blood product usage both during and after cardiac surgical procedures has been challenged by a changing patient population, and most recently by the withdrawal of the antifibrinolytic aprotinin (Trasylol, Bayer Pharmaceuticals, West Haven, CT, USA) from the market. To meet these challenges, a variety of topical hemostatic tools have continued to emerge in the surgical armamentarium. ⋯ Optimal application of novel topical adjuncts can be limited due to the lack of clarity on how to differentiate between these adjunctive hemostatic products and their appropriate uses. This paper will review the classes of these products, how and where such products can be used during cardiovascular surgery for achieving hemostasis, and the potential for improved outcomes through the appropriate selection and use of these agents.
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Comparative Study
Axillary artery cannulation for cardiopulmonary bypass during surgery on the ascending aorta and arch.
Performing axillary artery cannulation, during cardiopulmonary bypass in patients with an atherosclerotic ascending aorta or acute dissection of the ascending aorta and arch, is of growing interest. Our aim is to present our experience, to describe the surgical technique, and to demonstrate the sufficient cerebral and total body perfusion through axillary artery cannulation. ⋯ Antegrade cerebral perfusion is of paramount importance in cases of aortic atherosclerosis or aortic dissection. The axillary artery provides an excellent site for safe antegrade perfusion, which may play a role in preventing stroke.
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Echocardiographic evaluation of anomalous pulmonary venous connection (APVC) may be difficult especially in patients with complex congenital heart diseases. Angiography may also be hazardous in sick patients. ⋯ We have presented a patient, operated with the diagnosis of partial APVC to the azygous vein. In this patient the diagnosis was suspected by echocardiography and confirmed by using three-dimensional computed tomography with angiography.
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Randomized Controlled Trial Comparative Study
Endothoracic injection of room air for internal mammary artery harvest.
Arterial spasm is described as an event occurring after internal mammary artery (IMA) harvesting. Endothoracic papaverine and carbon dioxide application have been used to prevent IMA spasm before surgical dissection. This technique may make harvest quicker and easier. The aim of this study is to evaluate the effect of room air injection into the endothoracic fascia on IMA blood flow and harvest time. ⋯ Injection of room air beneath the endothoracic fascia before IMA dissection may prevent spasm and shorten harvest time, which avoids any risk of intimal injury.
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Coronary revascularization methods continue to be refined, and the emergence of the drug-eluting stent (DES) has especially changed clinical practice related to ischemic heart disease. For chronic hemodialysis (HD) patients, however, the impact of DES on clinical outcome is yet to be determined. Forty-six consecutive chronic HD patients who underwent myocardial revascularization in our institute were retrospectively reviewed. ⋯ The one-year patency rate for the CABG grafts was 93.3% (left ITA: 100%, right ITA: 84.6%, sapenous vein: 90.9%, gastro-epiploic artery: 100%), and six-month restenosis rate for PCI was 57.1% (balloon angio-plasty: 75%, bare metal stent 40%, DES: 58.3%). Even in the era of DES, clinical results favored CABG. The difference in clinical results is due to the sustainability of successful revascularization.